title: Associations among nocturnal sleep, daytime intradialytic sleep, and mortality risk in patients on daytime conventional hemodialysis: US Renal Data System special study data.
abstract: Fragmented nocturnal sleep is commonly reported by patients undergoing daytime conventional hemodialysis (CHD) and may be associated with higher mortality risk. Subjective sleepiness during CHD is also frequently observed. We examined the association of reported sleep fragmentation and nocturnal and daytime (intradialytic) sleep durations with survival in a national cohort of 1440 CHD patients who were interviewed in 2005-2007 in a phone survey conducted by the US Renal Data System. Patient survival was followed through September 30, 2010 in the US Renal Data System. A total of 76% of patients reported that they typically dozed off or slept during their treatment, and intradialytic dozing was especially common among patients whose treatment shift started before 1000 hours. There was a trend for patients who reported dozing during CHD to report nocturnal sleep fragmentation (60.4% vs. 55.1%; P = 0.07). With adjustment for intradialytic sleep and other covariates, nocturnal sleep fragmentation was not associated with survival. Mortality risk was higher for patients who reported sleeping 9 or more hours/night compared with the referent category of nocturnal sleep equal to 6-7 hours (hazard ratio: 1.50 [95% confidence interval: 1.04-2.17]; P = 0.03). Continued investigation of the association of timing and duration of sleep with hemodialysis patient outcomes is warranted.
authors.affiliation: Rehabilitation/Quality of Life Special Studies Center, United States Renal Data System, Atlanta, Georgia, USA. nkutner@emory.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Kutner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.forename: Kirsten
authors.initials: K
authors.lastname: Johansen
authors.forename: Donald
authors.initials: D
authors.lastname: Bliwise
mesh_terms: D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D012892:Sleep Deprivation / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology