title: Association of sleep-related problems with CKD in the United States, 2005-2008.
abstract: BACKGROUND
  Sleep-related problems, which have been associated with poor health outcomes, have not been investigated thoroughly in people with chronic kidney disease (CKD). We examined the prevalence of a variety of sleep-related problems in persons with and without CKD.
  
  
  METHODS
  National cross-sectional survey (National Health and Nutrition Examination Survey 2005-2008).
  
  
  METHODS
  Community-based survey of 9,110 noninstitutionalized US civilian residents 20 years or older.
  
  
  METHODS
  CKD, defined as estimated glomerular filtration rate (eGFR) of 15-59 mL/min/1.73 m(2) (stages 3 and 4) or eGFR ≥60 mL/min/1.73 m(2) and albumin-creatinine ratio ≥30 mg/g (stages 1 and 2).
  
  
  RESULTS
  Sleep quality, defined using self-report in a multi-item sleep questionnaire including items from previously validated instruments.
  
  
  METHODS
  Albuminuria and eGFR assessed from urine and blood samples; sleep, demographics, and comorbid conditions assessed using a standardized questionnaire.
  
  
  RESULTS
  Inadequate sleep (≤6 hours per night) differed by CKD severity (37.4%, 43.0%, and 30.9% for no CKD, CKD stages 1 and 2, and CKD stages 3 and 4, respectively; P = 0.003). Frequent sleeping pill use (8.4%, 9.9%, and 16.6%), leg symptoms (39.2%, 48.0%, and 50.9%), and nocturia (20.9%, 35.2%, and 43.6%; P < 0.001 for all) also differed by CKD severity. After adjustment for age, sex, race/ethnicity, obesity, diabetes, and cardiovascular disease, the prevalence of these sleep-related problems remained higher in people with CKD stages 1 and 2 relative to no CKD. Most other measures of sleep quality, disorder, and functional outcomes did not differ by CKD.
  
  
  CONCLUSIONS
  Inability to establish causality and possible unmeasured confounding.
  
  
  CONCLUSIONS
  Providers should be aware of early sleep-related CKD manifestations, including inadequate sleep, leg symptoms, and nocturia, and of the high rate of reported sleep medication use in this population.
authors.affiliation: Department of Medicine, San Francisco General Hospital and University of California, USA. laura.plantinga@emory.edu
authors.forename: Laura
authors.initials: L
authors.lastname: Plantinga
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lee
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.forename: Brenda
authors.initials: B
authors.lastname: Gillespie
authors.forename: Deborah
authors.initials: D
authors.lastname: Rolka
authors.forename: Sharon
authors.initials: S
authors.lastname: Saydah
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D057566:Self Report; D012709:Serum Albumin / Q000032:analysis; D020919:Sleep Disorders, Intrinsic / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D006993:Hypnotics and Sedatives; D012709:Serum Albumin; D003404:Creatinine