CDC Surveillance System: Reporting of Various Sleep Symptoms by CKD Stage Among U.S. Adults

Percentage of U.S. Population Reporting Various Sleep Symptoms^a by CKD Stage and Year and Definition National Health and Nutrition Examination Survey
Year	Definition	No CKD	CKD Stages 1 & 2	CKD Stages 3 & 4
2005–2006	Inadequate Sleep	35.7% (CI 32.8-38.5)	42.8% (CI 35.4-50.1)	29.1% (CI 22.4-35.7)
2005–2006	Trouble Sleeping	24.5% (CI 23.1-25.9)	25.3% (CI 18.6-31.9)	28.7% (CI 24.0-33.5)
2005–2006	Sleep Disorder	7.4% (CI 6.4-8.4)	8.8% (CI 4.4-13.1)	7.9% (CI 5.1-10.6)
2005–2006	Nocturia	20.0% (CI 17.4-22.6)	34.5% (CI 27.7-41.2)	48.7% (CI 44.3-53.0)
2007–2008	Inadequate Sleep	38.9% (CI 35.1-42.7)	40.0% (CI 33.9-46.0)	31.7% (CI 26.3-37.1)
2007–2008	Trouble Sleeping	23.7% (CI 22.1-25.3)	32.2% (CI 25.6-38.9)	27.5% (CI 22.5-32.5)
2007–2008	Sleep Disorder	7.3% (CI 6.4-8.3)	11.6% (CI 7.0-16.2)	8.9% (CI 4.7-13.2)
2007–2008	Nocturia	21.7% (CI 19.3-24.2)	35.0% (CI 31.1-38.9)	47.8% (CI 40.0-55.7)
2009–2010	Inadequate Sleep	36.4% (CI 34.6-38.2)	43.3% (CI 38.2-48.4)	30.3% (CI 24.6-36.0)
2009–2010	Trouble Sleeping	24.5% (CI 22.1-26.9)	31.3% (CI 26.2-36.5)	34.8% (CI 28.0-41.6)
2009–2010	Sleep Disorder	7.0% (CI 6.2-7.7)	11.8% (CI 7.9-15.7)	10.0% (CI 5.6-14.3)
2009–2010	Nocturia	21.4% (CI 19.5-23.3)	38.0% (CI 33.0-43.0)	50.7% (CI 45.5-55.9)
2011–2012	Inadequate Sleep	37.9% (CI 35.0-40.9)	37.3% (CI 29.0-45.6)	24.8% (CI 18.6-31.0)
2011–2012	Trouble Sleeping	26.9% (CI 24.0-29.8)	28.8% (CI 20.7-37.0)	28.0% (CI 23.7-32.4)
2011–2012	Sleep Disorder	8.4% (CI 6.9-9.8)	14.2% (CI 7.9-20.5)	12.3% (CI 7.9-16.7)
2011–2012	Nocturia	21.0% (CI 18.7-23.4)	40.5% (CI 31.8-49.2)	43.6% (CI 36.6-50.6)
2013–2014	Inadequate Sleep	34.9% (CI 32.1-37.6)	36.2% (CI 30.6-41.7)	33.8% (CI 27.5-40.1)
2013–2014	Trouble Sleeping	27.1% (CI 24.7-29.4)	29.2% (CI 24.1-34.3)	41.0% (CI 33.1-48.9)
2013–2014	Sleep Disorder	9.6% (CI 8.4-10.9)	13.6% (CI 9.3-17.9)	17.7% (CI 11.9-23.4)
2013–2014	Nocturia	24.3% (CI 21.1-27.5)	38.7% (CI 33.5-43.9)	39.4% (CI 33.2-45.6)

Notes:

* Indicates that the result for this cell was suppressed because of imprecision due to a sample size that was too small or the standard error of the result being too large (>30% of the estimate).
95% confidence intervals, when available, are shown in parentheses.

Footnotes:
^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.

Field	Data
Description of Measure	Prevalence of sleep-related problems among persons with and without CKD in the general population
Data Source	NCHS
Type of Data Source	Public
Data Set	NHANES
Health Care System Data	No
Regional or National?	National
Demographic Group	Non-institutionalized U.S. residents aged 20+
Numerator	Non-pregnant adult participants with data on albuminuria and creatinine who reported sleep-related problems
Denominator	Non-pregnant adult participants with data on albuminuria and creatinine who completed a sleep disorders questionnaire
Primary Data Source Indicator	slqXXX: sleep questionnaire items, plus item on nocturia from kidney questionnaire
Definition of CKD	Presence of single albuminuria or eGFR<60 ml/min/1.73 m²
Glomerular filtration rate	Estimated 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 0.993^age 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 Measurement	Questionnaire (interviewer-administered)
Secondary (1) Variable	lbxscr: Serum creatinine
Secondary (1) Indicator Method of Measurement	Examination/Laboratory
Secondary (2) Variable	rhd143, rhd141/rhd140, urxpreg: current pregnancy
Secondary (2) Indicator Method of Measurement	Questionnaire (interviewer-administered) or exam (urine pregnancy status)
Secondary (3) Variable	urxcua/urxucr: urinary proteins
Secondary (3) Indicator Method of Measurement	Examination/laboratory
Frequency of Measurement (Primary)	Once (cross-sectional)
U.S. Region Covered by Primary Variable	All
Period Currently Available	2005–2014
Pending Data	2015-2016
Additional Data Items of Interest	Stage of CKD
Limitations of Indicator	Self-reported sleep-related problems (may be under- or overestimated); cross-sectional
Analytic Considerations	Appropriate 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