Prevalence and risk factors of sleep disturbance in continuous ambulatory peritoneal dialysis patients in Guangzhou, southern China

Sleep disturbance is significantly associated with overall morbidity, mortality, and quality of life in end-stage renal disease patients. Although it was reported that the prevalence of poor sleep quality was 41-83% in hemodialysis patients, sleep disturbance was not well understood in peritoneal dialysis (PD) patients, especially in Asian PD patients. The present study attempted to assess the prevalence and related risk factors of sleep disturbance among continuous ambulatory peritoneal dialysis (CAPD) patients in Guangzhou, southern China. Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality in eligible 212 CAPD patients (53.3% men), average age 49.9 +/- A 16.7 years. The average global PSQI score of the CAPD patients was 9.5 +/- A 5.2, with 171 (80.4%) poor sleepers (PSQI scores > or = 5). The PSQI score was negatively correlated with serum albumin (r = -0.21, P = 0.003) subjective global assessment (SGA) score (r = -0.27, P = 0.001) and positively correlated with age (r = 0.34, P < 0.001), high-sensitivity C-reactive protein (r = 0.20, P = 0.008), level of calcium x phosphate product (r = 0.19, P = 0.009), cardiovascular disease (r = 0.17, P = 0.019), Charlson comorbidity index score (r = 0.21, P = 0.004), malnutrition-inflammation score (MIS) (r = 0.31, P < 0.001), and duration on CAPD (r = 0.20, P = 0.005). In multiple analysis, old age, high calcium x phosphate product, low SGA score (beta = -0.23, P = 0.042), and high MIS (beta = 0.30, P = 0.007) were independent predictors of sleep disturbance in CAPD patients. We clearly demonstrated the novel relationship of malnutrition and calcium x phosphate product with poor sleep quality in CAPD patients, which may be a part of the explanation for the strong links between sleep quality and overall morbidity and mortality.