Sleep disturbance is reported to have a relationship with risk factors for cardiovascular diseases that commonly found in patients with chronic kidney disease (CKD). One of the methods that can be used in assessing a person’s sleep disorder is to evaluate a person’s sleep quality.
Among them by using the Pittsburgh Sleep Quality Index (PSQI), which is a questionnaire method that has several components in it. The factors related to sleep quality in CKD patients are still not much explored. In this study, we tried to make observations on any factors related to the sleep quality of CKD patients.
Several Factors associated with Sleep Quality
Sleep disturbance is closely related to cardiovascular disease. About 15-25% of the population in America experience sleep disorders. The study referred to vascular diseases such as ventricular dysfunction, hypertension, and coronary heart disease experienced by the community.
Several mechanisms are due to excessive sympathetic nerve stimulation and the occurrence of extensive inflammatory processes. Cardiovascular disease is a condition that often found in CKD patients. Thus, disturbed sleep patterns can also be found in CKD patients.
We suspect an association between a person’s sleep duration and changes in blood pressure. Based on the occurrence of oscillations between rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep that cause oscillations of plasma renin activity. Besides, the lower limit for both systole and diastolic blood pressure decreases during NREM due to a decrease in plasma renin activity and an increase in vagal beats.
There is a relation between daytime disturbance due to disturbed sleep patterns and the inflammation process. To assess whether the severity of sleep patterns affects the inflammatory process or vice versa, an investigation of the history of the use of sleeping pills and disturbances during the daytime towards markers of the inflammatory process is the hs-CRP molecule and blood type-based markers.
Last but not least, there is a relationship between anthropometry of the body and the patient’s sleep quality. Obstructive sleep apnea (OSA) or a condition where the airway blocked during sleep cause obesity. Thus, it can be a factor related to the patient’s sleep quality.
The study involved 64 patients diagnosed with CKD stage II-V, and it was conducted at Universitas Airlangga Hospital and a private hospital in Surabaya. Besides, 25 patients did dialysis/hemodialysis (HD) therapy, and 39 other people did not undergo hemodialysis (non-HD).
This research is a cross-sectional type, and the data is collected through interviews, physical examinations, and laboratory examinations. PSQI questionnaire does the determination of a patient’s sleep quality.
This questionnaire is an instrument to determine sleep quality by using 7 components, namely subjectivity of sleep quality, sleep latency, sleep duration, habitual sleep efficiency (HBE), disturbance of sleep patterns, use of sleeping pills, and disturbances during the day during the past month. The result is the sleep quality is good if the PSQI score
The results of data analysis of several parameters observed showed that: first, short sleep duration (less than 5 hours per day) is associated with an increased blood pressure of diastole in the non-HD CKD patient group. Thus, it indicates a tendency that diastolic blood pressure is higher in patients with shorter sleep duration.
Second, disturbances throughout the day and a history of sleeping pills that show disturbed sleep patterns related to hs-CRP levels in both HD and non-HD CKD patients. The neutrophil-lymphocyte ratio has an association with impaired sleep patterns in non-HD patients. It indicates a link between the assessment component of sleep disturbance patterns and markers of inflammation (here illustrated by hs-CRP levels and neutrophil-lymphocyte ratio).
Third, there is a correlation between disturbed sleep patterns with the patient’s neck circumference during anthropometry examination. Thus, the value of poor sleep quality is associated with higher patient neck circumference and also in line with the results that patients with PSQI values> 5 (poor sleep quality) have
The results of this study indicate that several factors related to sleep quality of patients with CKD, such as diastolic blood pressure, inflammatory markers of hs-CRP, and neutrophil-lymphocyte ratio, and anthropometry. These results can be an incentive for clinicians to pay more attention to sleep disturbance as part of cardiovascular risk factors in CKD patients.
Author: Prof. Mochammad Thaha, dr, Ph.D., Sp.PD, K-GH, FINASIM, FACP, FASN
Maulana Antiyan Empitu, Ika Nindya Kadariswantiningsih, Mochammad Thaha, Cahyo Wibisono Nugroho, Eka Arum Cahyaning Putri, Zaky El Hakim, Maulana Muhtadin Suryansyah, Rieza Rizqi Alda, Mohammad Yusuf Alsagaff, Mochammad Amin, Djoko Santoso, Yusuke Suzuki (2019). Determiner of Poor Sleep Quality in Chronic Kidney Disease Patients Links to Elevated Diastolic Blood Pressure, hs-CRP, and Blood-count-based Inflammatory Predictors. The Indonesian Biomedical Journal. Vol 11, No 1, pp.p.100-6.