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Pittsburgh Sleep Quality Index score predicts all-cause mortality in Chinese dialysis patients

  • Nephrology - Original Paper
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Abstract

Background

The relationship between Pittsburgh Sleep Quality Index (PSQI) score and survival of dialysis patients has not been well studied. The aim of this study was to explore the association between PSQI score and all-cause mortality in dialysis patients.

Methods

Fifty-one hemodialysis and 58 peritoneal dialysis patients were enrolled in this study. PSQI score > 5 and ≤ 5 indicated "poor sleepers" and "good sleepers", respectively. The primary outcome was all-cause mortality. Kaplan–Meier survival curve and Cox proportional hazards regression analysis were performed.

Results

The median PSQI score was 7.0 (4.0–10.0). Sixty-seven (61.5%) patients had poor sleep quality (SQ). Compared with good sleepers, poor sleepers had significantly lower levels of hemoglobin [74.0 (61.0, 85.0) vs. 78.0 (68.0, 97.0), P = 0.03] and serum bicarbonate (18.0 ± 4.5 vs. 20.0 ± 3.7, P = 0.022). The follow-up time was 69.1 ± 29.9 months. By multivariate Cox proportional hazards analysis, PSQI total score was the independent risk factor of all-cause mortality [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.05–1.36, P = 0.007]. Restricted cubic spline (RCS) analysis showed that 7 was the cutoff value at which the effect of PSQI score on mortality changed. Patients with a PSQI score > 7 had a 2.96-fold increased risk of all-cause mortality (HR 2.96, 95% CI 1.15–7.61, P = 0.025).

Conclusions

PSQI score can be used as a predictor of all-cause mortality in dialysis patients, and those with PSQI > 7 were associated with increased odds of mortality.

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Abbreviations

SQ:

Sleep quality

RLS:

Restless leg syndrome

PSQI:

Pittsburgh Sleep Quality Index

DOPPS:

Dialysis outcomes and practice patterns study

KDQOL-SF:

Kidney disease quality of life short form

JESS:

Japanese version of the Epworth Sleepiness Scale

CHEQ:

CHOICE health experience questionnaire

HD:

Hemodialysis

PD:

Peritoneal dialysis

BMI:

Body mass index

BP:

Blood pressure

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

CVD:

Cardiovascular disease

Scr:

Serum creatinine

BUN:

Blood urea nitrogen

UA:

Uric acid

WBC:

White blood cell

Hb:

Hemoglobin

Alb:

Albumin

TC:

Total cholesterol

TG:

Triglyceride

Ca:

Calcium

P:

Phosphate

PTH:

Parathyroid hormone

eGFR:

Estimated glomerular filtration rate

SD:

Standard deviation

IQR:

Interquartile range

RCS:

Restricted cubic splines

HR:

Hazard ratio

References

  1. Walker S, Fine A, Kryger MH (1995) Sleep complaints are common in a dialysis unit. Am J Kidney Dis 26(5):751–756. https://doi.org/10.1016/0272-6386(95)90438-7

    Article  CAS  PubMed  Google Scholar 

  2. Hanly P (2008) Sleep disorders and end-stage renal disease. Curr Opin Pulm Med 14(6):543–550. https://doi.org/10.1097/MCP.0b013e3283130f96

    Article  PubMed  Google Scholar 

  3. Kimata N, Fuller DS, Saito A et al (2014) Pruritus in hemodialysis patients: results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS). Hemodial Int 18(3):657–667. https://doi.org/10.1111/hdi.12158

    Article  PubMed  Google Scholar 

  4. Pai MF, Hsu SP, Yang SY et al (2007) Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia. Ren Fail 29(6):673–677. https://doi.org/10.1080/08860220701459642

    Article  PubMed  Google Scholar 

  5. Edalat-Nejad M, Jafarian N, Yousefichaijan P (2014) Diabetic nephropathy: a strong predictor of sleep quality in hemodialysis patients. Saudi J Kidney Dis Transpl 25(4):774–780. https://doi.org/10.4103/1319-2442.134994

    Article  PubMed  Google Scholar 

  6. Bilgic A, Akgul A, Sezer S et al (2007) Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr 17(6):381–388. https://doi.org/10.1053/j.jrn.2007.08.008

    Article  PubMed  Google Scholar 

  7. Mollayeva T, Thurairajah P, Burton K et al (2016) The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev 25:52–73. https://doi.org/10.1016/j.smrv.2015.01.009

    Article  PubMed  Google Scholar 

  8. 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 Transpl 23(3):998–1004. https://doi.org/10.1093/ndt/gfm630

    Article  Google Scholar 

  9. Iseki K, Tsuruya K, Kanda E et al (2014) Effects of sleepiness on survival in Japanese hemodialysis patients: J-DOPPS study. Nephron Clin Pract 128(3–4):333–340. https://doi.org/10.1159/000366479

    Article  CAS  PubMed  Google Scholar 

  10. Unruh ML, Buysse DJ, Dew MA et al (2006) Sleep quality and its correlates in the first year of dialysis. Clin J Am Soc Nephrol 1(4):802–810. https://doi.org/10.2215/CJN.00710206

    Article  PubMed  Google Scholar 

  11. Harris TJ, Nazir R, Khetpal P et al (2012) Pain, sleep disturbance and survival in hemodialysis patients. Nephrol Dial Transpl 27(2):758–765. https://doi.org/10.1093/ndt/gfr355

    Article  Google Scholar 

  12. Brekke FB, Waldum B, Amro A et al (2014) Self-perceived quality of sleep and mortality in Norwegian dialysis patients. Hemodial Int 18(1):87–94. https://doi.org/10.1111/Hdi.12066

    Article  PubMed  Google Scholar 

  13. Ricardo AC, Goh V, Chen J et al (2017) Association of sleep duration, symptoms, and disorders with mortality in adults with chronic kidney disease. Kidney Int Rep 2(5):866–873. https://doi.org/10.1016/j.ekir.2017.05.002

    Article  PubMed  PubMed Central  Google Scholar 

  14. Masuda T, Murata M, Honma S et al (2011) Sleep-disordered breathing predicts cardiovascular events and mortality in hemodialysis patients. Nephrol Dial Transpl 26(7):2289–2295. https://doi.org/10.1093/ndt/gfq756

    Article  Google Scholar 

  15. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate [published correction appears in Ann Intern Med. 2011 Sep 20;155(6):408]. Ann Intern Med 150(9):604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006

    Article  PubMed  PubMed Central  Google Scholar 

  16. Buysse DJ, Reynolds CF 3rd, 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  PubMed  Google Scholar 

  17. Shafi ST, Shafi T (2017) A comparison of quality of sleep between patients with chronic kidney disease not on hemodialysis and end-stage renal disease on hemodialysis in a developing country. Ren Fail 39(1):623–628. https://doi.org/10.1080/0886022X.2017.1361836

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cengić B, Resić H, Spasovski G et al (2012) Quality of sleep in patients undergoing hemodialysis. Int Urol Nephrol 44(2):557–567. https://doi.org/10.1007/s11255-010-9881-x

    Article  PubMed  Google Scholar 

  19. Turkmen K, Yazici R, Solak Y et al (2012) Health-related qualıty of lıfe, sleep qualıty, and depressıon in peritoneal dialysis and hemodıalysıs patıents. Hemodial Int 16(2):198–206. https://doi.org/10.1111/j.1542-4758.2011.00648.x

    Article  PubMed  Google Scholar 

  20. Chiu YL, Chuang YF, Fang KC et al (2009) Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transpl 24(1):247–251. https://doi.org/10.1093/ndt/gfn439

    Article  CAS  Google Scholar 

  21. Turk AC, Ozkurt S, Turgal E et al (2018) The association between the prevalence of restless leg syndrome, fatigue, and sleep quality in patients undergoing hemodialysis. Saudi Med J 39(8):792–798. https://doi.org/10.15537/smj.2018.8.22398

    Article  PubMed  PubMed Central  Google Scholar 

  22. Araujo SM, de Bruin VM, Nepomuceno LA et al (2010) Restless legs syndrome in end-stage renal disease: clinical characteristics and associated comorbidities. Sleep Med 11(8):785–790. https://doi.org/10.1016/j.sleep.2010.02.011

    Article  PubMed  Google Scholar 

  23. Lin CH, Wu VC, Li WY et al (2013) Restless legs syndrome in end-stage renal disease: a multicenter study in Taiwan. Eur J Neurol 20(7):1025–1031. https://doi.org/10.1111/ene.12095

    Article  PubMed  Google Scholar 

  24. Afsar B, Elsurer R (2015) Association between serum bicarbonate and pH with depression, cognition and sleep quality in hemodialysis patients. Ren Fail 37(6):957–960. https://doi.org/10.3109/0886022X.2015.1038476

    Article  CAS  PubMed  Google Scholar 

  25. Tada T, Kusano KF, Ogawa A et al (2007) The predictors of central and obstructive sleep apnoea in haemodialysis patients. Nephrol Dial Transpl 22(4):1190–1197. https://doi.org/10.1093/ndt/gfl748

    Article  Google Scholar 

  26. Sekercioglu N, Curtis B, Murphy S et al (2015) Sleep quality and its correlates in patients with chronic kidney disease: a cross-sectional design. Ren Fail 37(5):757–762. https://doi.org/10.3109/0886022X.2015.1024555

    Article  PubMed  Google Scholar 

  27. Benz RL, Pressman MR, Hovick ET et al (2000) Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. Am J Kidney Dis 35(6):1052–1060. https://doi.org/10.1016/s0272-6386(00)70039-4

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by grants from the National Natural Science Foundation of China (no. 81770709) and the Guangzhou Municipal Science and Technology Project (no. 201904010142).

Author information

Author notes

  1. Qianqian Han and Bo Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People’s Republic of China

    Qianqian Han, Bo Liu, Shumin Lin, Jiajia Li, Peifen Liang, Sha Fu, Guiqiong Zheng, Suqiong Yang & Qiongqiong Yang

  2. Clinical Trials Unit, the First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, People’s Republic of China

    Bin Li

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  1. Qianqian Han
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Contributions

QH, SL, BL, BL, and QY designed and supervised the study. BL, SF, and PL recruited patients. GZ and SY followed-up on patients. BL, JL, and QH performed data analysis. QH, SL, BL, and QY wrote the manuscript. All authors have thoroughly reviewed the manuscript and approved the final manuscript for publication.

Corresponding authors

Correspondence to Bin Li or Qiongqiong Yang.

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Conflict of interest

The authors claim that this study was conducted without any commercial or financial relationships or conflicts of interest.

Ethical approval and consent

The protocol of this study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, with the approval number SYSEC-KY-KS-2020-166. The Ethics Committee agreed that this study exempted from informed consent.

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Han, Q., Liu, B., Lin, S. et al. Pittsburgh Sleep Quality Index score predicts all-cause mortality in Chinese dialysis patients. Int Urol Nephrol 53, 2369–2376 (2021). https://doi.org/10.1007/s11255-021-02842-6

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