Subjective and Objective Sleep Quality in Patients on Conventional Thrice-Weekly Hemodialysis: Comparison With Matched Controls From the Sleep Heart Health Study

Background: Studies examining sleep in the hemodialysis (HD) population have largely lacked an adequate comparison group. It therefore is uncertain whether poor sleep quality in the HD population reflects age, chronic health conditions, or effects of conventional HD therapy. Study Design: Cross-sectional matched-group study. Setting & Participants: Forty-six in-center HD patients were compared with 137 community participants participating in the Sleep Heart Health Study matched for age, sex, body mass index, and race. Predictor: HD patients compared with community-dwelling non-HD participants. Outcomes & Measurements: Home unattended polysomnography was performed and scored by using similar protocols. Sleep habits and sleepiness were assessed by using the Sleep Habits Questionnaire and Epworth Sleepiness Scale. Results: Average age of study samples was 63 years, 72% were white, and average body mass index was 28 ± 5 kg/m². HD patients were significantly more likely than community participants to have short sleep (odds ratio, 3.27; 95% confidence interval, 1.16 to 9.25) and decreased sleep efficiency (odds ratio, 5.5; 95% confidence interval, 1.5 to 19.6). HD patients reported more difficulty getting back to sleep (odds ratio, 2.25; 95% confidence interval, 1.11 to 4.60) and waking up too early (odds ratio, 2.39; 95% confidence interval, 1.01 to 5.66). There was no association between polysomnography sleep time and self-reported sleep time (r = 0.09; P = 0.6) or between the Epworth Sleepiness Scale and severity of sleep apnea (r = 0.10; P = 0.5) in the HD population. Limitations: The study was limited to participants older than 45 years. Conclusions: Kidney failure treated with thrice-weekly HD is significantly associated with poor subjective and objective sleep quality.