SpringerLink
Log in

Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.

Aims

The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.

Methods

This cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m2 and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).

Results

The mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38–4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B12, and folate (p > 0.05).

Conclusions

EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Kurella M, Luan J, Lash JP et al (2005) Self-assessed sleep quality in chronic kidney disease. Int Urol Nephrol 37:159–165. https://doi.org/10.1007/s11255-004-4654-z

    Article  PubMed  Google Scholar 

  2. Turek NF, Ricardo AC, Lash JP (2012) Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis 60:823–833. https://doi.org/10.1053/j.ajkd.2012.04.027

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zhang J, Wang C, Gong W et al (2017) Poor sleep quality is responsible for the nondipper pattern in hypertensive but not in normotensive chronic kidney disease patients. Nephrology (Carlton) 22:690–698. https://doi.org/10.1111/nep.12839

    Article  CAS  Google Scholar 

  4. Maugeri A, Medina-Inojosa JR, Kunzova S et al (2018) Sleep duration and excessive daytime sleepiness are associated with obesity independent of diet and physical activity. Nutrients. https://doi.org/10.3390/nu10091219

    Article  PubMed  PubMed Central  Google Scholar 

  5. Li J, Huang Z, Hou J et al (2017) Sleep and CKD in Chinese adults: a cross-sectional study. Clin J Am Soc Nephrol 12:885–892. https://doi.org/10.2215/CJN.09270816

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yamamoto R, Shinzawa M, Isaka Y et al (2018) Sleep quality and sleep duration with CKD are associated with progression to ESKD. Clin J Am Soc Nephrol 13:1825–1832. https://doi.org/10.2215/CJN.01340118

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jhamb M, Ran X, Abdalla H et al (2020) Association of sleep apnea with mortality in patients with advanced kidney disease. Clin J Am Soc Nephrol 15:182–190. https://doi.org/10.2215/CJN.07880719

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sateia MJ (2014) International classification of sleep disorders-third edition: highlights and modifications. Chest 146:1387–1394. https://doi.org/10.1378/chest.14-0970

    Article  PubMed  Google Scholar 

  9. Ford ES, Cunningham TJ, Giles WH et al (2015) Trends in insomnia and excessive daytime sleepiness among US adults from 2002 to 2012. Sleep Med 16:372–378. https://doi.org/10.1016/j.sleep.2014.12.008

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hayley AC, Williams LJ, Kennedy GA et al (2014) Prevalence of excessive daytime sleepiness in a sample of the Australian adult population. Sleep Med 15:348–354. https://doi.org/10.1016/j.sleep.2013.11.783

    Article  PubMed  Google Scholar 

  11. Hayley AC, Williams LJ, Kennedy GA et al (2015) Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample. BMC Geriatr 15:74. https://doi.org/10.1186/s12877-015-0068-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Soysal P, Smith L, Tan SG et al (2021) Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia. Exp Gerontol 150:111364. https://doi.org/10.1016/j.exger.2021.111364

    Article  PubMed  Google Scholar 

  13. Hayley AC, Williams LJ, Kennedy GA et al (2014) Excessive daytime sleepiness and body composition: a population-based study of adults. PLoS ONE 9:e112238. https://doi.org/10.1371/journal.pone.0112238

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Hayley AC, Williams LJ, Kennedy GA et al (2015) Excessive daytime sleepiness and metabolic syndrome: a cross-sectional study. Metabolism 64:244–252. https://doi.org/10.1016/j.metabol.2014.09.011

    Article  CAS  PubMed  Google Scholar 

  15. Hayley AC, Williams LJ, Berk M et al (2013) The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women. Aust N Z J Psychiatry 47:772–778. https://doi.org/10.1177/0004867413490036

    Article  PubMed  Google Scholar 

  16. Cao X, Gu Y, Fu J et al (2019) Excessive daytime sleepiness with snoring or witnessed apnea is associated with handgrip strength: a population-based study. QJM 112:847–853. https://doi.org/10.1093/qjmed/hcz178

    Article  CAS  PubMed  Google Scholar 

  17. Newman AB, Spiekerman CF, Enright P et al (2000) Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The cardiovascular health study research group. J Am Geriatr Soc 48:115–123. https://doi.org/10.1111/j.1532-5415.2000.tb03901.x

    Article  CAS  PubMed  Google Scholar 

  18. Roumelioti ME, Buysse DJ, Sanders MH et al (2011) Sleep-disordered breathing and excessive daytime sleepiness in chronic kidney disease and hemodialysis. Clin J Am Soc Nephrol 6:986–994. https://doi.org/10.2215/CJN.05720710

    Article  PubMed  PubMed Central  Google Scholar 

  19. Benz RL, Pressman MR, Hovick ET et al (1999) A preliminary study of the effects of correction of anemia with recombinant human erythropoietin therapy on sleep, sleep disorders, and daytime sleepiness in hemodialysis patients (The SLEEPO study). Am J Kidney Dis 34:1089–1095. https://doi.org/10.1016/S0272-6386(99)70015-6

    Article  CAS  PubMed  Google Scholar 

  20. Agarwal R, Light RP (2011) Sleep and activity in chronic kidney disease: a longitudinal study. Clin J Am Soc Nephrol 6:1258–1265. https://doi.org/10.2215/CJN.10581110

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hanly PJ, Pierratos A (2001) Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 344:102–107. https://doi.org/10.1056/NEJM200101113440204

    Article  CAS  PubMed  Google Scholar 

  22. Lavoie MR, Patel JA, Camacho M (2019) Nocturnal dialysis improves sleep apnea more than daytime dialysis: a meta-analysis of crossover studies. Sleep Med 64:37–42. https://doi.org/10.1016/j.sleep.2019.06.005

    Article  PubMed  Google Scholar 

  23. Khawaja I, Yingling K, Bukamur H et al (2019) Vitamin B12 deficiency: a rare cause of excessive daytime sleepiness. J Clin Sleep Med 15:1365–1367. https://doi.org/10.5664/jcsm.7936

    Article  PubMed  PubMed Central  Google Scholar 

  24. McCarty DE, Reddy A, Keigley Q et al (2012) Vitamin D, race, and excessive daytime sleepiness. J Clin Sleep Med 8:693–697. https://doi.org/10.5664/jcsm.2266

    Article  PubMed  PubMed Central  Google Scholar 

  25. Melaku YA, Reynolds AC, Gill TK et al (2019) Association between macronutrient intake and excessive daytime sleepiness: an iso-caloric substitution analysis from the north west Adelaide Health Study. Nutrients. https://doi.org/10.3390/nu11102374

    Article  PubMed  PubMed Central  Google Scholar 

  26. Reid M, Maras JE, Shea S et al (2019) Association between diet quality and sleep apnea in the Multi-Ethnic Study of atherosclerosis. Sleep. https://doi.org/10.1093/sleep/zsy194

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang M, Zhou T, Li X et al (2020) Baseline vitamin D status, sleep patterns, and the risk of incident type 2 diabetes in data from the UK Biobank Study. Diabetes Care 43:2776–2784. https://doi.org/10.2337/dc20-1109

    Article  PubMed  PubMed Central  Google Scholar 

  28. Stenvinkel P, Heimburger O, Lindholm B et al (2000) Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 15:953–960. https://doi.org/10.1093/ndt/15.7.953

    Article  CAS  PubMed  Google Scholar 

  29. Carrero JJ, Thomas F, Nagy K et al (2018) Global prevalence of protein-energy wasting in kidney disease: a meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism. J Ren Nutr 28:380–392. https://doi.org/10.1053/j.jrn.2018.08.006

    Article  PubMed  Google Scholar 

  30. Dashti HS, Scheer FA, Jacques PF et al (2015) Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Adv Nutr 6:648–659. https://doi.org/10.3945/an.115.008623

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Grandner MA, Jackson N, Gerstner JR et al (2013) Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample. Appetite 64:71–80. https://doi.org/10.1016/j.appet.2013.01.004

    Article  PubMed  PubMed Central  Google Scholar 

  32. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006

    Article  PubMed  PubMed Central  Google Scholar 

  33. Levey AS, de Jong PE, Coresh J et al (2011) The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int 80:17–28. https://doi.org/10.1038/ki.2010.483

    Article  Google Scholar 

  34. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  CAS  PubMed  Google Scholar 

  35. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington, VA

    Book  Google Scholar 

  36. Dutoglu E, Soysal P, Smith L et al (2019) Nocturia and its clinical implications in older women. Arch Gerontol Geriatr 85:103917. https://doi.org/10.1016/j.archger.2019.103917

    Article  CAS  PubMed  Google Scholar 

  37. Durmaz B, Soysal P, Ellidokuz H et al (2018) Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. North Clin Istanb 5:216–220. https://doi.org/10.14744/nci.2017.85047

    Article  PubMed  PubMed Central  Google Scholar 

  38. Morin CM, Belleville G, Belanger L et al (2011) The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34:601–608. https://doi.org/10.1093/sleep/34.5.601

    Article  PubMed  PubMed Central  Google Scholar 

  39. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545. https://doi.org/10.1093/sleep/14.6.540

    Article  CAS  PubMed  Google Scholar 

  40. Plantinga L, Lee K, Inker LA et al (2011) Association of sleep-related problems with CKD in the United States, 2005–2008. Am J Kidney Dis 58:554–564. https://doi.org/10.1053/j.ajkd.2011.05.024

    Article  PubMed  Google Scholar 

  41. Izci B, Ardic S, Firat H et al (2008) Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 12:161–168. https://doi.org/10.1007/s11325-007-0145-7

    Article  PubMed  Google Scholar 

  42. Kasanuki K, Ferman TJ, Murray ME et al (2018) Daytime sleepiness in dementia with Lewy bodies is associated with neuronal depletion of the nucleus basalis of Meynert. Parkinsonism Relat Disord 50:99–103. https://doi.org/10.1016/j.parkreldis.2018.02.003

    Article  PubMed  PubMed Central  Google Scholar 

  43. Guigoz Y (2006) The mini nutritional assessment (MNA) review of the literature—what does it tell us? J Nutr Health Aging 10:466–485

    CAS  PubMed  Google Scholar 

  44. Kiesswetter E, Pohlhausen S, Uhlig K et al (2014) Prognostic differences of the mini nutritional assessment short form and long form in relation to 1 year functional decline and mortality in community-dwelling older adults receiving home care. J Am Geriatr Soc 62:512–517. https://doi.org/10.1111/jgs.12683

    Article  PubMed  Google Scholar 

  45. Holvoet E, Vanden Wyngaert K, Van Craenenbroeck AH et al (2020) The screening score of mini nutritional assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis. PLoS ONE 15:e0229722. https://doi.org/10.1371/journal.pone.0229722

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Soysal P, Smith L, Capar E et al (2019) Vitamin B12 and folate deficiencies are not associated with nutritional or weight status in older adults. Exp Gerontol 116:1–6. https://doi.org/10.1016/j.exger.2018.12.007

    Article  CAS  PubMed  Google Scholar 

  47. Grandner MA, Jackson N, Gerstner JR et al (2014) Sleep symptoms associated with intake of specific dietary nutrients. J Sleep Res 23:22–34. https://doi.org/10.1111/jsr.12084

    Article  PubMed  Google Scholar 

  48. Mong JA, Cusmano DM (2016) Sex differences in sleep: impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci 371:20150110. https://doi.org/10.1098/rstb.2015.0110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Cao Y, Taylor AW, Zhen S et al (2017) Soy isoflavone intake and sleep parameters over 5 years among Chinese adults: longitudinal analysis from the Jiangsu Nutrition study. J Acad Nutr Diet 117:536–544. https://doi.org/10.1016/j.jand.2016.10.016

    Article  PubMed  Google Scholar 

  50. Wennberg AMV, Wu MN, Rosenberg PB et al (2017) Sleep disturbance, cognitive decline, and dementia: a review. Semin Neurol 37:395–406. https://doi.org/10.1055/s-0037-1604351

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ohayon MM, Vecchierini MF (2002) Daytime sleepiness and cognitive impairment in the elderly population. Arch Intern Med 162:201–208. https://doi.org/10.1001/archinte.162.2.201

    Article  PubMed  Google Scholar 

  52. Rongve A, Boeve BF, Aarsland D (2010) Frequency and correlates of caregiver-reported sleep disturbances in a sample of persons with early dementia. J Am Geriatr Soc 58:480–486. https://doi.org/10.1111/j.1532-5415.2010.02733.x

    Article  PubMed  Google Scholar 

  53. Lo JC, Groeger JA, Cheng GH et al (2016) Self-reported sleep duration and cognitive performance in older adults: a systematic review and meta-analysis. Sleep Med 17:87–98. https://doi.org/10.1016/j.sleep.2015.08.021

    Article  PubMed  Google Scholar 

  54. Lande RG, Gragnani C (2015) Relationships between polypharmacy and the sleep cycle among active-duty service members. J Am Osteopath Assoc 115:370–375. https://doi.org/10.7556/jaoa.2015.077

    Article  PubMed  Google Scholar 

  55. Sacomori C, Cardoso FL, Louzada FM et al (2014) Excessive daytime sleepiness and nocturia in women. Sleep Med 15:677–680. https://doi.org/10.1016/j.sleep.2014.01.017

    Article  PubMed  Google Scholar 

  56. Calvin AD, Carter RE, Adachi T et al (2013) Effects of experimental sleep restriction on caloric intake and activity energy expenditure. Chest 144:79–86. https://doi.org/10.1378/chest.12-2829

    Article  PubMed  PubMed Central  Google Scholar 

  57. Markwald RR, Melanson EL, Smith MR et al (2013) Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proc Natl Acad Sci USA 110:5695–5700. https://doi.org/10.1073/pnas.1216951110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. St-Onge MP, Roberts AL, Chen J et al (2011) Short sleep duration increases energy intakes but does not change energy expenditure in normal-weight individuals. Am J Clin Nutr 94:410–416. https://doi.org/10.3945/ajcn.111.013904

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Peuhkuri K, Sihvola N, Korpela R (2012) Diet promotes sleep duration and quality. Nutr Res 32:309–319. https://doi.org/10.1016/j.nutres.2012.03.009

    Article  CAS  PubMed  Google Scholar 

  60. Cao Y, Zhen S, Taylor AW et al (2018) Magnesium intake and sleep disorder symptoms: findings from the Jiangsu nutrition study of Chinese adults at five-year follow-up. Nutrients. https://doi.org/10.3390/nu10101354

    Article  PubMed  PubMed Central  Google Scholar 

  61. Sforza E, Pichot V, Martin MS et al (2015) Prevalence and determinants of subjective sleepiness in healthy elderly with unrecognized obstructive sleep apnea. Sleep Med 16:981–986. https://doi.org/10.1016/j.sleep.2015.03.010

    Article  PubMed  Google Scholar 

  62. Onen F, Moreau T, Gooneratne NS et al (2013) Limits of the Epworth Sleepiness Scale in older adults. Sleep Breath 17:343–350. https://doi.org/10.1007/s11325-012-0700-8

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study is a part of a study approved by the Erciyes University Ethics Committee (2018/297).

Funding

None.

Author information

Authors and Affiliations

  1. Division of Nephrology, Başkent University Faculty of Medicine, İzmir Zübeyde Hanım Application and Research Centre, İzmir, Turkey

    Cihan Heybeli, Mehmet Asi Oktan & Ali Çelik

  2. Division of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    Pinar Soysal

  3. The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  4. Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    Rumeyza Kazancioglu

Authors
  1. Cihan Heybeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pinar Soysal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Asi Oktan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lee Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Çelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rumeyza Kazancioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: CH, MAO, PS. Data curation: PS. Formal analysis: CH, MAO, AÇ. Investigation: CH, PS, MAO, RK, LS. Methodology: CH, MAO, PS. Project administration: PS, RK. Resources: PS, RK. Software: CH. Supervision: RK, PS, AÇ. Validation: all authors. Visualization: all authors. Roles/writing: CH—original draft. Writing—review and editing: MAO, PS, LS, AÇ, RK.

Corresponding author

Correspondence to Cihan Heybeli.

Ethics declarations

Conflict of interest

None to declare.

Ethical approval

The study was approved by the local ethics committee.

Human and rights statement

The study protocols in both data collections were performed in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments.

Consent to participate

All participants provided written informed consent before the study was initiated.

Consent for publication

All participants provided written informed consent for the publication of their data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Heybeli, C., Soysal, P., Oktan, M.A. et al. Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease. Aging Clin Exp Res 34, 573–581 (2022). https://doi.org/10.1007/s40520-021-01966-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-021-01966-0

Keywords

Search

Navigation