Screening for sleep disorders in patients with advanced chronic kidney disease or end-stage kidney disease
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INTRODUCTION: Sleep disorders are common in patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Polysomnography (PSG) is the gold standard diagnostic tool but is not easily available in all jurisdictions. We aimed to evaluate various questionnaires and wrist actigraphy as screening tools for sleep disorders in the context of ESKD, by comparing results to unattended home PSG results. MATERIALS AND METHODS: Consecutive patients with advanced CKD or ESKD were recruited and assessed using a combination of self-reported instruments (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, International Restless Legs Questionnaire, Short Form 36), wrist actigraphy, and unattended home PSG. The utility of the questionnaires was summarized. Agreement between acti-graphy and PSG scores was assessed. RESULTS: There was a high prevalence of self-reported sleep disturbance among the 54 participants. The questionnaires had low positive and negative predictive values for their corresponding PSG-measured variables. There were no significant differences between paired PSG and actigraphy summary results for sleep efficiency and time spent awake after sleep onset (n = 27 paired comparisons). CONCLUSION: Commonly used screening questionnaires do not accurately predict sleep disorders in the context of advanced CKD or ESKD. Wrist actigraphy accurately identifies those with low sleep efficiency and long time spent awake after sleep onset, who are likely to have the highest diagnostic yield with PSG. Neither approach obviates the need for PSG for accurate diagnosis of sleep disorders in this population.