A Guide to Management of Sleepiness in ESKD

Am J Kidney Dis. 2020 May;75(5):782-792. doi: 10.1053/j.ajkd.2019.09.010. Epub 2020 Jan 23.

Abstract

Daytime sleepiness, also known as hypersomnolence, is common among patients receiving maintenance dialysis and following successful kidney transplantation. Sleepiness may be secondary to medical comorbid conditions, medication side effect, insufficient sleep syndrome, and sleep-disordered breathing or the result of a primary central disorder of hypersomnolence, such as narcolepsy. Unrecognized and untreated sleep disorders are associated with substantial morbidity and mortality among patients with end-stage kidney disease. Effective management of hypersomnolence can improve quality of life in patients with kidney disease. This review focuses on the principal causes of sleepiness in patients with end-stage kidney disease. Awareness of these disorders by treating nephrologists is crucial. This review provides a systematic approach to guide providers through the recognition, early diagnosis, and treatment of hypersomnolence, which is commonly encountered in this patient population. Areas of future research are also suggested.

Keywords: Hypersomnolence; circadian rhythm sleep disorders; dialysis; end-stage kidney disease (ESKD); fatigue; hypersomnia; insomnia; insufficient sleep syndrome; kidney transplant; narcolepsy; obstructive sleep apnea (OSA); review; sleep deprivation; sleep disorder; sleep hygiene; sleepiness.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Appointments and Schedules
  • Diet
  • Disease Management
  • Disorders of Excessive Somnolence / etiology
  • Disorders of Excessive Somnolence / therapy*
  • Early Diagnosis
  • Fatigue / etiology
  • Fatigue / therapy
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation
  • Life Style
  • Middle Aged
  • Postoperative Complications / etiology
  • Postoperative Complications / therapy
  • Quality of Life
  • Renal Dialysis / adverse effects
  • Severity of Illness Index
  • Sleep Deprivation
  • Sleep Hygiene
  • Sleep Wake Disorders / chemically induced
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / therapy

Substances

  • Hypnotics and Sedatives