Sleep-Related Disorders in Patients with CKD and Kidney Transplant Recipients

Sleep disorders such as insomnia, restless legs syndrome (RLS), and sleep apnea (SA) are common in patients with CKD. These conditions tend to become more prevalent and more severe as kidney function deteriorates and when a patient reaches ESKD. The prevalence of insomnia in the general population ranges from 4% to 29% compared with ( 1 ) 30%-67%, ( 2 ) 39%-54%, ( 3 ) 41%-79%, and ( 4 ) 9%-49% in patients with CKD, on hemodialysis, on peritoneal dialysis (PD), or in kidney transplant recipients (KTRs), respectively. RLS occurs in approximately 1%-15% of the general population compared with ( 1 ) 5%-18%, ( 2 ) 24%-33%, ( 3 ) 23%-64%, and ( 4 ) 6%-8% in patients with CKD, on hemodialysis, on PD, or in KTRs, respectively. Obstructive SA has been reported in ( 1 ) 40%-69%, ( 2 ) 25%-47%, ( 3 ) 9%-52%, and ( 4 ) 25%-30% in patients with CKD, on hemodialysis, on PD, or in KTRs, respectively. Fatigue is a complex symptom that has been reported in patients with CKD, ESKD, and in KTRs and can be associated with sleep disorders. Fatigue and sleep disorders have been associated with negative outcomes such as progression of CKD, increased risk of morbidity, mortality, and lower health-related quality of life. In this review, we highlight nonpharmacologic and pharmacologic options for treatment of these sleep disorders. Specifically, the diagnosis and evaluation, epidemiology, risk factors and associations, outcomes (such as CKD progression, morbidity, and mortality), treatment, and post-transplant outcomes for sleep disorders (insomnia, RLS, and SA) and fatigue will be discussed.