Youlu Zhao1,2,3,4, Yuhui Zhang1,2,3,4, Zhikai Yang1,2,3,4, Jinwei Wang1,2,3,4, Zuying Xiong5, Jinlan Liao5, Li Hao6, Guiling Liu6, Yeping Ren7, Qin Wang7, Liping Duan8, Zhaoxia Zheng8, Jie Dong9,10,11,12. 1. Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China. 2. Institute of Nephrology, Peking University, Beijing, China. 3. Key Laboratory of Renal Disease, Ministry of Health, Beijing, China. 4. Key Laboratory of Renal Disease, Ministry of Education, Beijing, China. 5. Renal Division, Peking University Shenzhen Hospital, Shenzhen, China. 6. Renal Division, the Second Hospital of Anhui Medical University, Anhui, China. 7. Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China. 8. Renal Division, Handan Central Hospital, Hebei, China. 9. Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China, jie.dong@bjmu.edu.cn. 10. Institute of Nephrology, Peking University, Beijing, China, jie.dong@bjmu.edu.cn. 11. Key Laboratory of Renal Disease, Ministry of Health, Beijing, China, jie.dong@bjmu.edu.cn. 12. Key Laboratory of Renal Disease, Ministry of Education, Beijing, China, jie.dong@bjmu.edu.cn.
Abstract
BACKGROUND: Patients with chronic kidney disease experience a high burden of sleep disorders, and there are associations between sleep disorders and cognitive impairment. OBJECTIVES: Based on our previous cross-sectional survey on cognitive impairment in peritoneal dialysis, we further explored the relationship between sleep disorders and cognitive impairment, and predictors for declining cognitive function. METHOD: We conducted a multicenter prospective cohort study enrolling 458 clinically stable patients on peritoneal dialysis who were then followed up for 2 years.Demographic data, comorbidities, depression, and biochemistry data were collected at baseline. Sleep disorders including insomnia, restless legs syndrome, sleep apnea syndrome, excessive daytime sleepiness, possible narcolepsy, sleep walking and nightmares, and possible rapid eye movement behavior disorders were assessed using a panel of specific sleep questionnaires at baseline and in a second survey. Global cognitive function was measured at baseline and in a second survey, using the Modified Mini-Mental State Examination. Specific cognitive domains were evaluated using Trail-Making Test Forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status were used to asses immediate and delayed memory, visuospatial skills, and language ability. RESULTS: Sleep disorders were common among peritoneal dialysis patients. The prevalence of cognitive impairment evaluated by the Modified Mini-Mental State Examination (3MS) increased from 19.8 to 23.9%. Possible narcolepsy was associated with decreased Modified Mini-Mental State Examination scores at baseline. During follow-up, sleepwalking and nightmares were associated with higher risks of declined delayed memory in the longitudinal study. CONCLUSIONS: Possible narcolepsy was associated with general cognitive dysfunction, and sleep walking and nightmares were risk factors for impaired delayed memory.
BACKGROUND:Patients with chronic kidney disease experience a high burden of sleep disorders, and there are associations between sleep disorders and cognitive impairment. OBJECTIVES: Based on our previous cross-sectional survey on cognitive impairment in peritoneal dialysis, we further explored the relationship between sleep disorders and cognitive impairment, and predictors for declining cognitive function. METHOD: We conducted a multicenter prospective cohort study enrolling 458 clinically stable patients on peritoneal dialysis who were then followed up for 2 years.Demographic data, comorbidities, depression, and biochemistry data were collected at baseline. Sleep disorders including insomnia, restless legs syndrome, sleep apnea syndrome, excessive daytime sleepiness, possible narcolepsy, sleep walking and nightmares, and possible rapid eye movement behavior disorders were assessed using a panel of specific sleep questionnaires at baseline and in a second survey. Global cognitive function was measured at baseline and in a second survey, using the Modified Mini-Mental State Examination. Specific cognitive domains were evaluated using Trail-Making Test Forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status were used to asses immediate and delayed memory, visuospatial skills, and language ability. RESULTS:Sleep disorders were common among peritoneal dialysis patients. The prevalence of cognitive impairment evaluated by the Modified Mini-Mental State Examination (3MS) increased from 19.8 to 23.9%. Possible narcolepsy was associated with decreased Modified Mini-Mental State Examination scores at baseline. During follow-up, sleepwalking and nightmares were associated with higher risks of declined delayed memory in the longitudinal study. CONCLUSIONS: Possible narcolepsy was associated with general cognitive dysfunction, and sleep walking and nightmares were risk factors for impaired delayed memory.