title: Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study.
abstract: BACKGROUND
  Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients.
  
  
  METHODS
  Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality.
  
  
  RESULTS
  The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001).
  
  
  CONCLUSIONS
  These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.
authors.affiliation: University of Pittsburgh, Presbyterian Hospital C1111, Pittsburgh, PA 15213, USA. unruh@pitt.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.forename: Anjay
authors.initials: A
authors.lastname: Rastogi
authors.forename: Sam
authors.initials: S
authors.lastname: James
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schiller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gassman
authors.forename: Christopher
authors.initials: C
authors.lastname: Chan
authors.forename: Robert
authors.initials: R
authors.lastname: Lockridge
authors.forename: Alan
authors.initials: A
authors.lastname: Kliger
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D012890:Sleep