Sleep disorders are common and underrecognized in patients at all stages of chronic kidney disease. They include sleep apnea, insomnia, excessive sleepiness, restless legs syndrome and periodic limb movement disorder. They can be related to underlying uremia or comorbidities. Sleep disorders can affect the quality of life, and some are associated with increased morbidity and mortality. Clinical assessment, polysomnography and other standardized assessments are required for diagnosis. Therapeutic approaches include improvement in uremia management, treatment of comorbidities or specific interventions directed at individual sleep disorders. Diagnosis and treatment of sleep disorders in this population may improve quality of life and patient survival.

1.
Kimmel PL, Miller G, Mendelson WB: Sleep apnea syndrome in chronic renal disease. Am J Med 1989;86:308–314.
2.
Unruh ML, Sanders MH, Redline S, Piraino BM, Umans JG, Hammond TC, Sharief I, Punjabi NM, Newman AB: Sleep apnea in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the Sleep Heart Health Study. J Am Soc Nephrol 2006;17:3503–3509.
3.
Wadhwa NK, Mendelson WB: A comparison of sleep-disordered respiration in ESRD patients receiving hemodialysis and peritoneal dialysis. Adv Perit Dial 1992;8:195–198.
4.
Beecroft J, Duffin J, Pierratos A, Chan CT, McFarlane P, Hanly PJ: Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease. Eur Respir J 2006;28:151–158.
5.
Beecroft JM, Duffin J, Pierratos A, Chan CT, McFarlane P, Hanly PJ: Decreased chemosensitivity and improvement of sleep apnea by nocturnal hemodialysis. Sleep Med 2009;10:47–54.
6.
Anastassov GE, Trieger N: Edema in the upper airway in patients with obstructive sleep apnea syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:644–647.
7.
Chiu KL, Ryan CM, Shiota S, Ruttanaumpawan P, Arzt M, Haight JS, Chan CT, Floras JS, Bradley TD: Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med 2006;174:1378–1383.
8.
Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane PA, Hanly PJ: Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea. Eur Respir J 2007;30:965–971.
9.
Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane P, Hanly PJ: Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant 2008;23:673–679.
10.
Tang SC, Lam B, Ku PP, Leung WS, Chu CM, Ho YW, Ip MS, Lai KN: Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 2006;17:2607–2616.
11.
Tang SC, Lam B, Lai AS, Pang CB, Tso WK, Khong PL, Ip MS, Lai KN: Improvement in sleep apnea during nocturnal peritoneal dialysis is associated with reduced airway congestion and better uremic clearance. Clin J Am Soc Nephrol 2009;4:410–418.
12.
Beecroft JM, Zaltzman J, Prasad R, Meliton G, Hanly PJ: Impact of kidney transplantation on sleep apnoea in patients with end-stage renal disease. Nephrol Dial Transplant 2007;22:3028–3033.
13.
Tang SC, Lam B, Yao TJ, Leung WS, Chu CM, Ho YW, Ip MS, Lai KN: Sleep apnea is a novel risk predictor of cardiovascular morbidity and death in patients receiving peritoneal dialysis. Kidney Int 2010;77:1031–1038.
14.
Auckley DH, Schmidt-Nowara W, Brown LK: Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation. Am J Kidney Dis 1999;34:739–744.
15.
Lee JJ, Kim GS, Kim JA, Kim SJ, Kang JG, Kim GH, Jung HH: Improvement of sleep-related breathing disorder in patients with end-stage renal disease after kidney transplantation. Clin Transplant 2009, Epub ahead of print.
16.
Sabbatini M, Minale B, Crispo A, Pisani A, Ragosta A, Esposito R, Cesaro A, Cianciaruso B, Andreucci VE: Insomnia in maintenance haemodialysis patients. Nephrol Dial Transplant 2002;17:852–856.
17.
Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM, Singer MA, Hopman WM: Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 2003;18:126–132.
18.
Hui DS, Wong TY, Ko FW, Li TS, Choy DK, Wong KK, Szeto CC, Lui SF, Li PK: Prevalence of sleep disturbances in Chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2000;36:783–788.
19.
Hanly PJ, Pierratos A: Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001;344:102–107.
20.
Loewen A, Siemens A, Hanly P: Sleep disruption in patients with sleep apnea and end-stage renal disease. J Clin Sleep Med 2009;5:324–329.
21.
Hanly PJ, Gabor JY, Chan C, Pierratos A: Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis 2003;41:403–410.
22.
Parker KP, Bliwise DL, Bailey JL, Rye DB: Daytime sleepiness in stable hemodialysis patients. Am J Kidney Dis 2003;41:394–402.
23.
Unruh ML, Sanders MH, Redline S, Piraino BM, Umans JG, Chami H, Budhiraja R, Punjabi NM, Buysse D, Newman AB: Subjective and objective sleep quality in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the sleep heart health study. Am J Kidney Dis 2008;52:305–313.
24.
Elder SJ, Pisoni RL, Akizawa T, Fissell R, Andreucci VE, Fukuhara S, Kurokawa K, Rayner HC, Furniss AL, Port FK, Saran R: 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 2008;23:998–1004.
25.
Novak MJ, Sheth H, Bender FH, Fried L, Piraino B: Improvement in Pittsburgh Symptom Score index after initiation of peritoneal dialysis. Adv Perit Dial 2008;24:46–50.
26.
Bro S, Bjorner JB, Tofte-Jensen P, Klem S, Almtoft B, Danielsen H, Meincke M, Friedberg M, Feldt-Rasmussen B: A prospective, randomized multicenter study comparing APD and CAPD treatment. Perit Dial Int 1999;19:526–533.
27.
Eryilmaz MM, Ozdemir C, Yurtman F, Cilli A, Karaman T: Quality of sleep and quality of life in renal transplantation patients. Transplant Proc 2005;37:2072–2076.
28.
Chen HY, Chiang CK, Wang HH, Hung KY, Lee YJ, Peng YS, Wu KD, Tsai TJ: Cognitive-behavioral therapy for sleep disturbance in patients undergoing peritoneal dialysis: a pilot randomized controlled trial. Am J Kidney Dis 2008;52:314–323.
29.
Walker S, Fine A, Kryger MH: Sleep complaints are common in a dialysis unit. Am J Kidney Dis 1995;26:751–756.
30.
Winkelman JW, Chertow GM, Lazarus JM: Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996;28:372–378.
31.
Mucsi I, Molnar MZ, Ambrus C, Szeifert L, Kovacs AZ, Zoller R, Barotfi S, Remport A, Novak M: Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant 2005;20:571–577.
32.
Unruh ML, Levey AS, D’Ambrosio C, Fink NE, Powe NR, Meyer KB, Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study: Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival. Am J Kidney Dis 2004;43:900–909.
33.
Szentkiralyi A, Molnar MZ, Czira ME, Deak G, Lindner AV, Szeifert L, Torzsa P, Vamos EP, Zoller R, Mucsi I, Novak M: Association between restless legs syndrome and depression in patients with chronic kidney disease. J Psychosom Res 2009;67:173–180.
34.
Benz RL, Pressman MR, Hovick ET, Peterson DD: Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. Am J Kidney Dis 2000;35:1052–1060.
35.
Beecroft JM, Zaltzman J, Prasad GV, Meliton G, Hanly PJ: Improvement of periodic limb movements following kidney transplantation. Nephron Clin Pract 2008;109:c133–c139.
36.
Molnar MZ, Novak M, Ambrus C, Szeifert L, Kovacs A, Pap J, Remport A, Mucsi I: Restless legs syndrome in patients after renal transplantation. Am J Kidney Dis 2005;45:388–396.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.