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Indicator Details — Native Americans: Prevalence of Sleep Problems Among American Indians With and Without CKDa
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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?”).
Description of MeasurePrevalence of sleep problems
Data SourceStrong Heart Study
Type of Data SourcePrivate
Data SetSHS
Health Care System DataNo
Regional or National?National
Demographic GroupAmerican Indians aged 45-74 from 13 tribes/communities 
NumeratorNumber of participants with reported sleep problems at exam 3
DenominatorAll participants with sleep information at exam 3
Definition of CKDNo 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 m
Glomerular filtration rateCalculated by MDRD-4 Study equation
ProteinuriaSpot urine albumin:creatinine ratio
Primary Data Source IndicatorPercentage of participants with self-reported sleep problems
Primary Indicator Method of MeasurementQuestionnaire
Frequency of Measurement (Primary)Once
U.S. Region Covered by Primary VariableArizona, Oklahoma, and the Dakotas
Period Currently Available1998–1999
Pending DataPossible continued passive follow-up only
Additional Data Items of InterestAge, gender, diabetes, hypertension
Limitations of IndicatorLoss to follow-up may be differential by sleep quality
Analytical ConsiderationsAnalysis performed by SHS investigators; denominators for each study exam and indicator must be defined properly
References and Sources:

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