Association Between Sleep Disturbance and Physical Function Among Patients with Advanced CKD

Background: Sleep disturbance (SLD) and impaired physical function (PF) are common symptoms in patients with advanced chronic kidney disease (CKD) and are associated with lower health-related quality of life. The relationship between these symptoms remains poorly understood. Methods: Cross-sectional analysis of a convenience sample of adult patients with advanced CKD on kidney replacement therapy (KRT). SLD and PF were assessed using Patient-Reported Outcome Measurement Information System (PROMIS) item banks. Spearman’s rank correlation analysis evaluated the association between SLD (PROMIS T-score ≥ 60) and impaired PF (PROMIS T-score < 40). Univariable and multivariable regression models further assessed this relationship, adjusting for sociodemographic (age, sex, racialized status, immigrant status, material deprivation) and clinical (hemoglobin, albumin, comorbidity, KRT modality) covariates, as well as symptoms (depression, pain interference, fatigue). Multiple imputation by chained equations accounted for missing data. Results: Among 683 participants, mean(SD) age was 59(21) years; 60% were male, 46% white, 58% kidney transplant recipients (KTRs). The mean(SD) SLD T-score was 50(11); 17% reported SLD. The mean(SD) PF T-score was 43(11); 44% reported impaired PF. SLD and PF were negatively correlated, ρ = -0.29, p < .001. This association remained significant after adjusting for sociodemographic and clinical covariates, and even when adjusting for any of depression, pain interference, or fatigue, but not when all three symptoms were included. Participants with SLD had over three times the odds of reporting impaired PF (odds ratio [OR] = 3.05, 95% CI [2.01, 4.66], p < .001). This association remained significant after adjusting for sociodemographic and clinical factors, and after further adjustment for depression or pain interference, but not for fatigue or when all three were included. Conclusion: Higher SLD is associated with lower PF in patients with advanced CKD on KRT. This relationship may be partly mediated by symptoms, particularly fatigue. Further research is needed to determine whether targeted interventions for SLD can significantly impact PF in this population. Funding: Private Foundation Support, Government Support – Non-U.S.