Prevalence of Sleep Problems Among American Indians With and Without CKD

Footnotes:
^a P = 0.005, 0.03, 0.002, and 0.005 for inadequate sleep, sleeping pill use, leg symptoms, and nocturia, respectively, for CKD vs. no CKD.

Sleep problems are common in the American Indian population, with reported inadequate sleep, sleeping pill use, leg symptoms (cramps or jerks), and nocturia being more frequently reported among American Indians with CKD than those without CKD

Chart Explanation: Overall, American Indians with CKD reported more sleep problems than those without CKD, although sleep problems were common in both groups. Those with more severe CKD also had higher prevalence of daytime sleepiness, leg cramps, and apnea, compared to those with mild CKD. Inadequate sleep and sleeping pill use did not differ by severity of CKD.

The Strong Heart Study consisted of several components and three study exams (baseline, 1989-1992; second exam, 1993-1995; and third exam, 1998-1999), followed by morbidity and mortality surveillance of 4,500 tribal participants. Strong Heart enrolled men and women aged 45-74 at baseline from 13 American Indian tribes/communities in Arizona, Oklahoma, and the Dakotas. As part of the Sleep Heart Health Study (Quan et al., 1997), 2,896 Strong Heart participants with information on CKD status also self-reported on various aspects of sleep at the third exam, including sleep adequacy (“Do you get enough sleep?”), daytime sleepiness (“Do you feel excessively sleepy during the day?”), sleeping pill use (“Do you use sleeping pills or aids to fall asleep?”), leg symptoms (“Do you have leg cramps or jerks that wake you up?”), nocturia (“Does the need to use the bathroom wake you up?”), and apnea (“Do you stop breathing while sleeping?”).

Field	Data
Description of Measure	Prevalence of sleep problems
Data Source	Strong Heart Study
Type of Data Source	Private
Data Set	SHS
Health Care System Data	No
Regional or National?	National
Demographic Group	American Indians aged 45-74 from 13 tribes/communities
Numerator	Number of participants with reported sleep problems at exam 3
Denominator	All participants with sleep information at exam 3
Definition of CKD	No CKD, eGFR >90 ml/min/1.73 m² & albumin:creatinine ratio <30 mg/g Stage 1, eGFR >90 ml/min/1.73 m² & albumin:creatinine ratio >30 mg/g Stage 2, eGFR 60-89 ml/min/1.73 m² & albumin:creatinine ratio >30 mg/g Stages 3-5, eGFR <60 ml/min/1.73 m²
Glomerular filtration rate	Calculated by MDRD-4 Study equation
Proteinuria	Spot urine albumin:creatinine ratio
Primary Data Source Indicator	Percentage of participants with self-reported sleep problems
Primary Indicator Method of Measurement	Questionnaire
Frequency of Measurement (Primary)	Once
U.S. Region Covered by Primary Variable	Arizona, Oklahoma, and the Dakotas
Period Currently Available	1998–1999
Pending Data	Possible continued passive follow-up only
Additional Data Items of Interest	Age, gender, diabetes, hypertension
Limitations of Indicator	Loss to follow-up may be differential by sleep quality
Analytical Considerations	Analysis performed by SHS investigators; denominators for each study exam and indicator must be defined properly

References and Sources:

Quan SF, Howard BV, Iber C, et al. The Sleep Heart Health Study: design, rationale, and methods. Sleep. 1997;20(12):1077-85.
http://www.ncbi.nlm.nih.gov/pubmed/9493915

Suggested Citation:

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd