Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis

Lek-Hong Tan; Pei-Shan Chen; Hsiu-Yin Chiang; Emily King; Hung-Chieh Yeh; Ya-Luan Hsiao; David Ray Chang; Sheng-Hsuan Chen; Min-Yen Wu; Chin-Chi Kuo

doi:10.1016/j.xkme.2022.100458

Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis

Kidney Med. 2022 Mar 31;4(5):100458. doi: 10.1016/j.xkme.2022.100458. eCollection 2022 May.

Authors

Lek-Hong Tan¹, Pei-Shan Chen², Hsiu-Yin Chiang², Emily King³, Hung-Chieh Yeh^{2

4}, Ya-Luan Hsiao⁵, David Ray Chang^{2

4}, Sheng-Hsuan Chen², Min-Yen Wu², Chin-Chi Kuo^{2

4}

Affiliations

¹ Department of Urology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
² Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Medical Media Design and Application, Saint Bear Incorporated, Taichung, Taiwan.
⁴ Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
⁵ Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.

Abstract

Rationale & objective: Poor sleep quality and insomnia are pervasive among patients with advanced chronic kidney disease (CKD); however, these health issues have not been systematically evaluated.

Study design: Systematic review and meta-analysis.

Setting & study populations: Adult patients with CKD not receiving kidney replacement therapy (KRT), as well as adults receiving KRT, including hemodialysis, peritoneal dialysis, and kidney transplantation.

Selection criteria for studies: A systematic literature search using PubMed, Embase, and PsycNET, was conducted for articles published between January 1, 1990, and September 28, 2018.

Data extraction: Data on the prevalences of poor sleep quality and insomnia in patients with CKD, including those receiving and not receiving KRT, were extracted.

Analytical approach: Pooled prevalences were estimated using a random-effects meta-analysis and were stratified according to age, CKD stage, World Health Organization region, risk of bias, Pittsburgh Sleep Quality Index score, and the different criteria for insomnia that were used at diagnosis.

Results: Of 3,708 articles, 93 were selected, and significant methodological heterogeneity was present. The pooled prevalences of poor sleep quality for CKD without KRT, hemodialysis, peritoneal dialysis, and kidney transplantation were 59% (95% CI, 44%-73%), 68% (95% CI, 64%-73%), 67% (95% CI, 44%-86%), and 46% (95% CI, 34%-59%), respectively. The corresponding prevalences of insomnia were 48% (95% CI, 30%-67%), 46% (95% CI, 39%-54%), 61% (95% CI, 41%-79%), and 26% (95% CI, 9%-49%), respectively. Insomnia was significantly more prevalent among patients aged 51-60 years and those aged >60 years than among those aged <50 years. The prevalence of insomnia in the European region was the lowest of all World Health Organization regions.

Limitations: High interstudy heterogeneity.

Conclusions: Approximately half of the patients with advanced CKD had poor sleep quality or insomnia, and the prevalence was even higher among those who received KRT. Kidney transplantation may reduce the burden of poor sleep quality and insomnia.

Keywords: Chronic kidney disease; hemodialysis; insomnia; kidney transplantation; peritoneal dialysis; poor sleep quality.