The Effect of Sleep Disorder Diagnosis on Mortality in End-Stage Renal Disease Patients

Featured Application: This retrospective evaluation of the association of sleep disorder diagnosis and mortality in end-stage renal disease (ESRD) patients emphasizes the importance of the diagnosis and treatment of sleep disorders in this population. Increased risk of all-cause mortality not accounted for by traditional cardiovascular risk factors has been linked to chronic kidney disease. This study tested the hypothesis that mortality may be greater in patients with end-stage renal disease (ESRD) and a sleep disorder diagnosis. The United States Renal Data System database was queried to determine the effect of sleep disorder diagnoses on mortality in ESRD patients enrolled between 2004 and 2015. Sleep disorders were identified using International Classification of Diseases-9 and -10 codes. Mortality risk associated with sleep disorders was examined using Cox proportional hazards (CPH) modeling. In the final CPH model, sleep disorder diagnoses were associated with decreased risk of mortality, with hazard ratios (and 95% confidence intervals) for insomnia, hypersomnolence, restless leg syndrome, and obstructive/central sleep apnea of 0.76 (0.75–0.76), 0.81 (0.78–0.84), 0.79 (0.77–0.80), and 0.82 (0.81–0.82), respectively. Black or other race and Hispanic ethnicity, and to a small extent, female sex and increasing Charlson comorbidity index, were also associated with decreased risk, whereas increasing age, hemodialysis (versus peritoneal dialysis) and catheter or graft access type were associated with increased risk. This study suggests that the diagnosis of a sleep disorder may be associated with improved survival in ESRD patients.