Insomnia and its influencing factors in maintenance hemodialysis patients:A multi-center,crosssectional,observational study

Objective Insomnia affects quality-of-life in patients on maintenance hemodialysis (MHD). The study was intended to explore the current status and clinical severity of insomnia and examine the related risk factors in MHD patients. Methods For this multi-center,cross-sectional,observational study,555 MHD patients were recruited from seven dialysis centers in Pearl River Delta region from July 2020 to November 2020. They were divided into two groups according to the International Classification of Sleep Disorders:Third Edition. Four grades of normal sleep,mild insomnia,moderate insomnia and severe insomnia were differentiated according to the scores calculated by Pittsburgh Sleep Quality Index(PSQI). The responses of questionnaires were recorded along with demographic profiles, age of dialysis,comorbidities,medications and baseline data. Results The age range was(55. 37±13. 95)years and 55. 2% were males. The prevalence of insomnia was as high as 38. 49%. As compared with normal sleep group,the levels of cystatin C and pruritus VAS score were higher in insomnia group. Females,patients with restless leg syndrome,non-takers of iron supplement and those with a lower transferrin saturation were more susceptible to insomnia(P<0. 05). However,transferrin saturation was lower in insomnia group(P<0. 05). Simple linear regression analysis revealed that sleep quality index was positively correlated with age,cystatin C,pruritus score and restless leg. On the contrary,it was negatively correlated with males and iron supplementing(P<0. 05). Binary Logistic regression analysis indicated that pruritus(OR=1. 077,95%CI:1. 012-1. 146,P=0. 020),restless leg(OR=2. 403,95%CI:1. 225-4. 713,P=0. 011)and lower transferrin saturation(OR=0. 981,95%CI:0. 967-0. 996,P=0. 013) were risk factors for insomnia. Further multinomial Logistic regression analysis revealed that age(OR=1. 023,95%CI:1. 002-0. 1. 045,P=0. 035),restless leg(OR=2. 573,95%CI:1. 039-6. 370,P=0. 041) and females(OR=0. 573,95%CI:0. 334-0. 983,P=0. 043)were risk factors for worsening insomnia.Conclusion Pruritus,restless leg and lower transferrin saturation may contribute to insomnia in MHD patients. And age,restless leg and females are associated with severer insomnia.