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Sleep Disorders in Chronic Kidney Disease

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Management of Chronic Kidney Disease

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Abstract

Sleep disorders have been reported in 80% or more of patients with end-stage renal disease. The relation between sleep and kidney disease is bidirectional, since persons who sleep less are more prone to kidney disease.

Sleep disorders in kidney disease—due to a constellation of factors—characterize a life between excessive daytime sleepiness and sleeplessness. Patients with chronic kidney disease have delayed sleep onset, reduced sleep time and sleep efficiency, and have frequent awakening. Patients on hemodialysis adopting a schedule of treatment thrice a week experience various degrees of sleep shortage. The best sleep is achieved in the night after dialysis; the worst night is the night after the longest dialytic interval. Early morning dialysis shifts are associated with sleep shortage. Most frequently encountered sleep disorders in dialysis patients are insomnia, obstructive and central sleep apnea, restless leg syndrome, periodic limb movements of sleep, excessive daytime sleepiness, sleepwalking, and nightmares. Sleep disorders in uremia, which carry the risk of increased mortality, are ameliorated but not cured by a successful kidney transplant. Sleep apnea worsens even further when graft function deteriorates and its prevalence does not differ from that in patients on the waiting list for transplantation. The worst sleepers are those with insuppressible hyperparathyroidism needing parathyroidectomy. Parathyroidectomy in turn improves the disordered sleep. Daily hemodialysis, nocturnal hemodialysis, and cycler-assisted peritoneal dialysis improve sleep quality. Many putative factors have been identified for disordered sleep in chronic kidney disease, including obesity, smoking, overuse of hypnotics, depression, pain of any origin, hypertension, systemic inflammation, and impaired melatonin clock. Treatment of pruritus and pain and sleep hygiene are preliminary. Levodopa is of benefit for restless leg syndrome. Benzodiazepine receptor agonists of the non-benzodiazepine class (Z drugs) are used for insomnia. Melatonin may help in recovering melatonin rhythm and the sleep–wake rhythm. Cognitive behavioral therapy, although in its infancy, is very promising.

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Acknowledgements

I would like to thank Professor Davide Viggiano, University Luigi Vanvitelli, Naples, Italy for many helpful suggestions concerning the MCI section. I am also indebted to Joseph Sepe MD, Professor of Biological Sciences, University of Maryland Global Campus, USA, Adjunct Professor Department of Mathematics and Physics University of Campania, Luigi Vanvitelli, Naples, Italy, for helpful insights in language editing of the manuscript.

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  1. Postgraduate School of Integrated Gestalt Psychotherapy, Torre Annunziata, Naples, Italy

    Rosa Maria De Santo

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  1. Rosa Maria De Santo
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  1. Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Mustafa Arıcı

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De Santo, R.M. (2023). Sleep Disorders in Chronic Kidney Disease. In: Arıcı, M. (eds) Management of Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-42045-0_27

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