Melody of sleep by sun: Association between serum vitamin D levels and sleep quality in ESRD patients.

Zoha Fatima; Ujala Abdul Rashid; Umara Nasim; Hafiza Amina Muattar

doi:10.32593/jstmu/Vol6.Iss1.233

Zoha Fatima Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
Ujala Abdul Rashid Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
Umara Nasim Department of Medicine, Bilal Hospital, Rawalpindi, Pakistan
Hafiza Amina Muattar Department of Community Medicine, Akhter Saeed Hospital, Lahore, Pakistan

DOI: https://doi.org/10.32593/jstmu/Vol6.Iss1.233

Keywords: ESRD, Hemodialysis, PSQI Score, Vitamin D

Abstract

Background: Hemodialysis (HD) is a commonly employed treatment modality for chronic kidney disease (CKD) patients. It is also closely related to the sleep-wake cycle. It has both sleep-improving and deteriorating results. Sleep regulation is tightly coupled to vitamin D; hence, its deficiency might impact the duration and quality of sleep. This study intends to evaluate the association between sleep quality and serum vitamin D levels in HD patients.

Objective: To assess the quality of sleep in patients with ESRD on routine HD and determine the association of vitamin D deficiency with sleep quality.

Methodology: This cross-sectional analytical study was conducted on the patients presenting to the dialyzing centre of the Department of Nephrology, Holy Family Hospital, Rawalpindi, Pakistan, for twice-weekly routine hemodialysis, from May 2022 to June 2022.

Results: In this study, the quality of sleep in End Stage Renal Disease (ESRD) patients on twice-weekly hemodialysis (HD) was assessed using the PSQI score. PSQI scores were associated with serum vitamin D levels in these patients. A significantly strong positive correlation existed between serum levels of 25-OH D and sleep quality (r = −0.468, p = 0.001).

Conclusion: More than half of the patients undergoing routine hemodialysis could not sleep well at night. Among other related factors, vitamin D deficiency was an independent risk factor for poor sleep quality. Further studies are needed to determine the impact of vitamin D supplementation on improving sleep quality to strengthen the association between vitamin D levels and sleep disorders.

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Author Biographies

Zoha Fatima, Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan

House Officer, Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan

Ujala Abdul Rashid, Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan

Post Graduate Trainee, Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan

Umara Nasim, Department of Medicine, Bilal Hospital, Rawalpindi, Pakistan

Medical Officer, Department of Medicine, Bilal Hospital, Rawalpindi, Pakistan

Hafiza Amina Muattar, Department of Community Medicine, Akhter Saeed Hospital, Lahore, Pakistan

Post Graduate Trainee, Department of Community Medicine, Akhter Saeed Hospital, Lahore, Pakistan

References

Forni Ogna V, Ogna A, Pruijm M, Bassi I, Zuercher E, Halabi G, et al. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study. Biomed Res Int. 2015; 2015.

DOI: https://doi.org/10.1155/2015/103686.

Yang XH, Zhang BL, Gu YH, Zhan XL, Guo LL, Jin HM. Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: a meta-analysis of clinical trials. Sleep Med. 2018; 51:59-65.

DOI: https://doi.org/10.1016/J.SLEEP.2018.06.020.

Pojatić Đ, Pezerović D, Mihaljević D, Degmečić D. Factors Associated With Sleep Disorders in Patients on Chronic Hemodialysis Treatment. Southeastern Eur Medl J. 2020; 4:74-86. DOI: https://doi.org/10.26332/SEEMEDJ.V4I1.123.

Hejazian SM, Ahmadian E, Zununi Vahed S, Faraji Gogani L, Farnood F. The Association of Sleep Quality and Vitamin D Levels in Hemodialysis Patients. Biomed Res Int. 2021; 2021. DOI: https://doi.org/10.1155/2021/4612091

Natale P, Ruospo M, Saglimbene VM, Palmer SC, Strippoli GFM. Interventions for improving sleep quality in people with chronic kidney disease. Cochrane Database Syst Rev. 2019; 2019.

DOI: https://doi.org/10.1002/14651858.CD012625.PUB2.

McMullan CJ, Curhan GC, Forman JP. Association of short sleep duration and rapid decline in renal function. Kidney Int. 2016; 89:1324-30.

DOI: https://doi.org/10.1016/J.KINT.2015.12.048.

Al-Rasheed NM, Al-Rasheed NM, Bassiouni YA, Hasan IH, Al-Amin MA, Al-Ajmi HN, et al. Vitamin D attenuates pro-inflammatory TNF-α cytokine expression by inhibiting NF-кB/p65 signalling in hypertrophied rat hearts. J Physiol Biochem. 2015; 71:289-99.

DOI: https://doi.org/10.1007/S13105-015-0412-1.

González EA, Sachdeva A, Oliver DA, Martin KJ. Vitamin D Insufficiency and Deficiency in Chronic Kidney Disease. Am J Nephrol. 2004; 24:503-10.

DOI: https://doi.org/10.1159/000081023.

Nigwekar SU, Bhan I, Thadhani R. Ergocalciferol and cholecalciferol in CKD. Am J Kidney Dis. 2012; 60:139-56.

DOI: https://doi.org/10.1053/J.AJKD.2011.12.035

Muscogiuri G, Barrea L, Scannapieco M, di Somma C, Scacchi M, Aimaretti G, et al. The lullaby of the sun: the role of vitamin D in sleep disturbance. Sleep Med. 2019; 54:262-5.

DOI: https://doi.org/10.1016/J.SLEEP.2018.10.033.

Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behaviour. FASEB J. 2015; 29:2207-22.

DOI: https://doi.org/10.1096/FJ.14-268342

Patrick RP, Ames BN. Vitamin D hormone regulates serotonin synthesis. Part 1: relevance for Autism. FASEB J. 2014; 28:2398-413. DOI: https://doi.org/10.1096/FJ.13-246546.

NKF KDOQI Guidelines (accessed June 24, 2022). Available from: http://kidneyfoundation.cachefly.net /professionals/KDOQI/guidelines_pedbone/guide8.htm

Zahed NS, Namakchian M, Davoudi Z, Taherkhani A. Effect of vitamin D on sleep quality in hemodialysis patients. J Renal Inj Prev. 2020; 10:e32–e32.

DOI: https://doi.org/10.34172/JRIP.2021.32.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28:193-213.

DOI: https://doi.org/10.1016/0165-1781(89)90047-4.

Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Med Rev. 2016; 25:52-73.

DOI: https://doi.org/10.1016/J.SMRV.2015.01.009.

Anwar N, Mahmud SN. Quality of Sleep in CKD Patients on Chronic Hemodialysis and the Effect of Dialysis Shift. J Coll Physicians Surg Pak. 2018; 28:636-9.

DOI: https://doi.org/10.29271/JCPSP.2018.08.636.

Chou YT, Lee PH, Yang CT, Lin CL, Veasey S, Chuang LP, et al. Obstructive sleep apnea: a stand-alone risk factor for chronic kidney disease. Nephrol Dial Transplant. 2011; 26:2244-50. DOI: https://doi.org/10.1093/NDT/GFQ821

Petrov ME, Kim Y, Lauderdale DS, Lewis CE, Reis JP, Carnethon MR, et al. Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study. Sleep Med. 2014; 15:1140-6.

DOI: https://doi.org/10.1016/J.SLEEP.2014.05.021.

Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M. Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr. 2007; 17:381- 8.

DOI: https://doi.org/10.1053/J.JRN.2007.08.008

Merlino G, Piani A, Dolso P, Adorati M, Cancelli I, Valente M, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrology Dialysis Transplantation. 2006; 21:184-90.

DOI: https://doi.org/10.1093/ndt/gfi144.

Petrov ME, Kim Y, Lauderdale DS, Lewis CE, Reis JP, Carnethon MR, et al. Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study. Sleep Med. 2014; 15:1140-6.

DOI: https://doi.org/10.1016/J.SLEEP.2014.05.021.

Hejazian SM, Ahmadian E, Zununi Vahed S, Faraji Gogani L, Farnood F. The Association of Sleep Quality and Vitamin D Levels in Hemodialysis Patients. Biomed Res Int. 2021; 2021. DOI: https://doi.org/10.1155/2021/4612091.

Kim JH, Chang JH, Kim DY, Kang JW. Association between self-reported sleep duration and serum vitamin D level in elderly Korean adults. J Am Geriatr Soc. 2014; 62:2327-32. DOI: https://doi.org/10.1111/JGS.13148.

Gholamrezaei A, Bonakdar ZS, Mirbagher L, Hosseini N. Sleep disorders in systemic lupus erythematosus. Does vitamin D play a role? Lupus. 2014; 23:1054-8.

DOI: https://doi.org/10.1177/0961203314532563.

Schiller A, Gadalean F, Schiller O, Timar R, Bob F, Munteanu M, et al. Vitamin D Deficiency—Prognostic Marker or Mortality Risk Factor in End Stage Renal Disease Patients with Diabetes Mellitus Treated with Hemodialysis-A Prospective Multicenter Study. PLoS One. 2015; 10.

DOI: https://doi.org/10.1371/JOURNAL.PONE.0126586.

Krassilnikova M, Ostrow K, Bader A, Heeger P, Mehrotra A. Low dietary intake of vitamin D and vitamin D deficiency in hemodialysis patients. J Nephrol Ther. 2014; 4(3).

DOI:https://doi.org/10.4172/2161-0959.1000166.

Chou FF, Lee CH, Chen JB, Huang SC, Lee CT. Sleep disturbances before and after parathyroidectomy for secondary hyperparathyroidism. Surgery. 2005; 137(4):426-30.

DOI: https://doi.org/10.1016/j.surg.2004.12.010.

de Santo RM, Esposito MG, Cesare CM, Cice G, Perna A, Violetti E, et al. High Prevalence of Sleep Disorders in Hemodialyzed Patients Requiring Parathyroidectomy. J Ren Nutr. 2008; 18:52-5.

DOI: https://doi.org/10.1053/j.jrn.2007.10.011.

Dusilová-Sulková S, Šafránek R, Vávrová J, Horáček J, Pavlíková L, Palička V. Low-dose cholecalciferol supplementation and dual vitamin D therapy in haemodialysis patients. Int Urol Nephrol. 2015; 47:169-76.

DOI: https://doi.org/10.1007/s11255-014-0842-7

Delanaye P, Weekers L, Warling X, Moonen M, Smelten N, Médart L, Krzesinski JM, et al. Cholecalciferol in haemodialysis patients: a randomized, double-blind, proof-of-concept and safety study. Nephrol Dial Transplant. 2013; 28(7):1779-86.

DOI: https://doi.org/10.1093/ndt/gft001

Larsen AU, Hopstock LA, Jorde R, Grimnes G. No improvement of sleep from vitamin D supplementation: insights from a randomized controlled trial. Sleep Med. 2021; 3:100040.

DOI: https://doi.org/10.1016/J.SLEEPX.2021.100040