Association Between Sleep Disorders and Cognitive Impairment in Middle Age and Older Adult Hemodialysis Patients: A Cross-Sectional Study

Ru Tian, Yun Bai, Yidan Guo, Pengpeng Ye, Yang Luo, Ru Tian, Yun Bai, Yidan Guo, Pengpeng Ye, Yang Luo

Abstract

Objective: The aims of the current study were to (1) explore the features of overall poor sleep and specific sleep disorders in Chinese middle age and older adult hemodialysis patients; (2) examine the association between sleep disorders and cognitive impairment (CI) in middle age and older patients undergoing hemodialysis in China. Methods: Data of patients undergoing maintenance hemodialysis were collected from the prospective cohort study of CI in Chinese patients undergoing hemodialysis (Registered in Clinical Trials.gov, ID: NCT03251573). We included 613 patients (mean age = 63.7; SD = 7.8) in this study. We assessed sleep conditions using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and cognitive function by the Chinese Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) scale. Then the association between sleep disorders and CI was evaluated using multivariate logistic regression analysis. Results: The prevalence of sleep disorders in this group of 613 hemodialysis patients was 77.0%. Patients with CI were more inclined to have sleep disorders in specific aspects of sleep latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction (p < 0.05). In multivariate logistic regression analyses, every 1-point increase in global PSQI score was associated with a 1.2-fold increased risk of CI (adjusted OR = 1.201; 95%CI = 1.123-1.284, p < 0.001). For each specific PSQI, every 1-point increase in sleep disturbances score was associated with a 2.6-fold increased risk of CI (adjusted OR = 2.624; 95%CI = 1.891-3.640, p < 0.001), and every 1-point increase in daytime dysfunction score was associated with a 3.7-fold increased risk of CI (adjusted OR = 3.709; 95%CI = 2.653-5.184, p < 0.001), whereas every 1-point increase in sleep duration score was associated with a decreased risk of CI (adjusted OR = 0.600; 95%CI = 0.434-0.830, p = 0.002). Conclusion: Poor sleep quality especially sleep disturbances, daytime dysfunction, and long sleep duration are associated with CI in middle age and older adult hemodialysis patients. Thus, the early detection of sleep disorders may help identify patients with cognitive impairment among hemodialysis individuals. Clinical Trial Registration: [Clinical Trials.gov], identifier [NCT03251573].

Keywords: cognitive function; cognitive impairment; hemodialysis; sleep; sleep disorders.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer XL has declared a shared parent affiliation with the authors RT, YG, and YL at the time of the review.

Copyright © 2021 Tian, Bai, Guo, Ye and Luo.

Figures

FIGURE 1
FIGURE 1
Proportion of a score of >5 on global and a score of 3 on each specific PSQI in HD patients with or without CI. PSQI, the Pittsburgh Sleep Quality Index; HD, hemodialysis; CI, cognitive impairment.

References

    1. Angermann S., Schier J., Baumann M., Steubl D., Hauser C., Lorenz G., et al. (2018). Cognitive impairment is associated with mortality in hemodialysis patients. J. Alzheimers Dis. 66 1529–1537. 10.3233/JAD-180767
    1. Bastos J. P., Sousa R. B., Nepomuceno L. A., Adrianzen O. A., Bruin P. F., Araujo M. L., et al. (2007). Sleep disturbances inpatients on maintenance hemodialysis: role of dialysis shift. Rev. Assoc. Med. Bras. 53 492–496. 10.1590/s0104-42302007000600014
    1. Beaudreau S. A., Spira A. P., Stewart A., Kezirian E. J., Lui L. Y., Ensrud K., et al. (2012). Validation of the Pittsburgh sleep quality index and the epworth sleepiness scale in older black and white women. Sleep Med. 13 36–42. 10.1016/j.sleep.2011.04.005
    1. Buysse D. J. (2014). Sleep health: can we define it? Does it matter. Sleep 37 9–17. 10.5665/sleep.3298
    1. Buysse D. J., Reynolds C. F., III, Monk T. H., Berman S. R., Kupfer D. J. (1989). The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 28 193–213. 10.1016/0165-1781(89)90047-4
    1. Cengic B., Resic H., Spasovski G., Avdic E., Alajbegovic A. (2012). Quality of sleep in patients undergoing hemodialysis. Int. Urol. Nephrol. 44 557–567. 10.1007/s11255-010-9881-x
    1. Davison S. N., Levin A., Moss A. H., Jha V., Brown E. A., Brennan F., et al. (2015). Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: developing a roadmap to improving quality care. Kidney Int. 88 447–459. 10.1038/ki.2015.110
    1. Drew D. A., Weiner D. E., Tighiouart H., Scott T., Lou K., Kantor A., et al. (2015). Cognitive function and all-cause mortality in maintenance hemodialysis patients. Am. J. Kidney Dis. 65 303–311. 10.1053/j.ajkd.2014.07.009
    1. Eggers B., Hermann W., Barthel H., Sabri O., Wagner A., Hesse S. (2003). The degree of depression in Hamilton rating scale is correlated with the density of presynaptic serotonin transporters in 23 patients with Wilson’s disease. J. Neurol. 250 576–580. 10.1007/s00415-003-1039-7
    1. Elder S. J., Pisoni R. L., Akizawa T., Fissell R., Andreucci V. E., Fukuhara S., 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. 10.1093/ndt/gfm630
    1. Eryavuz N., Yuksel S., Acarturk G., Uslan I., Demir S., Demir M., et al. (2008). Comparison of sleep quality between hemodialysis and peritoneal dialysis patients. Int. Urol. Nephrol. 40 785–791. 10.1007/s11255-008-9359-2
    1. Gadie A., Shafto M., Leng Y., Kievit R. A., Can C. (2017). How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults. BMJ Open 7:e014920. 10.1136/bmjopen-2016-014920
    1. Harris T. J., Nazir R., Khetpal P., Peterson R. A., Chava P., Patel S. S., et al. (2012). Pain, sleep disturbance and survival in hemodialysis patients. Nephrol. Dial. Transplant. 27 758–765. 10.1093/ndt/gfr355
    1. Hinz A., Glaesmer H., Brähler E., Loffler M., Engel C., Enzenbach C., et al. (2017). Sleep quality in the general population: psychometric properties of the Pittsburgh sleep quality index, derived from a German community sample of 9284 people. Sleep Med. 30 57–63. 10.1016/j.sleep.2016.03.008
    1. Iliescu E. A., Coo H., McMurray M. H., Meers C. L., Quinn M. M., Singer M. A., et al. (2003). Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol. Dial. Transplant. 18 126–132. 10.1093/ndt/18.1.126
    1. Kang E. W., Abdel-Kader K., Yabes J., Glover K., Unruh M. (2012). Association of sleep-disordered breathing with cognitive dysfunction in CKD stages 4-5. Am. J. Kidney Dis. 60 949–958. 10.1053/j.ajkd.2012.08.033
    1. Kurella Tamura M., Larive B., Unruh M. L., Stokes J. B., Nissenson A., Mehta R. L., et al. (2010). Prevalence and correlates of cognitive impairment in hemodialysis patients: the frequent hemodialysis network trials. Clin. J. Am. Soc. Nephrol. 5 1429–1438. 10.2215/CJN.01090210
    1. Kurella M., Luan J., Yaffe K., Chertow G. M. (2004). Validation of the Kidney Disease Quality of Life (KDQOL) cognitive function subscale. Kidney Int. 66 2361–2367. 10.1111/j.1523-1755.2004.66024.x
    1. Kutner N. G., Zhang R., Huang Y., Bliwise D. L. (2007). Association of sleep difficulty with Kidney Disease Quality of Life cognitive function score reported by patients who recently started dialysis. Clin. J. Am. Soc. Nephrol. 2 284–289. 10.2215/CJN.03000906
    1. Lu J., Li D., Li F., Zhou A., Wang F., Zuo X., et al. (2011). Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals: a population-based study. J. Geriatr. Psychiatry Neurol. 24 184–190. 10.1177/0891988711422528
    1. Luo Y., Marray A. M., Guo Y., Tian R., Ye P., Li X., et al. (2020). Cognitive impairment and associated risk factors in older adult hemodialysis patients:a cross-sectional survey. Sci. Rep. 10:12542. 10.1038/s41598-020-69482-1
    1. Murray A. M., Tupper D. E., Knopman D. S., Gilbertson D. T., Pederson S. L., Li S., et al. (2006). Cognitive impairment in hemodialysis patients is common. Neurology 67 216–223.
    1. Nakakubo S., Doi T., Makizako H., Tsutsumimoto K., Hotta R., Kurita S., et al. (2019). Sleep condition and cognitive decline in Japanese community-dwelling older people: data from a 4-year longitudinal study. J. Sleep Res. 28:e12803. 10.1111/jsr.12803
    1. O’Lone E., Connors M., Masson P., Wu S., Kelly P. J., Gillespie D., et al. (2016). Cognition in people with end-stage kidney disease treated with hemodialysis: a systematic review and meta-analysis. Am J. Kidney Dis. 67 925–935. 10.1053/j.ajkd.2015.12.028
    1. Pai M. F., Hsu S. P., Yang S. Y., Ho T. I., Lai C. F., Peng Y. S. (2007). Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia. Ren. Fail. 29 673–677. 10.1080/08860220701459642
    1. Ratcliff R., Van Dongen H. P. (2009). Sleep deprivation affects multiple distinct cognitive processes. Psychon. Bull. Rev. 16 742–751. 10.3758/PBR.16.4.742
    1. Rodriguez L., Tighiouart H., Scott T., Lou K., Giang L., Sorensen E., et al. (2013). Association of sleep disturbances with cognitive impairment and depression in maintenance hemodialysis patients. J. Nephrol. 26 101–110. 10.5301/jn.5000131
    1. Salahuddin M., Maru T. T., Kumalo A., Pandi-Perumal S. R., Bahammam A. S., Manzar M. D. (2017). Validation of the Pittsburgh sleep quality index in community dwelling Ethiopian adults. Health Qual. Life Outcomes 15:58. 10.1186/s12955-017-0637-5
    1. Tian R., Guo Y., Ye P., Zhang C., Luo Y. (2020). The validation of the Beijing version of the montreal cognitive assessment in Chinese patients undergoing hemodialysis. PLoS One 15:e0227073. 10.1371/journal.pone.0227073
    1. van Zwieten A., Wong G., Ruospo M., Palmer S. C., Barulli M. R., Iurillo A., et al. (2018). Prevalence and patterns of cognitive impairment in adult hemodialysis patients: the COGNITIVE-HD study. Nephrol. Dial. Transplant. 33 1197–1206. 10.1093/ndt/gfx314
    1. Wang S., Qin W., Jia J. (2014). Progress in cognitive impairment research of Alzheimer’s disease. Chin. J. Geriatr. 33 682–684. 10.3760/cma.j.issn.0254-9026.2014.06.034
    1. Waters F., Bucks R. S. (2011). Neuropsychological effects of sleep loss: implication for neuropsychologists. J. Int. Neuropsychol. Soc. 17 571–586. 10.1017/S1355617711000610
    1. Zhao Y., Zhang Y., Yang Z., Wang J., Xiong Z., Liao J., et al. (2019). Sleep disorders and cognitive impairment in peritoneal dialysis: a multicenter prospective cohort study. Kidney Blood Press. Res. 44 1115–1127. 10.1159/000502355

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