Sleep-Related Disorders in Patients with Chronic Kidney Disease and Kidney Transplant Recipients

Sleep disorders such as insomnia, restless legs syndrome (RLS), and sleep apnea are common in patients with chronic kidney disease (CKD). These conditions tend to become more prevalent and more severe as kidney function deteriorates and when a patient reaches end-stage kidney disease (ESKD). The prevalence of insomnia in the general population ranges from 4-29% compared to i) 30-67%, ii) 39-54%, iii) 41-79%, and iv) 9-49% in patients with CKD, on hemodialysis, on peritoneal dialysis (PD), or in kidney transplant recipients (KTRs) respectively. RLS occurs in about 1-15% of the general population compared to i) 5-18%, ii) 24-33%, iii) 23-64%, and iv) 6-8% in patients with CKD, on hemodialysis, on PD, or in KTRs respectively. Obstructive sleep apnea has been reported in i) 40-69%, ii) 25-47%, iii) 9-52%, and iv) 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 non-pharmacologic 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, sleep apnea) and fatigue will be discussed.