Correlation between chronic kidney disease with sleep disorder and the incidence of anxiety and depression in Inner Mongolia region: a multicenter study

Objective To explore the correlation between anxiety and depression in patients with chronic kidney disease （CKD） and sleep disorders, providing better rationales and therapeutic targets for preventing and managing anxiety and depression. Methods A total of 653 CKD patients were selected from multiple hospitals in Inner Mongolia and evaluated by self-rating anxiety scale （SAS）, self-rating depression scale （SDS）, Hamilton anxiety scale （HAMA）, Hamilton depression scale（HAMD） and Pittsburgh sleep quality index（PSQI）. General profiles and accompanying symptoms were collected, and statistical analysis was conducted with SPSS and Graphpad prism software. Results A multicenter study in Inner Mongolia indicated that the incidence of anxiety in CKD patients was 6.4%, including mild anxiety（4.4%）, moderate anxiety （1.7%） and severe anxiety（0.3%）. The incidence of depression was 13.5%, including mild depression（9.2%）, moderate depression（3.4%） and severe depression（0.9%）. The incidence rate of anxiety/depression was 5.2%. The incidence rate of CKD patients with sleep disorders was 25.7%. And 79.3% of patients with sleep disorders showed poor sleep quality. Sleep time affected SAS/SDS scores in CKD patients and total PSQI score of sleep quality was correlated linearly with HAMA/HAMD. Sleep time ＜5 h was an independent risk factor for anxiety, depression and anxiety plus depression in CKD patients. The incidence of anxiety in patients with sleep time ＜5 h was 5.118 folds higher than that in those with sleep time ＞7 h. The incidence of depression was 6.76 folds higher and the incidence of anxiety plus depression was 4.244 folds higher. The incidence of depression in CKD patients sleeping for 5-7 h was 4.426 folds higher than that in those sleeping for over 7 h. CKD patients aged over 60 years were more prone to sleep disorders than those aged under 60 years（P＜0.05） and females were more prone to sleep disorders than males（P＜0.05）. Therefore female patients aged over 60 years were more prone to sleep disorders and anxiety/depression. CKD patients with such accompanying symptoms as fatigue, pain and itching were more prone to sleep disorders（P＜0.05）. The incidence rate of anxiety was higher in non-terminal stage than that in terminal stage（9.2% vs 5.9%）. The incidence rate of depression in end-stage（14.3%） was higher than that in non-end-stage（9.2%）. The incidence rate of anxiety/depression was higher in non terminal stage than that in terminal stage（7.3% vs 4.8%）（P＜0.05）. Conclusion Sleep disorders may seriously affect mental health of patients. Insufficient sleep time and lower quality are correlated with an onset of anxiety/depression. Strengthening sleep management may facilitate the prevention and management of anxiety/depression in CKD patients.