Skip to main content

Advertisement

SpringerLink
Log in

The effects of depression and age on sleep disturbances in patients with non-dialysis stage 3–5 chronic kidney disease: a single-center study

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Sleep disturbances have a negative impact on the prognosis of chronic kidney disease (CKD). However, information on the prevalence and predictors is limited. This study aimed to evaluate the prevalence and explore clinical factors affecting the quality of sleep in patients with non-dialysis CKD.

Methods

Participants included 152 adult non-dialysis patients with stage 3–5 CKD. Demographic and clinical data were collected. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively. Sleep disturbances were defined as a PSQI score ≥ 5. Logistic regression was conducted to explore the independent factors of sleep disturbances. Clinical parameters were correlated with BDI scores using linear regression models.

Results

The total prevalence of patients with sleep disturbances was 66.4%. Older age, higher BDI scores, lower estimated glomerular filtration rate (eGFR) changes per month (△eGFR/m) before the study, and lower serum magnesium levels were found in patients with sleep disturbances. BDI scores (odds ratio [OR] 1.224, 95% confidence interval [CI] 1.091–1.373, p = 0.001) and age (OR 1.041, 95% CI 1.013–1.069, p = 0.003) were independent predictors of sleep disturbances. Serum uric acid levels (β − 0.629, 95% CI − 1.244 to − 0.013, p = 0.046), △eGFR/m before the study (β − 0.454, 95% CI − 0.885 to − 0.024, p = 0.039), and daily protein intake (β − 0.052, 95% CI − 0.102 to − 0.002, p = 0.043) were negatively associated with BDI scores.

Conclusion

A high overall prevalence of sleep disturbances was found in patients with non-dialysis stage 3–5 CKD. Depression, as a manageable predictor, should be managed, especially in elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Elder SJ, Pisoni RL, Akizawa T, Fissell R, Andreucci VE, Fukuhara S, Kurokawa K, Rayner HC, Furniss AL, Port FK, Saran R (2008) Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transpl 23:998–1004

    Google Scholar 

  2. Turek NF, Ricardo AC, Lash JP (2012) Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis 60:823–833

    PubMed  PubMed Central  Google Scholar 

  3. Yang B, Xu J, Xue Q, Wei T, Xu J, Ye C, Mei C, Mao Z (2015) Non-pharmacological interventions for improving sleep quality in patients on dialysis: systematic review and meta-analysis. Sleep Med Rev 23:68–82

    PubMed  Google Scholar 

  4. El Harraqui R, Abda N, Bentata Y, Haddiya I (2014) Evaluation and analysis of insomnia in chronic hemodialysis. Pan Afr Med J 19:221

    PubMed  PubMed Central  Google Scholar 

  5. Anand S, Johansen KL, Grimes B, Kaysen GA, Dalrymple LS, Kutner NG, Chertow GM (2013) Physical activity and self-reported symptoms of insomnia, restless legs syndrome, and depression: the comprehensive dialysis study. Hemodial Int 17:50–58

    PubMed  Google Scholar 

  6. McMullan CJ, Curhan GC, Forman JP (2016) Association of short sleep duration and rapid decline in renal function. Kidney Int 89:1324–1330

    PubMed  PubMed Central  Google Scholar 

  7. Yamamoto R, Shinzawa M, Isaka Y, Yamakoshi E, Imai E, Ohashi Y, Hishida A, Investigators C-J (2018) Sleep quality and sleep duration with CKD are associated with progression to ESKD. Clin J Am Soc Nephrol 13:1825–1832

    PubMed  PubMed Central  Google Scholar 

  8. Martin JL, Fiorentino L, Jouldjian S, Mitchell M, Josephson KR, Alessi CA (2011) Poor self-reported sleep quality predicts mortality within 1 year of inpatient post-acute rehabilitation among older adults. Sleep 34:1715–1721

    PubMed  PubMed Central  Google Scholar 

  9. Pai MF, Hsu SP, Yang SY, Ho TI, Lai CF, Peng YS (2007) Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia. Ren Fail 29:673–677

    PubMed  Google Scholar 

  10. Chiu YL, Chuang YF, Fang KC, Liu SK, Chen HY, Yang JY, Pai MF, Peng YS, Wu KD, Tsai TJ (2009) Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transpl 24:247–251

    CAS  Google Scholar 

  11. Lai X, Chen W, Bian X, Wang T, Li J, Wang H, Guo Z (2015) Predictors of poor sleep quality and excessive daytime sleepiness in peritoneal dialysis patients. Ren Fail 37:61–65

    PubMed  Google Scholar 

  12. Chen W, Shen YD, Chen R, Ding GX (2005) Investigation on sleep status of college and high school students. Zhonghua Yu Fang Yi Xue Za Zhi 39:48–50

    PubMed  Google Scholar 

  13. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    PubMed  CAS  Google Scholar 

  14. D'Onofrio G, Simeoni M, Rizza P, Caroleo M, Capria M, Mazzitello G, Sacco T, Mazzuca E, Panzino MT, Cerantonio A, Segura-Garcia C, Andreucci M, De Fazio P, Fuiano G (2017) Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients. Ren Fail 39:45–53

    PubMed  Google Scholar 

  15. Shafi ST, Shafi T (2017) A comparison of quality of sleep between patients with chronic kidney disease not on hemodialysis and end-stage renal disease on hemodialysis in a developing country. Ren Fail 39:623–628

    PubMed  PubMed Central  Google Scholar 

  16. Afsar B (2013) Relationship between total testosterone, cognitive function, depressive behavior, and sleep quality in chronic kidney disease patients not on dialysis. Clin Exp Nephrol 17:59–65

    PubMed  CAS  Google Scholar 

  17. Guney I, Akgul YS, Gencer V, Aydemir H, Aslan U, Ecirli S (2017) Sleep quality and risk factors of atherosclerosis in predialysis chronic kidney disease. Int J Artif Organs 39:563–569

    PubMed  Google Scholar 

  18. Tu CY, Chou YH, Lin YH, Huang WL (2018) Sleep and emotional disturbance in patients with non-dialysis chronic kidney disease. J Formos Med Assoc 118:986–994

    PubMed  Google Scholar 

  19. Brekke FB, Waldum-Grevbo B, von der Lippe N, Os I (2017) The effect of renal transplantation on quality of sleep in former dialysis patients. Transpl Int 30:49–56

    PubMed  Google Scholar 

  20. Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M (2007) Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr 17:381–388

    PubMed  Google Scholar 

  21. He S, Zhu J, Jiang W, Ma J, Li G, He Y (2019) Sleep disturbance, negative affect and health-related quality of life in patients with maintenance hemodialysis. Psychol Health Med 24:294–304

    PubMed  Google Scholar 

  22. Anwar N, Mahmud SN (2018) Quality of sleep in CKD patients on chronic hemodialysis and the effect of dialysis shift. J Coll Physicians Surg Pak 28:636–639

    PubMed  Google Scholar 

  23. Wang R, Tang C, Chen X, Zhu C, Feng W, Li P, Lu C (2016) Poor sleep and reduced quality of life were associated with symptom distress in patients receiving maintenance hemodialysis. Health Qual Life Outcomes 14:125

    PubMed  PubMed Central  Google Scholar 

  24. Edalat-Nejad M, Qlich-Khani M (2013) Quality of life and sleep in hemodialysis patients. Saudi J Kidney Dis Transpl 24:514–518

    PubMed  Google Scholar 

  25. Li H, Li X, Feng S, Zhang G, Wang W, Wang S (2014) Sleep disorders and its related risk factors in patients undergoing chronic peritoneal dialysis. Chin Med J (Engl) 127:1289–1293

    CAS  Google Scholar 

  26. Ogna A, Forni Ogna V, Haba Rubio J, Tobback N, Andries D, Preisig M, Tafti M, Vollenweider P, Waeber G, Marques-Vidal P, Heinzer R (2016) Sleep characteristics in early stages of chronic kidney disease in the hypnolaus cohort. Sleep 39:945–953

    PubMed  PubMed Central  Google Scholar 

  27. Kurella M, Luan J, Lash JP, Chertow GM (2005) Self-assessed sleep quality in chronic kidney disease. Int Urol Nephrol 37:159–165

    PubMed  Google Scholar 

  28. Kumar B, Tilea A, Gillespie BW, Zhang X, Kiser M, Eisele G, Finkelstein F, Kotanko P, Levin N, Rajagopalan S, Saran R (2010) Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study. Clin Nephrol 73:104–114

    PubMed  CAS  Google Scholar 

  29. Cohen SD, Patel SS, Khetpal P, Peterson RA, Kimmel PL (2007) Pain, sleep disturbance, and quality of life in patients with chronic kidney disease. Clin J Am Soc Nephrol 2:919–925

    PubMed  Google Scholar 

  30. De Santo RM, Bilancio G, Santoro D, Vecchi ML, Perna A, De Santo NG, Cirillo M (2010) A longitudinal study of sleep disorders in early-stage chronic kidney disease. J Ren Nutr 20:S59–63

    PubMed  Google Scholar 

  31. Edalat-Nejad M, Jafarian N, Yousefichaijan P (2014) Diabetic nephropathy: a strong predictor of sleep quality in hemodialysis patients. Saudi J Kidney Dis Transpl 25:774–780

    PubMed  Google Scholar 

  32. Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM, Singer MA, Hopman WM (2003) Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transpl 18:126–132

    Google Scholar 

  33. Roumelioti ME, Buysse DJ, Sanders MH, Strollo P, Newman AB, Unruh ML (2011) Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol 6:986–994

    PubMed  PubMed Central  Google Scholar 

  34. Mander BA, Winer JR, Walker MP (2017) Sleep and human aging. Neuron 94:19–36

    PubMed  PubMed Central  CAS  Google Scholar 

  35. Firoz MN, Shafipour V, Jafari H, Hosseini SH, Charati JY (2016) Sleep quality and depression and their association with other factors in hemodialysis patients. Glob J Health Sci 8:53485

    PubMed  Google Scholar 

  36. Araujo SM, Bruin VM, Daher EF, Medeiros CA, Almeida GH, Bruin PF (2011) Quality of sleep and day-time sleepiness in chronic hemodialysis: a study of 400 patients. Scand J Urol Nephrol 45:359–364

    PubMed  Google Scholar 

  37. Williams SW, Tell GS, Zheng B, Shumaker S, Rocco MV, Sevick MA (2002) Correlates of sleep behavior among hemodialysis patients. The kidney outcomes prediction and evaluation (KOPE) study. Am J Nephrol 22:18–28

    PubMed  Google Scholar 

  38. Iliescu EA, Yeates KE, Holland DC (2004) Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transpl 19:95–99

    Google Scholar 

  39. Gangwisch JE, Feskanich D, Malaspina D, Shen S, Forman JP (2013) Sleep duration and risk for hypertension in women: results from the nurses' health study. Am J Hypertens 26:903–911

    PubMed  PubMed Central  CAS  Google Scholar 

  40. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, Patel S, Hu FB (2003) A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 26:380–384

    PubMed  Google Scholar 

  41. Yamamoto R, Nagasawa Y, Iwatani H, Shinzawa M, Obi Y, Teranishi J, Ishigami T, Yamauchi-Takihara K, Nishida M, Rakugi H, Isaka Y, Moriyama T (2012) Self-reported sleep duration and prediction of proteinuria: a retrospective cohort study. Am J Kidney Dis 59:343–355

    PubMed  Google Scholar 

  42. Afsar B, Elsurer R, Covic A, Johnson RJ, Kanbay M (2011) Relationship between uric acid and subtle cognitive dysfunction in chronic kidney disease. Am J Nephrol 34:49–54

    PubMed  PubMed Central  CAS  Google Scholar 

  43. Puy L, Bugnicourt JM, Liabeuf S, Desjardins L, Roussel M, Diouf M, Chillon JM, Choukroun G, Massy ZA, Godefroy O (2018) Cognitive impairments and dysexecutive behavioral disorders in chronic kidney disease. J Neuropsychiatry Clin Neurosci 30:310–317

    PubMed  Google Scholar 

  44. Xiu S, Zheng Z, Liao Q, Chan P (2019) Different risk factors for cognitive impairment among community-dwelling elderly, with impaired fasting glucose or diabetes. Diabetes Metab Syndr Obes 12:121–130

    PubMed  PubMed Central  CAS  Google Scholar 

  45. Song X, Zhang Z, Zhang R, Wang M, Lin D, Li T, Shao J, Ma X (2018) Predictive markers of depression in hypertension. Medicine (Baltimore) 97:e11768

    CAS  Google Scholar 

  46. Wium-Andersen MK, Kobylecki CJ, Afzal S, Nordestgaard BG (2017) Association between the antioxidant uric acid and depression and antidepressant medication use in 96,989 individuals. Acta Psychiatr Scand 136:424–433

    PubMed  CAS  Google Scholar 

  47. Black CN, Bot M, Scheffer PG, Snieder H, Penninx B (2018) Uric acid in major depressive and anxiety disorders. J Affect Disord 225:684–690

    PubMed  CAS  Google Scholar 

  48. Chaudhari K, Khanzode S, Khanzode S, Dakhale G, Saoji A, Sarode S (2010) Clinical correlation of alteration of endogenous antioxidant-uric acid level in major depressive disorder. Indian J Clin Biochem 25:77–81

    PubMed  PubMed Central  CAS  Google Scholar 

Download references

Acknowledgements

We thank all the doctors at the division of Nephrology in our hospital, Tianjin, China, for their work.

Funding

Tianjin Health Bureau funded this study (Grant No. A0102).

Author information

Authors and Affiliations

  1. Department of Nephrology, Tianjin First Center Hospital, Nankai District, No. 24 Fukang Road, Tianjin, 300192, China

    Yingying Han, Xinyuan Song, Ying Liu, Wenyu Zhang, Jinping Li, Yangke Tu & Wenxiu Chang

Authors
  1. Yingying Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinyuan Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ying Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenyu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jinping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yangke Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wenxiu Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YYH and WXC drafted the manuscript. XCW critically reviewed the manuscript. XYS and YL collected the data. WYZ critically reviewed data management. JPL performed English editing. WXC performed statistical analysis. YKT critically reviewed the statistical data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wenxiu Chang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Tianjin First Center Hospital, 2015008S) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from each patient before the study began.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Han, Y., Song, X., Liu, Y. et al. The effects of depression and age on sleep disturbances in patients with non-dialysis stage 3–5 chronic kidney disease: a single-center study. Int Urol Nephrol 52, 739–748 (2020). https://doi.org/10.1007/s11255-020-02416-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02416-y

Keywords

Search

Navigation