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Levels of trace blood elements associated with severe sleep disturbance in maintenance hemodialysis patients

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Sleep disturbance is frequently observed in patients on maintenance hemodialysis (MHD), and this population usually presents imbalances in trace elements. We investigated the association between blood trace element levels and sleep quality in patients on MHD.

Methods

This cross-sectional and single-center study was performed in September 2019. Patients regularly undergoing hemodialysis for > 3 months at our center were recruited, and demographic, clinical, and laboratory parameters were recorded. The Pittsburgh Sleep Quality Index (PSQI) was applied to define sleep disturbance. Blood trace element (zinc, manganese, copper, selenium, and lead) levels were measured using an inductively coupled plasma mass spectrometer.

Results

In total, 121 patients on MHD (male/female = 68:53) were enrolled in the study (mean age 63.7 ± 13.9 years, median dialysis vintage 38.0 [20.0, 60.0] months). According to PSQI, 56 (46%) patients experienced severe sleep disturbance. These patients were characterized by older age, higher serum parathyroid hormone levels, and lower blood selenium levels (all P < 0.05). No significant differences in blood zinc, manganese, copper, and lead levels were observed between groups. Univariate binary logistic regression showed that lower blood selenium levels were associated with severe sleep disturbance (odds ratio = 0.976, 95% confidence interval: 0.954–0.999, P = 0.038). Multivariate analyses also confirmed the results after adjusting for confounding factors.

Conclusion

Our study indicated an association between lower blood selenium levels and the occurrence of severe sleep disturbances in patients on MHD. However, a prospective study with a larger sample size and assessing the importance of selenium supplementation are needed to confirm the results.

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Data Availability

The authors agree all data and statistical information essential to this paper will be made available for review if required.

References

  1. Chu G, Choi P, McDonald VM (2018) Sleep disturbance and sleep-disordered breathing in hemodialysis patients. Semin Dial 31(1):48–58. https://doi.org/10.1111/sdi.12617

    Article  PubMed  Google Scholar 

  2. He S, Zhu J, Jiang W (2019) Sleep disturbance, negative affect and health-related quality of life in patients with maintenance hemodialysis. Psychol Health Med 24(3):294–304. https://doi.org/10.1080/13548506.2018.1515493

    Article  PubMed  Google Scholar 

  3. Kimmel PL (2012) Pain, sleep disturbance and survival in hemodialysis patients. Nephrol Dial Transplant 27:758–765. https://doi.org/10.1093/ndt/gfr355

    Article  PubMed  Google Scholar 

  4. Novak M, Shapiro CM, Mendelssohn D, Mucsi I (2006) Diagnosis and management of insomnia in dialysis patients. Semin Dial 19:25–31. https://doi.org/10.1111/j.1525-139X.2006.00116.x

    Article  PubMed  Google Scholar 

  5. Hildreth CM (2011) Prognostic indicators of cardiovascular risk in renal disease. Front Physiol 2:121. https://doi.org/10.3389/fphys.2011.00121

    Article  PubMed  Google Scholar 

  6. Mehta R, Drawz PE (2011) Is nocturnal blood pressure reduction the secret to reducing the rate of progression of hypertensive chronic kidney disease? CurrHypertens Rep 13:378–385. https://doi.org/10.1007/s11906-011-0217-8

    Article  CAS  Google Scholar 

  7. Elder SJ, Pisoni RL, Akizawa T et al (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 Transplant 23:998–1004. https://doi.org/10.1093/ndt/gfm630

    Article  PubMed  Google Scholar 

  8. Saito H, Cherasse Y, Suzuki R et al. (2017) Zinc-rich oysters as well as zinc-yeast- and astaxanthin-enriched food improved sleep efficiency and sleep onset in a randomized controlled trial of healthy individuals. Mol Nutr Food Res, 61(5). 10.1002/mnfr.201600882

  9. Grandner MA, Jackson N, Gerstner JR, Knutson KL (2014) Sleep symptoms associated with intake of specific dietary nutrients. J Sleep Res 23(1):22–34. https://doi.org/10.1111/jsr.12084

    Article  PubMed  Google Scholar 

  10. Tonelli M, Wiebe N, Hemmelgarn B et al (2009) Trace elements in hemodialysis patients: a systematic review and meta-analysis. BMC Med 7:25. https://doi.org/10.1186/1741-7015-7-25

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Liu Y, Zheng Y, Wang L et al. (2020) Lower levels of blood zinc associated with intradialytic hypertension in maintenance hemodialysis patients. Biol Trace Elem Res. DOI:10.1007/s12011-020-02385-4

  12. Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4

    Article  CAS  Google Scholar 

  13. Zhao J, Luo L, Su X et al (2019) Investigation on the cause of severe sleep disorder in maintenance hemodialysis patients. Chin J Blood Purif 18(11):783–786. https://doi.org/10.3969/j.issn.1671-4091.2019.11.014

    Article  Google Scholar 

  14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO (2017) Clinical Practice Guide-line Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-mineral and Bone Disorder (CKD-MBD) [J]. Kidney Int Suppl 2017:1–59. https://doi.org/10.1016/j.kisu.2017.10.001

    Article  Google Scholar 

  15. Chinese National Renal Data System. (2017). Retrieved from http://www.cnrds.net/

  16. Emmelkamp PM, Mersch PP, Vissia E et al (1985) Social phobia: a comparative evaluation of cognitive and behavioral interventions. Behav Res Ther 23(3):365–369. https://doi.org/10.1016/0005-7967(85)90015-4

    Article  CAS  PubMed  Google Scholar 

  17. Ma X, Zhang Y, Ma S, Li P, Ding D, Liu H, Liu J, Zhang M (2018) Association between abnormal thalamic metabolites and sleep disturbance in patients with end-stage renal disease. Metab Brain Dis 33(5):1641–1648. https://doi.org/10.1007/s11011-018-0272-9

    Article  CAS  PubMed  Google Scholar 

  18. Neves PD, Graciolli FG, Oliveira IB et al (2017) Effect of mineral and bone metabolism on restless legs syndrome in hemodialysis patients. J Clin Sleep Med 13(1):89–94. https://doi.org/10.5664/jcsm.6396

    Article  PubMed  PubMed Central  Google Scholar 

  19. Santos RS, Coelho FM, da Silva BC et al (2016) Parathyroidectomy improves restless leg syndrome in patients on hemodialysis. PLoS One 11(5):e0155835. https://doi.org/10.1371/journal.pone.0155835

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Slater G, Steier J (2012) Excessive daytime sleepiness in sleep disorders. J Thorac Dis 4(6):608–616. https://doi.org/10.3978/j.issn.2072-1439.2012.10.07

    Article  PubMed  PubMed Central  Google Scholar 

  21. Knight DA, Tyznik WJ (1990) The effect of dietary selenium on humoral immunocompetence of ponies. J Anim Sci 68(5):1311–1317. https://doi.org/10.2527/1990.6851311x

    Article  CAS  PubMed  Google Scholar 

  22. Rucker D, Thadhani R, Tonelli M (2010) Trace element status in hemodialysis patients. Semin Dial 23(4):389–395. https://doi.org/10.1111/j.1525-139X.2010.00746.x

    Article  PubMed  Google Scholar 

  23. Tonelli M, Wiebe N, Bello A, Field CJ, Gill JS, Hemmelgarn BR, Holmes DT, Jindal K, Klarenbach SW, Manns BJ, Thadhani R, Kinniburgh D, Alberta Kidney Disease Network (2018) Concentrations of trace elements and clinical outcomes in hemodialysis patients: a prospective cohort study. Clin J Am Soc Nephrol 13(6):907–915. https://doi.org/10.2215/CJN.11451017

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cesbron A, Saussereau E, Mahieu L, Couland I, Guerbet M, Goulle JP (2013) Metallic profile of whole blood and plasma in a series of 106 healthy volunteers. J Anal Toxicol 37(7):401–405. https://doi.org/10.1093/jat/bkt046

    Article  CAS  PubMed  Google Scholar 

  25. Ward RA, McLeish KR (2003) Oxidant stress in hemodialysis patients: what are the determining factors? Artif Organs 27(3):230–236. https://doi.org/10.1046/j.1525-1594.2003.07170.x

    Article  CAS  PubMed  Google Scholar 

  26. Cherasse Y, Aritake K, Oishi Y et al (2018) The leptomeninges produce prostaglandin D2 involved in sleep regulation in mice. Front Cell Neurosci 12:357. https://doi.org/10.3389/fncel.2018.00357

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Gairola C, Tai HH (1985) Selective inhibition of leukotriene B4 biosynthesis in rat pulmonary alveolar macrophages by dietary selenium deficiency. Biochem Biophys Res Commun 132(1):397–403. https://doi.org/10.1016/0006-291x(85)91035-6

    Article  CAS  PubMed  Google Scholar 

  28. Higuchi T, Abe M, Mizuno M, Yamazaki T, Suzuki H, Moriuchi M, Oikawa O, Okawa E, Ando H, Okada K (2015) Association of restless legs syndrome with oxidative stress and inflammation in patients undergoing hemodialysis. Sleep Med 16(8):941–948. https://doi.org/10.1016/j.sleep.2015.03.025

    Article  PubMed  Google Scholar 

  29. Salehi M, Sohrabi Z, Ekramzadeh M, Fallahzadeh MK, Ayatollahi M, Geramizadeh B, Hassanzadeh J, Sagheb MM (2013) Selenium supplementation improves the nutritional status of hemodialysis patients: a randomized, double-blind, placebo-controlled trial. Nephrol Dial Transplant 28(3):716–723. https://doi.org/10.1093/ndt/gfs17

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We are indebted to all nephrologists and nurses in our hemodialysis center for their excellent management of hemodialysis patients. We also thank the patients and staffs involved in the cross-sectional study. We specially thank Shilin Xu, B.S.Nurse, because all the laboratory data in the study derived from the electronic management system for blood purification center (Hope®, software) are developed by him, which can import the laboratory test results according to the patients’ IDs included in the study.

Funding

This research was supported by a grant from the Science and Technology Planning Project of Guangdong Province (2016A020215023) and a grant from the Guangdong Provincial Department of Science and Technology Project (2017B090904027).

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Author notes

  1. Shilin Xu and De’e Zou contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China

    Shilin Xu, De’e Zou, Ruiying Tang, Shuting Li, Wenxuan Chen, Yun Liu, Yan Liu & Xiaoshi Zhong

  2. Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou, China

    Luona Wen & Yan Liu

Authors
  1. Shilin Xu
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  2. De’e Zou
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  7. Yun Liu
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Contributions

S.X. contributed to the study design, partial data collection, and drafting of the manuscript; D. Z was involved in the analysis and interpretation of the data; R.T, S.L, W.C, L.W, and Y.L completed the PSQI questionnaire for patients and collection of clinical data; and Y.L and X.Z were involved in the study design, critical revision of the manuscript for important intellectual content, and final approval of the submitted manuscript.

Corresponding author

Correspondence to Xiaoshi Zhong.

Ethics declarations

Ethics approval

The research protocol conforms to the Declaration of Helsinki and was approved by the Ethics Committee of the Guangzhou Red Cross Hospital, Jinan University Hospital (license code: 2019-235-01). All patients gave their informed consent prior to their inclusion in the study.

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Written informed consent was obtained from all patients.

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The participants gave consent for the results to be publicized.

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The authors declare no conflicts of interest.

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Xu, S., Zou, D., Tang, R. et al. Levels of trace blood elements associated with severe sleep disturbance in maintenance hemodialysis patients. Sleep Breath 25, 2007–2013 (2021). https://doi.org/10.1007/s11325-021-02336-w

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  • DOI: https://doi.org/10.1007/s11325-021-02336-w

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