||Background: Poor sleep has been linked to poor overall health and wellbeing in the general population. Sleep disturbances are very common among patients with End-Stage Kidney Disease (ESKD).
Objectives: To determine whether poor sleep as captured by Patient Reported Outcomes Measurement Information System-57 short form questionnaire (PROMIS-57) is associated with poor health-related quality of life (HRQOL) in ESKD patients.
Methods: A convenience sample of patients with ESKD was recruited from two hospital-based dialysis clinics in Toronto, Canada. Sleep disturbance (exposure) was assessed using Sleep Disturbance domain of PROMIS-57 profile. Sleep disturbance scores were converted to T-scores with a mean of 50 and a standard deviation of 10, with higher scores indicating greater sleep disturbances. The EuroQol-5 Dimension-5 Level (EQ-5D-5L) utility score (primary outcome) was used to assess HRQOL. EQ-5D-5L health states were converted to utility scores using the Canadian value set. Higher EQ-5D-5L utility scores indicated better HRQOL. Multiple imputation was used to handle missing data and Box Cox analysis was employed to determine an appropriate transformation to achieve normally distributed EQ-5D-5L utility scores.
Results: Of 276 patients enrolled (mean [?SD] age = 55 [?18] years, 57% male), 34% were on dialysis and 63% were kidney transplant recipients. The mean [?SD] T-score for sleep disturbance was 49 [?11] and the median EQ-5D-5L utility score before applying the transformation was 0.87 (IQR = 0.21). The Spearman?s rank order correlation revealed a moderate negative association between sleep disturbance and EQ-5D-5L utility score (r = -0.41, p < 0.001). The association remained significant after adjusting for age, gender, ethnicity, marital status, education, income, diabetes, comorbidities, and modality of renal replacement therapy, in a multivariable adjusted linear regression (B = -0.0096, 95%CI = -0.0121 to -0.0071, p < 0.001).
Conclusions: Sleep disturbance is associated with poor HRQOL in patients with ESKD. PROMIS-57 Sleep Disturbance provides a simple and quick way to screen for sleep disturbances. Further research is required to determine whether interventions for sleep problems would improve HRQOL in ESKD patients.