In 2013-2014, sleep problems like inadequate sleep (35%), trouble sleeping (27%), sleep disorder (7%), 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 Measure||Prevalence of sleep-related problems among persons with and without CKD in the general population|
|Type of Data Source||Public|
|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 0.993age 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 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|
|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|