Dreams disrupted: a comprehensive review of sleep disorders in chronic kidney disease

Sleep disorders are common in chronic kidney disease (CKD), significantly affecting quality of life, morbidity, and prognosis.This review examines the classification, prevalence, pathophysiology, diagnosis, and management of insomnia, sleep-disordered breathing including obstructive and central sleep apnea (OSA/CSA), restless legs syndrome (RLS), and excessive daytime sleepiness (EDS) in CKD.Up to 80% of dialysis patients experience sleep disturbances, often underdiagnosed due to overlapping CKD symptoms like fatigue and cognitive dysfunction.Their pathophysiology involves uremic toxin accumulation, fluid overload, electrolyte imbalances, hormonal dysregulation, and chronic inflammation, all contributing to poor sleep.Diagnosis relies on validated tools such as the Pittsburgh Sleep Quality Index, Insomnia Severity Index, STOP-BANG Questionnaire, and Cambridge-Hopkins Restless Legs Syndrome Diagnostic Questionnaire, alongside objective assessments like polysomnography, home sleep apnea testing, and actigraphy.Management requires a multidisciplinary approach.Insomnia is treated with cognitive-behavioral therapy for insomnia, melatonin, and shortterm medications.RLS benefits from dopaminergic agents and iron supplementation, while OSA/CSA respond to positive airway pressure (PAP) therapy and nocturnal hemodialysis.Light therapy and intradialytic exercise show promise for EDS.Early recognition and comprehensive management of sleep disorders in CKD are crucial for improving outcomes, reducing cardiovascular risks, and enhancing well-being.Future research should focus on tailored interventions that integrate sleep medicine with nephrology to address this often overlooked aspect of CKD care.