Lower serum sodium levels predict poor clinical outcomes in patients with insomnia
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RESEARCH ARTICLE
Open Access
Lower serum sodium levels predict poor clinical outcomes in patients with insomnia Eunjin Bae1, Tae Won Lee1, Ha Nee Jang2, Hyun Seop Cho2, Sehyun Jung2, Seunghye Lee2, Se-Ho Chang2,3 and Dong Jun Park1,3*
Abstract Background: The association between lower serum sodium levels and the clinical outcomes of insomnia patients remains unclear. We explored whether lower serum sodium is associated with poor clinical outcomes in patients with insomnia. Methods: We retrospectively enrolled patients with a diagnosis of insomnia from January 2011 to December 2012. We divided participants into three groups according to initial serum sodium level: tertile 1 (< 138 mmol/L), tertile 2 (138.0–140.9 mmol/L), and tertile 3 (≥ 141.0 mmol/L). To calculate the relative risk of death, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox proportional hazard models. Results: A total of 412 patients with insomnia were included, of whom 13.6% (n = 56) had hyponatremia. Patients with lower serum sodium concentrations were older and had lower hemoglobin, calcium, phosphorus, and albumin levels. At the median follow-up of 49.4 months, 44 patients had died and 62 experienced acute kidney injury (AKI). Kaplan-Meier analysis showed significantly higher mortality in patients in the lowest tertile for serum sodium. The lowest tertile of the serum sodium level and the AKI were associated with all-cause mortality. However, the lowest tertile of the serum sodium level was not significantly associated with AKI. Conclusions: The lowest tertile of the serum sodium level was associated with a higher mortality rate in insomnia patients. Our results suggest that the serum sodium level could serve as a prognostic factor in insomniacs; patients with lower sodium levels require particular care. Keywords: Insomnia, Mortality, Serum sodium, Hyponatremia
Background Insomnia is a disorder characterized by at least one “nocturnal sleep symptom” and a daytime or “waking symptom” attributable to poor sleep [1]. The prevalence of insomnia in the general population is approximately 10–20%; about 50% of cases are chronic [2]. Insomnia is * Correspondence: [email protected] 1 Department of Internal Medicine, College of Medicine, Gyeongsang National University and Gyeongsang National University Changwon Hospital , Changwon, South Korea 3 Institute of Health Science, Gyeongsang National University, Jinju, South Korea Full list of author information is available at the end of the article
not only associated with a poor quality of life, but also with the risk of cognitive dysfunction [3], hypertension (HT) [4], metabolic diseases [5], and coronary artery disease (CAD) [6]. Although the pathophysiology of insomnia is complex, neurohormonal and sociocultural factors, as well as medical illnesses, are all associated with the condition. It is important to identify predisposing factors for insomnia. Serum sodium level is important for neuronal function and osmoregulation between cells and the extracellular fluid [7]. Sodiu
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