TY - JOUR
T1 - Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in patients on incident hemodialysis
AU - Fitzpatrick, Jessica
AU - Kerns, Eric S.
AU - Kim, Esther D.
AU - Sozio, Stephen M.
AU - Jaar, Bernard G.
AU - Estrella, Michelle M.
AU - Tereshchenko, Larisa G.
AU - Monroy-Trujillo, Jose M.
AU - Parekh, Rulan S.
AU - Bourjeily, Ghada
N1 - Funding Information:
All authors have seen and approved the manuscript. Work for this study was performed at Johns Hopkins University, Baltimore, Maryland. The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease Study was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant R01DK072367 (principal investigator: R.S.P.) and a grant from the National Kidney Foundation of Maryland (principal investigator: S.M.S.). R.S.P. is supported by the Canada Research Chair in chronic kidney disease epidemiology. L.G.T. was supported by grant HL118277. G.B. is supported by grants HD 078515 and HL 130702. The authors report no conflicts of interest.
Publisher Copyright:
© 2021 American Academy of Sleep Medicine.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - StudyObjectives: Patients with end-stage kidney disease commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in patients on hemodialysis, but the burden of symptoms fromsleep disturbances has emerged as amarker thatmay shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary cardiovascular outcomes or mortality among adults initiating hemodialysis. Methods: In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary cardiovascular outcomes includedQTcorrection (ms), heart rate variance (ms2), left ventricularmass index (g/m2), and left ventricular hypertrophy. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression. Results: Mean age was 55 years, andmedian bodymass index was 28 kg/m2 (interquartile range, 24, 33), with 70% of patients being African Americans. Median FOSQ-10 score was 19.7 (interquartile range, 17.1, 20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (hazard ratio, 1.09; 95% confidence interval, 1.01-1.18). Lower FOSQ-10 scores were associated with longer QTcorrection duration and lower heart rate variance but not left ventricular mass index or left ventricular mass index. Conclusions: In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in patients with end-stage kidney disease to identify individuals at increased risk for cardiovascular complications and death.
AB - StudyObjectives: Patients with end-stage kidney disease commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in patients on hemodialysis, but the burden of symptoms fromsleep disturbances has emerged as amarker thatmay shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary cardiovascular outcomes or mortality among adults initiating hemodialysis. Methods: In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary cardiovascular outcomes includedQTcorrection (ms), heart rate variance (ms2), left ventricularmass index (g/m2), and left ventricular hypertrophy. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression. Results: Mean age was 55 years, andmedian bodymass index was 28 kg/m2 (interquartile range, 24, 33), with 70% of patients being African Americans. Median FOSQ-10 score was 19.7 (interquartile range, 17.1, 20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (hazard ratio, 1.09; 95% confidence interval, 1.01-1.18). Lower FOSQ-10 scores were associated with longer QTcorrection duration and lower heart rate variance but not left ventricular mass index or left ventricular mass index. Conclusions: In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in patients with end-stage kidney disease to identify individuals at increased risk for cardiovascular complications and death.
KW - Cardiovascular risk
KW - End-stage kidney disease
KW - FOSQ
KW - Mortality
KW - Obstructive sleep apnea
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U2 - 10.5664/jcsm.9304
DO - 10.5664/jcsm.9304
M3 - Article
C2 - 33779539
AN - SCOPUS:85111721744
SN - 1550-9389
VL - 17
SP - 1707
EP - 1715
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 8
ER -