Baodi Huang,1,* Yujun Qian,1,* Ying Gao,2 Zhenye Chen,3 Li Zhang,1 Huijuan Mao,1 Changying Xing,1 Haibin Ren,1,* Jing Wang1,* 

1Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, People’s Republic of China; 2The Second School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 3Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jing Wang, Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, People’s Republic of China, Email wangjing2012@njmu.edu.cn Haibin Ren, Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, People’s Republic of China, Email 13814093699@163.com

Background: The issue of compromised sleep quality among patients with end-stage kidney disease (ESKD), particularly those undergoing peritoneal dialysis (PD), is notably pronounced. Dialysis patients exhibit significant alterations in cardiac autonomic nerve activity. However, the relationship between autonomic nervous system activity and sleep remains inadequately elucidated.
Methods: This cross-sectional study enrolled adult maintenance PD patients in our center. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Heart rate variability (HRV) and Skin sympathetic nerve activity (SKNA) parameters were recorded to reflect autonerve activity responses or regulation capacity.
Results: A total of 73 PD patients participated in this study, with a prevalence of poor sleep quality at 38.4%. Serum creatinine (1157.0± 294.3 vs 969.6± 353.4 mmHg, p = 0.022) and phosphorus levels (2.1± 0.5 vs 1.7± 0.5 mmHg, p = 0.002) were higher in the poor sleep quality group compared to the good group. Linear regression analyses indicated that PSQI scores were associated with SKNA (β, − 2.54; 95% CI, − 4.90 to − 0.19; P=0.035), standard deviation of all sinus RR intervals (SDNN) (β, − 0.05; 95% CI, − 0.09 to − 0.01; P=0.015), and SD2 (β, − 0.04; 95% CI, − 0.07 to − 0.01; P=0.018).
Conclusion: Poor sleep quality in PD patients may be associated with longer dialysis vintage, higher BMI, higher diastolic blood pressure, and higher level of serum uremic toxin, and affected by cardiac autonomic nerve function disorder.

Keywords: peritoneal dialysis, end-stage kidney disease, skin sympathetic nerve activity, heart rate variability, autonomic nervous system, sleep quality