REVIEW Sleep disturbance and sleep-disordered breathing in hemodialysis patients Ginger Chu 1,2 | Peter Choi 1 | Vanessa M. McDonald 2,3,4 1 Nephrology Department, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, NSW, Australia 2 School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia 3 Priority Research Centre for Healthy Lung, School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia 4 Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter New England Local Health District, NSW, Australia Correspondence Ginger Chu RN MN PhD(c), Nephrology Department, 1a Dudley Rd, Charlestown, NSW, Australia. Email: ginger.chu@hnehealth.nsw.gov.au Abstract Sleep disturbance is one of the most common dialysis-related symptoms reported by hemodialysis patients. Poor sleep confers significant physical and psychological burden on patients with kidney disease and is associated with reduced quality of life and survival. More recent evidence also indicates that sleep-disordered breathing may be a risk factor for kidney injury. 1 | INTRODUCTION Despite the high prevalence and the importance of sleep disturbance to patients with kidney disease, relatively few studies have addressed therapeutic interventions to improve patient outcomes for sleep-disordered patients, and there is a lack of clinical guideline to aid patient management. The purpose of this review is to describe the existing studies that have evaluated sleep disorders in the hemodialysis (HD) popula- tion, to outline the current understanding of the pathophysiology of sleep-disordered breathing (SDB), and to discuss the role of HD modality in the management of SDB. Sleep disturbance is common in people with chronic kidney dis- ease (CKD), 1 and the severity progresses when deteriorating kidney function necessitates dialysis. 2 Up to 80% of patients with end-stage kidney disease (ESKD) experience sleep disturbance. 3,4 Although sleep disturbance may be associated with declining kidney function and uremic syndrome, 5,6 an increasing dose of standard dialysis treatment in the ESKD population itself does not improve the sleep quality of most patients. 7 The cause of disturbed sleep in HD patients can be considered either intrinsic or extrinsic. Pain associated with dialysis treatment, such as chronic pain, cannulation pain, or muscle cramping, is a com- mon external factor that potentially cause sleep disturbance in HD patients. 8,9 Other uremia-related problems such as accumulation of uremic toxins and fluid may reduce sleep efficiency and cause sleep disturbance in patients on maintenance HD. 2,10 Specific types of sleep disorders in patients receiving dialysis include insomnia, rest- less leg syndrome (RLS), periodic limb movement disorder (PLMD), and SDB. 11–13 Each may represent different or overlapping clinical entities, with different pathophysiological mechanisms and clinical correlates. For example, anemia, hyperphosphatemia, reduced mela- tonin levels, and change in circadian rhythm are thought to be the main causes of insomnia and RLS/PLMD, 14–17 while upper airway edema and destabilized ventilatory sensitivity are reported to cause the development of SDB in renal patients. 18–20 Sleep disturbance is one of the most prevalent and intense symptom burdens identified by patients with ESKD. 21,22 The conse- quences of sleep disorders such as fatigue and depression can The authors declare that there are no conflicts of interest and external funding received for this project. DOI: 10.1111/sdi.12617 Seminars in Dialysis. 2017;1–11. wileyonlinelibrary.com/journal/sdi © 2017 Wiley Periodicals, Inc. | 1