Sleep disorders are said to impact between 45% to 80% of adults with end‐stage kidney disease (ESKD) and affect about 50 percent of patients with earlier stages of chronic kidney disease (CKD). Researchers have compiled studies on common interventions for improving sleep quality to help people with CKD with sleep disorders.* 

What types of issues can impact sleep quality?

People with CKD can have severe sleep problems related to a multitude of factors, such as medication use, mental health (depression and/or anxiety), pain, and/or itchiness. All of these factors can affect your quality of sleep, including the time it takes to get to sleep, one’s ability to stay asleep, and your total sleep time. Kidney disease can also be associated with disordered breathing, which also impacts sleep quality.

Other risks factors for sleep disorders include:

• Older age
• Male sex
• Obesity
• Smoking
• Increased neck circumference
• Diabetes

Dialysis treatment modality may also lead to sleep dysfunction, although “people treated with automated peritoneal dialysis (PD) appear to have less severe sleep‐related breathing disorders (SBD) compared to continuous ambulatory PD use.” In contrast, kidney transplantation is associated with a low rate of sleep disorders.

Sleep disorders are prevalent in people with CKD, and they can lead to a variety of related medical conditions, such as:

• Increased cardiovascular risk
• Arterial hypertension
• Subclinical atherosclerosis
• Coronary heart disease
• Type 2 diabetes (diabetes mellitus)
• Dyslipidemia

What they did 

Sixty‐seven studies, involving more than 3,400 participants, were analyzed for information on the benefits of interventions, any potential side effects, and level of quality. The interventions used in the 67 studies included:

• Relaxation techniques
• Exercise
• Acupressure
• Cognitive-behavioral therapy (CBT)
• Educational interventions
• Benzodiazepine treatment
• Dopaminergic agonists
• Telephone support
• Melatonin
• Reflexology
• Light therapy
• Different forms of peritoneal dialysis
• Music
• Aromatherapy
• Massage

What they found

The most promising research showed that acupressure may shorten sleep latency (the time it takes to fall asleep) and reduce fatigue, but the research lacked a comparison with a sham acupressure treatment. Moreover, “sleep hygiene education may decrease the time taken to sleep, increase sleep duration, and may reduce sleep disturbance.”

Overall, they discovered that most of the studies were small, and there was an absence of studies that involved children. Additionally, zero studies received a high-quality GRADE as part of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. 

What it means

The researchers explained that currently, “[t]here is insufficient evidence to provide direction to health policymakers and practitioners.” 

To that end, the researchers offer suggestions for future research:

1. Studies of interventions for improving sleep in children with CKD
2. Studies of interventions for sleep‐disordered breathing and obstructive sleep apnea
3. Investigation of longer-term treatment with extended periods of follow‐up
4. Studies of promising interventions to examine effects on patient-centered outcomes, such as next-day function and quality of life for adults, as well as educational and social functioning and neurocognitive development in children
5. Exploration of the adverse effects of treatment
6. Larger studies comparing acupressure with sham acupressure

Because of the high symptom burden in CKD patients, prioritizing new research initiatives that focus on improving sleep quality can help healthcare providers better understand what the best techniques are for their patients.

*Natale, P., Ruospo, M., Saglimbene, V. M., Palmer, S. C., et al. (2019, May 26). Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database of Systematic Reviews. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012625.pub2/full