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Indicator Details: Percentage of U.S. Population Reporting Various Sleep Symptoms by CKDa
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a Inadequate sleep, ≤6 hours per night on average; trouble sleeping and sleep disorder, diagnosed by health care provider; daytime sleepiness and use of sleeping pills, reported for 5+ nights in the previous 30 days; leg symptoms, frequent leg cramps or jerks or diagnosed restless leg syndrome; and nocturia, 2 or more episodes of urination that disrupted sleep per night on average. Note that the NHANES sleep questionnaire was limited to three items starting in 2009-2010: number of hours slept per night, diagnosed trouble sleeping, and diagnosed sleep disorder. Nocturia was determined through the kidney questionnaire in all years. Thus, daytime sleepiness, use of sleeping pills, and leg symptoms were discontinued after 2008.

In 2013-2014, sleep problems like inadequate sleep (35%), trouble sleeping (27%), sleep disorder (10%), and nighttime urination (24%) were frequently reported in the U.S. population in those without CKD.

Each of these sleep problems was more commonly reported in those with CKD compared to those without CKD. Compared to the U.S. population, those with moderate to severe CKD had 7 to 20 percentage points higher prevalence of trouble sleeping and nighttime urination.
Chart Explanation: In 2013-2014, a substantial proportion of the U.S. population reported sleep symptoms, with sleep symptoms generally more frequently reported by those with CKD. Those with CKD stages 1 and 2 were more likely than those without CKD to report inadequate sleep (36.2% vs. 34.9%); for those with CKD 3 and 4, inadequate sleep was less prevalent (33.8%). Those with CKD more often reported trouble sleeping (29.2% for stages 1 and 2; and 41.0% for stages 3 and 4) as well having a sleep disorder (13.6% for stages 1 and 2; and 17.7% for stages 3 and 4) when compared to those without CKD (27.1% and 9.6%). In addition, greater prevalence of nocturia stages 1 and 2, and CKD stages 3 and 4, respectively, reporting nocturia, or nighttime urniation. All comparisons were statistically significantly different (P<.001 by χ2 test).
The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.

Problems with sleep are well-documented in end-stage renal disease but less is known about these problems in earlier-stage CKD. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here, we examined data from a survey on sleep disorders conducted during the 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014 NHANES. Inadequate sleep was defined as ≤6 hours per night on average; trouble sleeping and sleep disorder were defined by a health care provider diagnosis; and nocturia was defined by 2 or more episodes of urination that disrupted sleep per night on average.
Description of MeasurePrevalence of sleep-related problems among persons with and without CKD in the general population
Data SourceNCHS
Type of Data SourcePublic
Health Care System DataNo
Regional or National?National
Demographic GroupNon-institutionalized U.S. residents aged 20+
NumeratorNon-pregnant adult participants with data on albuminuria and creatinine who reported sleep-related problems
DenominatorNon-pregnant adult participants with data on albuminuria and creatinine who completed a sleep disorders questionnaire
Primary Data Source IndicatorslqXXX: sleep questionnaire items, plus item on nocturia from kidney questionnaire
Definition of CKDPresence of single albuminuria or eGFR<60 ml/min/1.73 m²
Glomerular filtration rateEstimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ  x 0.993age x (1.018 if female) x (1.159 if NH Black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male
Primary Indicator Method of MeasurementQuestionnaire (interviewer-administered)
Secondary (1) Variablelbxscr: Serum creatinine
Secondary (1) Indicator Method of MeasurementExamination/Laboratory
Secondary (2) Variablerhd143, rhd141/rhd140, urxpreg: current pregnancy
Secondary (2) Indicator Method of MeasurementQuestionnaire (interviewer-administered) or exam (urine pregnancy status)
Secondary (3) Variableurxcua/urxucr: urinary proteins
Secondary (3) Indicator Method of MeasurementExamination/laboratory
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available2005–2014
Pending Data2015-2016
Additional Data Items of InterestStage of CKD
Limitations of IndicatorSelf-reported sleep-related problems (may be under- or overestimated); cross-sectional
Analytic ConsiderationsAppropriate NHANES survey weights must be used for all analyses; variables were limited to hours of sleep, trouble sleeping, and sleep disorder only starting in 2009-2010
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd