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Smaha K, Mixson A, Waller JL, Bollag WB, Taskar V, Padala SA, Baer SL, Healy WJ. Demographic and clinical risk factors for diagnosis of sleep disorders in ESRD patients. Am J Med Sci 2023; 366:270-277. [PMID: 37454928 DOI: 10.1016/j.amjms.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/24/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sleep disturbances in patients with end-stage renal disease (ESRD) are common and more prevalent than in the general population. This study aims to assess the demographic and clinical risk factors for the diagnosis of sleep disorders in ESRD patients. METHODS This study is a retrospective analysis of the United States Renal Data System (USRDS) to evaluate risk factors for the diagnosis of sleep disorders, including hypersomnolence, insomnia, restless leg syndrome (RLS), or obstructive or central sleep apnea (OSA/CSA). All ESRD subjects enrolled in the USRDS between 2004-2015 were eligible for inclusion. The risk factors analyzed were age, race, sex, ethnicity, access type, dialysis modality, and the Charlson Comorbidity Index (CCI). All statistical analysis was performed using SAS 9.4, and statistical significance was assessed using an alpha level of 0.05. Descriptive statistics on all variables overall and by each sleep diagnosis were determined. RESULTS Increasing age, black race, other race, and Hispanic ethnicity were associated with decreased risk of each sleep diagnosis while CCI was associated with increased risk. Females were at increased risk of RLS and insomnia while males were at increased risk of OSA/CSA. Catheter and graft access decreased risk of RLS but increased risk of insomnia compared to AVF access. Catheter access increased risk of OSA/CSA compared to graft access. Hemodialysis increased risk of OSA/CSA compared to peritoneal dialysis. CONCLUSIONS Some ESRD patients are at an increased risk for diagnosis of sleep disorders based on age, race, sex, comorbid health conditions, and dialysis modality.
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Affiliation(s)
- Katlyn Smaha
- Medical College of Georgia School of Medicine at Augusta University, Augusta, GA, USA
| | - Andrew Mixson
- Medical College of Georgia School of Medicine at Augusta University, Augusta, GA, USA
| | - Jennifer L Waller
- Population Health Sciences at Augusta University, Augusta, GA United States
| | - Wendy B Bollag
- Physiology, Medical College of Georgia at Augusta University, Augusta, GA, United States; Charlie Norwood VA Medical Center, Augusta, GA, United States
| | - Varsha Taskar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Augusta University, Augusta, GA, USA
| | - Sandeep Anand Padala
- Division of Nephrology, Department of Medicine, Augusta University, Augusta, GA, USA
| | | | - William J Healy
- Medical College of Georgia School of Medicine at Augusta University, Augusta, GA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Augusta University, Augusta, GA, USA.
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Hsu WH, Yang CC, Tsai CY, Majumdar A, Lee KY, Feng PH, Tseng CH, Chen KY, Kang JH, Lee HC, Wu CJ, Kuan YC, Liu WT. Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution. Life (Basel) 2023; 13:life13051218. [PMID: 37240863 DOI: 10.3390/life13051218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/20/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E-I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E-I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA.
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Affiliation(s)
- Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Chang Yang
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Jiunn-Horng Kang
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Yi-Chun Kuan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
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3
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AL Garni RS, Cooke M. The concept of HRQoL for patients on hemodialysis in Saudi Arabia: an exploratory study. Health Qual Life Outcomes 2021; 19:273. [PMID: 34952589 PMCID: PMC8709990 DOI: 10.1186/s12955-021-01906-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of health-related quality of life (HRQoL), a patient-reported outcome measure, is poorly defined within the Saudi literature. There is a lack of culturally adapted measures to assess the HRQoL of patients on hemodialysis in Saudi Arabia. Hence, this study aims to explore and define the concept of HRQoL, identify its key domains and develop a conceptual model as perceived by patients with renal failure who are undergoing hemodialysis in Saudi Arabia. METHODS Qualitative research methods was used; data were collected in one dialysis center in the Eastern Region of Saudi Arabia. Twenty-two semi structured qualitative interviews were conducted using a topic guide. The data were analyzed using thematic analysis methods as the transcripts were coded, the categories identified, and the themes generated. RESULTS Seven definitions of the HRQoL concept emerged from data analysis in terms of health status and psychological wellbeing including the satisfaction with life, socialization and the ability to play the expected social role and having social relationships that are supportive, religiosity and the belief in God and being able to perform religious worships and finally needs satisfaction was used to define HRQoL which included financial needs and the quality of healthcare services. All these themes were utilized to develop one common definition that emphasized the personal satisfaction with health, social, psychological and financial needs in addition to religious performance and the quality of healthcare services provided. The conceptual model was developed using five key domains of HRQoL: physiological, social, psychological, religious and vocational domains that were defined by certain indicators and the relationships between the domains were clarified in the model. CONCLUSION The findings of this study could guide the selection of the appropriate HRQoL instrument to assess the HRQoL of patients on hemodialysis in Saudi Arabia, which would ensure the validity of the findings that could be used in healthcare decisions and planning of care.
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Affiliation(s)
- Rima Saleem AL Garni
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441 Kingdom of Saudi Arabia
| | - Mary Cooke
- Urgent and Emergency Nursing, Division of Nursing, Midwifery and Social Work, The University of Manchester, University Place, Oxford Road, Manchester, M139PL UK
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Zhang H, Yang Y, Huang J, Lailan S, Tao X. Correlates of objective sleep quality in older peritoneal dialysis patients. Ren Fail 2021; 43:180-187. [PMID: 33459122 PMCID: PMC7833042 DOI: 10.1080/0886022x.2020.1871369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sleep disturbance is a prominent concern in dialysis patients and detrimentally impacts clinical and self-reported health outcomes. This study aimed to collect sleep data from in-home actigraphy and to explore possible predictors of sleep quality in older peritoneal dialysis patients. METHODS This was a cross-sectional study. Peritoneal dialysis patients aged ≥60 years participated in this study. For each participant, sleep quality was assessed by analyzing the data produced by an actigraphic device worn on the wrist 24 h a day for seven consecutive days. Physical function was assessed using handgrip strength and the Timed Up and Go test. Depression was assessed using the self-reported Geriatric Depression Scale. Multiple linear regression analyses were performed to examine the factors influencing sleep efficiency and sleep time. RESULTS Based on data collected from 50 participants (N = 50, mean age 70.4 years, 70% male), including 333 nights of actigraphy-monitored sleep, the mean sleep efficiency was 75.5%±14.2% and the mean total sleep time 391.0 ± 99.3 min per night. Higher hemoglobin (β = 0.38, p = 0.007) and lower serum phosphorus (β = -0.30, p = 0.042) levels were significant predictors of better sleep efficiency. The only significant predictor of the total sleep time was age (β = 0.32, p = 0.021). CONCLUSION Older peritoneal dialysis patients had poor sleep, characterized by low sleep efficiency. Low hemoglobin and high serum phosphorus levels were predictors of poor sleep efficiency and, as such, modifiable factors for clinicians to consider when treating patients with sleep complaints.
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Affiliation(s)
- Haifen Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Yang
- Nursing Department, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaying Huang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhui Lailan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xingjuan Tao
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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5
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Azarnoush H, Mortazavi M, Rouhani MH, Seirafian S, Atapour A, Hosseini M, Toghyani A. Dietary nutrients' intake and sleep quality in peritoneal dialysis patients. Sleep Sci 2021; 14:174-178. [PMID: 35082988 PMCID: PMC8764949 DOI: 10.5935/1984-0063.20200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
Sleep disturbances are common in dialysis patients. However, there is a lack of information on nutritional determinants of sleep disorders in dialysis patients. The objective of the current study was to investigate the association between nutrients’ intake and sleep quality in peritoneal dialysis patients. The cross-sectional study was done on 114 peritoneal dialysis patients referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Information on sleep quality and dietary intakes were collected using Pittsburgh sleep quality index and 168-item food frequency questionnaire respectively. Anthropometric measurements were done by a trained dietitian based on standard protocols. Socio-demographic and clinical data were obtained through a structured questionnaire. The binary logistic regression model was used to detect the association between nutrients’ intake and sleep quality. Our results indicated that there was not any significant difference in basic (socio-demographic and clinical) characteristics between peritoneal dialysis patients with good and poor sleep quality (p>0.05). The results of logistic regression indicated a positive significant association between dietary intake of carbohydrate (OR:3;95% CI:1.32-6.81; p<0.05), fat (OR:3;95% CI:1.32-6.81; p<0.05), and fiber (OR:2.53;95% CI: 1.12-5.67; p<0.05) with poor sleep quality in crude and adjusted models (p<0.05). However, there was not any significant association between dietary intake of protein and poor sleep quality (p>0.05). The results of the present study indicated that dietary intake of nutrients affect sleep quality in dialysis patients. These results help healthcare professionals in making nutritional interventions to improve sleep quality in dialysis patients.
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Affiliation(s)
- Hamed Azarnoush
- Isfahan University of Medical Sciences, Internal Medicine Department, Medical School - Isfahan - Iran (the Islamic Republic of) - Iran
| | - Mojgan Mortazavi
- Isfahan University of Medical Sciences, Internal Medicine Department, Medical School - Isfahan - Iran (the Islamic Republic of) - Iran.,Isfahan University of Medical Sciences, Isfahan Kidney Diseases Research Center, Alzahra Hospital - Isfahan - Iran (the Islamic Republic of) - Iran
| | - Mohammad Hossein Rouhani
- Isfahan University of Medical Sciences, Food Security Center and Department of Community Nutrition - Isfahan - Iran (the Islamic Republic of) - Iran
| | - Shiva Seirafian
- Isfahan University of Medical Sciences, Internal Medicine Department, Medical School - Isfahan - Iran (the Islamic Republic of) - Iran.,Isfahan University of Medical Sciences, Isfahan Kidney Diseases Research Center, Alzahra Hospital - Isfahan - Iran (the Islamic Republic of) - Iran
| | - Abdolamir Atapour
- Isfahan University of Medical Sciences, Internal Medicine Department, Medical School - Isfahan - Iran (the Islamic Republic of) - Iran.,Isfahan University of Medical Sciences, Isfahan Kidney Diseases Research Center, Khorshid Hospital - Isfahan - Iran (the Islamic Republic of) - Iran
| | - Mohsen Hosseini
- Isfahan University of Medical Sciences, Department of Biostatistics and Epidemiology, School of Public Health - Isfahan - Iran (the Islamic Republic of) - Iran
| | - Arash Toghyani
- Isfahan University of Medical Sciences, Internal Medicine Department, Medical School - Isfahan - Iran (the Islamic Republic of) - Iran
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6
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Asghar MS, Ahsan MN, Jawed R, Rasheed U, Ali Naqvi SA, Hassan M, Yaseen R, Mallick N, Zehra M, Saleem M. A Comparative Study on the Use of Alprazolam and Melatonin for Sleep Disturbances in Hemodialysis Patients. Cureus 2020; 12:e11754. [PMID: 33403184 PMCID: PMC7773292 DOI: 10.7759/cureus.11754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Sleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning. Irrespective of the adverse effects reported, benzodiazepines are widely utilized among patients with sleep disorders in end-stage renal disease. Melatonin is a newer agent being studied for use in hemodialysis patients for improvement of sleep quality. The aim of our observational study is to witness the effectiveness of both benzodiazepine and exogenous melatonin as a treatment of sleep disorders in patients undergoing hemodialysis. Materials and methods We conducted a comparative, observational study in ESRD patients who are on hemodialysis. These patients were selected from attendees of the hemodialysis unit, nephrology department of a tertiary care hospital, including those who were on regular hemodialysis, thrice-weekly in frequency for at least once per year, and taking regular sleep medications for at least three months with frequently reported drug dosages of alprazolam 0.5 mg once daily or melatonin 3 mg once daily (before bedtime). The subjective sleep assessment was done by utilizing four scales, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Results A total of 117 hemodialysis-dependent patients met the inclusion criteria, among whom 79 patients were using alprazolam while 38 were using melatonin for their disturbed sleep. The mean age of the study participants was 49.12 ± 12.75, comprising 72 males (61.53%) and 45 females (38.46%). The duration of the diagnosis of chronic kidney disease (CKD), duration of onset of hemodialysis, and estimated glomerular filtration rate (eGFR) was comparable in both groups. Both groups had similar laboratory markers except for higher hemoglobin in the melatonin group (p=0.028) and high parathyroid hormone (PTH) levels in the alprazolam group (p=0.001). PSQI scores were 8.76 ± 3.09 in the alprazolam group and 7.32 ± 2.65 in the melatonin group (p=0.015). In the sub-scores, there were no differences in sleep latency (p=0.481) and daytime dysfunction (p=0.662) while sleep efficiency (p=0.167) and subjective sleep quality (p=0.132) were not statistically significant. The significant differences were lower scores of sleep duration (p=0.040) and sleep disturbance (p=0.003) in the melatonin group. The ESS scores revealed no significant difference in either group (p=0.074). With respect to the ISI and SSS, higher scores were obtained in the alprazolam group. Overall, 89 study participants had reported poor sleep quality, out of which 81% were using alprazolam, and 65% were using melatonin (p=0.071). A total of 50 study participants exhibited excessive daytime sleepiness with 45% of them were using alprazolam and 36% were using melatonin. About 54% of the alprazolam using hemodialysis patients had moderate insomnia while 50% of the melatonin using patients had sub-threshold insomnia (p=0.062). Conclusion As melatonin use has shown better sleep quality and less insomnia severity as compared to alprazolam use in our study, it is postulated that the sleep-wake cycle should be commonly targeted by pharmacological therapy in ESRD.
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Affiliation(s)
| | | | - Rumael Jawed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | | | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Rabail Yaseen
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Najia Mallick
- Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Mahrukh Zehra
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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7
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Tu CY, Chou YH, Lin YH, Huang WL. Sleep and emotional disturbance in patients with non-dialysis chronic kidney disease. J Formos Med Assoc 2019; 118:986-994. [DOI: 10.1016/j.jfma.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/24/2018] [Accepted: 10/22/2018] [Indexed: 12/18/2022] Open
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8
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Subjective Sleep Quality and Excessive Daytime Sleepiness in Hemodialysis Patients Waitlisted for Renal Transplant. Cogn Behav Neurol 2019; 32:25-30. [PMID: 30896574 DOI: 10.1097/wnn.0000000000000182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep disturbances are common in hemodialysis (HD) patients, impeding their daily activities and reducing their overall quality of life. The aim of this study was to investigate sleep quality and excessive daytime sleepiness (EDS) in HD patients waitlisted for renal transplant. METHODS The study included 137 patients (84 men and 53 women) undergoing HD three times per week; the mean age was 49.74±12.49 years. I used the Pittsburgh Sleep Quality Index (PSQI) to identify poor sleepers and the Epworth Sleepiness Scale (ESS) to identify those with EDS. RESULTS PSQI scores classified 87 of the 137 patients (63.5%) as poor sleepers, and ESS scores indicated that 47 patients (34.3%) had EDS. Among the 87 poor sleepers, 46% presented with EDS. Among the patients with EDS, 85% were also poor sleepers. Multivariate analysis revealed a positive correlation between the PSQI and ESS scores (P=0.002). CONCLUSIONS Poor sleep quality and EDS are quite common among patients receiving HD, but these sleep disturbances often go undiagnosed or untreated. Better awareness and treatment of SDs could improve quality of life for HD patients waitlisted for renal transplant.
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Ishida JH, McCulloch CE, Steinman MA, Grimes BA, Johansen KL. Psychoactive Medications and Adverse Outcomes among Older Adults Receiving Hemodialysis. J Am Geriatr Soc 2019; 67:449-454. [PMID: 30629740 DOI: 10.1111/jgs.15740] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. OBJECTIVES To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis. DESIGN Observational cohort study. SETTING National registry of patients receiving hemodialysis (US Renal Data System). PARTICIPANTS A total of 60 007 adults 65 years or older receiving hemodialysis with Medicare Part D coverage in 2011. MEASUREMENTS The predictors were use of sedative-hypnotics and anticholinergic antidepressants (modeled as separate time-varying exposures). The outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, and fracture (modeled separately). RESULTS Overall, 17% and 6% used sedative-hypnotics and anticholinergic antidepressants, respectively, in 2011. In multivariable-adjusted Cox regression, anticholinergic antidepressant use was associated with a 25%, 27%, and 39% higher hazard of altered mental status, fall, and fracture, respectively, compared with no use. Use of sedative-hypnotics was not associated with adverse outcomes. CONCLUSION Anticholinergic antidepressants were associated with adverse outcomes in older hemodialysis patients, and alternative treatments should be considered. Sedative-hypnotics were not associated with the risks evaluated in this study, but further investigation of the harms of this class of agents is warranted before their recommendation as a treatment option for insomnia in this population. J Am Geriatr Soc 67:449-454, 2019.
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Affiliation(s)
- Julie H Ishida
- Department of Medicine, University of California, San Francisco, California.,Division of Nephrology, San Francisco VA Medical Center, San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, California
| | - Barbara A Grimes
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Kirsten L Johansen
- Department of Medicine, University of California, San Francisco, California.,Division of Nephrology, San Francisco VA Medical Center, San Francisco, California.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California
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10
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Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients. Int Urol Nephrol 2018; 50:745-754. [DOI: 10.1007/s11255-018-1796-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
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11
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Malhotra R, Persic V, Zhang W, Brown J, Tao X, Rosales L, Thijssen S, Finkelstein FO, Unruh ML, Ikizler A, Garimella PS, Ix JH, Kooman J, Levin NW, Handelman GJ, Kotanko P. Tryptophan and Kynurenine Levels and Its Association With Sleep, Nonphysical Fatigue, and Depression in Chronic Hemodialysis Patients. J Ren Nutr 2017; 27:260-266. [DOI: 10.1053/j.jrn.2017.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/12/2023] Open
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12
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Palagini L, Mauri M, Faraguna U, Carli L, Tani C, Dell’Osso L, Mosca M, Riemann D. Insomnia symptoms, perceived stress and coping strategies in patients with systemic lupus erythematosus. Lupus 2016; 25:988-96. [DOI: 10.1177/0961203316631630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
Objective The aim of this study is to evaluate perceived stress and coping strategies in individuals with systemic lupus erythematosus (SLE) according to the presence of insomnia symptoms, using a set of variables that include anxiety and depressive symptoms evaluation. Methods Ninety SLE women were evaluated in a cross-sectional study using the Perceived Stress Scale (PSS), Brief COPE, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI) and Self-rating Anxiety Scale (SAS). Results Individuals with insomnia symptoms ( n = 57, 66%) presented higher PSS ( p < 0.001), PSQI ( p < 0.0001), BDI, ( p < 0.0001) scores and showed less-effective coping strategies such as the use of behavioral disengagement ( p = 0.04), self-blame ( p = 0.02) and emotional-focused coping ( p = 0.001). In a multi-regression model ISI was the independent determinant of high PSS and of behavioral disengagement; PSQI was the only determinant of self-blame ( p = 0.02) and emotional-focused coping. Conclusions SLE individuals with insomnia symptoms show high levels of perceived stress and more frequent use of disengaging and emotional-focused coping strategies. This body of evidence suggests that individuals with SLE and comorbid insomnia symptoms may therefore require additional interventions for insomnia.
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Affiliation(s)
- L Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
| | - M Mauri
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
| | - U Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - L Carli
- Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - C Tani
- Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - L Dell’Osso
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
| | - M Mosca
- Department of Clinical Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - D Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Freiburg University Medical Center, Germany
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Otaghi M, Bastami M, Borji M, Tayebi A, Azami M. The Effect of Continuous Care Model on the Sleep Quality of Hemodialysis Patients. Nephrourol Mon 2016; 8:e35467. [PMID: 27570752 PMCID: PMC4983154 DOI: 10.5812/numonthly.35467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/29/2016] [Indexed: 02/05/2023] Open
Abstract
Background One of the most prevalent problems in hemodialysis patients is sleep disturbance. Poor sleep quality has unpleasant bio-psycho-social outcomes. The positive effects of implementing the continuous care model (CCM) were verified with different variables, including sleep quality. This study was done with different populations, using two groups. Objectives This study aims to identify the sleep quality of hemodialysis patients in the city of Ilam and determine the effects of CCM on sleep quality. Patients and Methods We performed a quasi-experimental research study with 56 hemodialysis patients at the Shahid Mostafa Hospital in Ilam during 2014 and 2015. Pretests and posttests were conducted with the study groups and the control groups. Pretests were conducted over a one-month period, then repeated immediately before the study. Posttests were conducted immediately after the study and then repeated one month later. Participants were selected by census method and randomly divided into two groups. Ethical considerations were observed. Based on the continuous care model, interventions were performed through educational sessions over a three-week period. Consultations for continuous sleep monitoring, controls, and evaluations were conducted with the study group over the next nine weeks. Data were gathered from patient demographics questionnaires and PQSI, then introduced in SPSS 22 and analyzed with descriptive and analytic statistics (t-paired, ANOVA with repeated measures, follow-up tests such as S-N-K, Duncan, Sheffe and Tukey). Results One month prior to the study, 94.6% of the participants suffered from poor sleep quality. Immediately before and after the study, 91% complained of poor sleep quality. And one month after intervention, the figure dropped to 82%. Applying the CCM positively affected the sleep quality of hemodialysis patients in Ilam, and was statistically meaningful one month after intervention (P = 0.001). Conclusions Hemodialysis patients need a consistent care plan to manage poor sleep quality. This research has proven the effectiveness of implementing CCM as an intervention for improving the sleep quality of hemodialysis patients. CCM provides a comprehensive model for caring for hemodialysis patients, and its executive stages are congruent with the many stages of the nursing process. Practitioners in different domains of nursing care, education, and management can derive great benefit from this valuable care model
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Affiliation(s)
- Masoumeh Otaghi
- Research Center of Prevention of Psychosocial Damages, Ilam University of Medical Sciences, Ilam, IR Iran
- Nursing Department, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Mohamadreza Bastami
- Research Center of Prevention of Psychosocial Damages, Ilam University of Medical Sciences, Ilam, IR Iran
- Nursing Department, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Milad Borji
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding author: Milad Borji, Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran. Tel: +98-9183404704, E-mail:
| | - Ali Tayebi
- Department of Medical-Surgical, School of Nursing, Baqiatallah University of Medical Sciences, Tehran, IR Iran
| | - Milad Azami
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
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Abstract
As medical advances are made in the care of persons with chronic illnesses including those with end-stage renal disease (ESRD), patients are not only experiencing increasing life expectancy but also bearing the burden of illness and treatment for a longer duration of time. With this in mind, it is increasingly important for health care providers to pay close attention to their individual patient's perceptions of their health, fitness, life satisfaction, and well-being. This assessment of Health-Related Quality of Life (HRQOL) also includes an evaluation of the patient's level of satisfaction with treatment, outcome, and health status, also taking into account their perspective on future prospects. In addition to improving patient-provider communication by helping in the identification and prioritization of problems, it is important to note that high HRQOL has been shown to be associated with better medical outcomes, including reduction in hospitalizations and death. In this review, we outline several validated tools that are used to quantitatively measure HRQOL in the ESRD population and incorporate these instruments in a review of specific, evidence-based measures by which we can measurably improve health-related quality of life in dialysis patients.
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Affiliation(s)
- Donald Mitema
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Bernard G Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Nephrology Center of Maryland, Baltimore, Maryland
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Naini AE, Amra B, Mahmoodnia L, Taheri S. Sleep apnea syndrome and restless legs syndrome in kidney transplant recipients. Adv Biomed Res 2015; 4:206. [PMID: 26605235 PMCID: PMC4627182 DOI: 10.4103/2277-9175.166142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/25/2014] [Indexed: 11/05/2022] Open
Abstract
Background: This study was aimed to evaluate the prevalence of obstructive sleep apnea (OSA) and restless legs syndrome (RLS) in patients with end-stage renal disease (ESRD) after kidney transplantation. Materials and Methods: Two hundred kidney transplant recipients were enrolled in this cross-sectional study. Data on age, gender, etiology of ESRD, history of previous kidney transplantation, serum creatinine, and the presence or absence of OSA and RLS were collected. Symptoms of RLS were identified using the RLS questionnaire which was completed by the patients. The Berlin questionnaire and polysomnography were used for diagnosing OSA. Results: The mean age of the studied patients was 45.86 ± 10.24 years. The prevalence of OSA was 26% (52 of 200 studied patients) and of RLS was 51.5% (103 of 200 studied patients). Majority of the patients with high-risk OSA were male and significantly older than the patients with low-risk OSA (P < 0.05). The prevalence of RLS was higher in patients with high-risk OSA and a higher level of creatinine compared to that in those with a low risk of OSA (P < 0.0001). Level of creatinine in patients with positive RLS was significantly higher than in those with negative RLS (P < 0.0001). OSA was observed in almost 42% of patients with positive RLS, compared to 9% of patients with negative RLS (P < 0.0001). Conclusion: In summary, our results indicate that the prevalence of OSA and RLS in kidney transplant recipients was higher than in the general population. Also, there was a significant association between OSA and RLS in these patients.
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Affiliation(s)
- Afsoon Emami Naini
- Department of Nephrology, School of Medicine, Isfahan Kidney Disease Research Center, Isfahan, Iran
| | - Babak Amra
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Mahmoodnia
- Department of Nephrology, School of Medicine, Isfahan Kidney Disease Research Center, Isfahan, Iran
| | - Shahram Taheri
- Department of Nephrology, School of Medicine, Isfahan Kidney Disease Research Center, Isfahan, Iran
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Tosun N, Kalender N, Cinar FI, Bagcivan G, Yenicesu M, Dikici D, Kaya D. Relationship between dialysis adequacy and sleep quality in haemodialysis patients. J Clin Nurs 2015. [PMID: 26215674 DOI: 10.1111/jocn.12908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM AND OBJECTIVES The aim of this study is to examine the relationship between dialysis adequacy and sleep quality in haemodialysis patients. BACKGROUND Sleep problems are common in haemodialysis patients. Dialysis adequacy is one of the factors associated with sleep quality. Studies evaluating the association between dialysis adequacy and sleep quality in haemodialysis patients present different results. DESIGN Descriptive and cross-sectional study. METHODS This study was performed with a total of 119 patients who had applied to dialysis centres for haemodialysis treatment between January and March 2014. The data collection form consists of socio-demographic and medical characteristics as well as laboratory parameters. A modified Post-Sleep Inventory was used to examine sleep quality in the research. RESULTS There were no statistically significant relationship between sleep quality and dialysis adequacy (p > 0·05). When the Post-Sleep Inventory scores were evaluated according to sleep quality, 63·0% of patients had poor sleep quality, and 37·0% had good sleep quality. Sleep quality was worse in unemployed patients (X(2) = 4·852; p = 0·025) and patients who smoked heavily (Z = 2·289; p = 0·022). CONCLUSIONS In this study, there is no statistically significant relationship between dialysis adequacy and sleep quality. However, it was found that the majority of haemodialysis patients had poor sleep quality. RELEVANCE TO CLINICAL PRACTICE Even if the dialysis adequacy of patients is at the recommended level, their sleep qualities may be poor. Therefore, evaluations of the sleep quality of haemodialysis patients during the clinical practice must be taken into consideration.
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Affiliation(s)
- Nuran Tosun
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
| | - Nurten Kalender
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
| | | | - Gulcan Bagcivan
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
| | | | - Dilek Dikici
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
| | - Dilek Kaya
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey
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Kaya T, Acar BA, Sipahi S, Cinemre H, Acar T, Varım C, Tamer A. Relationships Between Malnutrition, Inflammation, Sleep Quality, and Restless Legs Syndrome in Hemodialysis Patients. Ther Apher Dial 2015; 19:497-502. [PMID: 26031339 DOI: 10.1111/1744-9987.12313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Restless legs syndrome (RLS) is a common neurologic sensorimotor disorder. It is also seen in hemodialysis patients in whom the mechanism is not thoroughly understood. The aim of this study was to evaluate the association between malnutrition-inflammation score (MIS), sleep quality, and RLS in chronic hemodialysis patients. This cross-sectional study included 232 adult stable chronic hemodialysis patients (mean age 60.9 ± 14.1 years, 56.5% male). RLS frequency, MIS, Pittsburgh Sleep Quality Index (PSQI), laboratory data of patients as well as severity of RLS were evaluated. Thirty-seven patients (15.9%) were diagnosed with RLS. Mean MIS of patients with or without RLS were similar. PSQI of patients with RLS was significantly higher than patients without RLS (P = 0.002). There was a significant positive correlation between RLS severity and PSQI (r = 0.445, P = 0.006). A significant positive correlation was also found between PSQI and MIS in patients with RLS (r = 0.419, P = 0.010). RLS severity was positively correlated with some inflammatory parameters such as white blood cell count and C-reactive protein (r = 0.427, P = 0.008 and r = 0.418 P = 0.010). PSQI was found as an independent significant predictor of RLS (odds ratio [OR] = 1.15 (1.06-1.25), P = 0.001) in multivariate logistic regression analysis. Our study revealed that there was no significant relationship between RLS and MIS in chronic hemodialysis patients. However, RLS severity is correlated with inflammatory parameters. Also, sleep quality in chronic hemodialysis patients with RLS is negatively associated with MIS.
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Affiliation(s)
- Tezcan Kaya
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Savaş Sipahi
- Department of Nephrology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Hakan Cinemre
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Türkan Acar
- Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ceyhun Varım
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ali Tamer
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
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18
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Yang B, Xu J, Xue Q, Wei T, Xu J, Ye C, Mei C, Mao Z. Non-pharmacological interventions for improving sleep quality in patients on dialysis: systematic review and meta-analysis. Sleep Med Rev 2014; 23:68-82. [PMID: 25645131 DOI: 10.1016/j.smrv.2014.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/02/2014] [Accepted: 11/13/2014] [Indexed: 12/19/2022]
Abstract
We conducted a meta-analysis to summarise and quantify the effects of non-pharmacological interventions on sleep quality improvement in uraemic patients on dialysis. We defined the primary outcome as the change of sleep quality before and after interventions (evaluated by polysomonography or subjective questionnaires such as Pittsburgh sleep quality index, PSQI). The change of fatigue scales, inflammatory cytokines and adverse events were analysed as secondary outcomes. Twelve eligible randomised controlled trials and one prospective cohort study were identified. All three identified non-pharmacological interventions could result in a greater PSQI score reduction compared to controls: 1) cognitive-behavioural therapy (CBT) versus sleep hygiene education (standardised mean difference (SMD) 0.85, 95% CI 0.37-1.34); 2) physical training versus no training (SMD 3.36, 95% CI 2.16-4.57) and 3) Acupressure (including other acupoints massages) versus control (SMD 1.77, 95% CI 0.80-2.73). In terms of subscores, we found that CBT may shorten sleep latency, alleviate sleep disturbance and reduce the use of sleep medications. The finding of the cohort study suggested that intradialytic aerobic exercise training improved sleep quality in haemodialysis patients with restless leg syndrome. In conclusion, in dialysis-dependent patients, CBT could shorten sleep latency, alleviate sleep disturbance and reduce the use of sleep medications. Acupressure (including other acupoints massages) and exercise training are promising interventions but the results in these subgroups should be interpreted cautiously due to the concern of methodological quality and potential confounding factors.
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Affiliation(s)
- Bo Yang
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiaruo Xu
- No. 5 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China
| | - Qiang Xue
- No. 5 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China
| | - Tingting Wei
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jing Xu
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Chaoyang Ye
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Changlin Mei
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Zhiguo Mao
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Arães SP, Hirotsu C, Tufik S, Andersen ML. Cerebro-renal interactions and cognitive function: the important role of sleep. Neurotoxicology 2014; 45:208. [PMID: 25445563 DOI: 10.1016/j.neuro.2014.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
Affiliation(s)
- S P Arães
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - C Hirotsu
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M L Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
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20
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Knezevic MZ, Djordjevic VV, Jankovic SM, Djordjevic VM. Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients. Nephrology (Carlton) 2014; 18:706-11. [PMID: 23848433 DOI: 10.1111/nep.12131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2013] [Indexed: 11/27/2022]
Abstract
AIM Insomnia is an important problem in dialysis patients. A greater prevalence of insomnia in chronic kidney disease compared with non-renal patients suggests a role for uraemic toxins in contributing to insomnia. The aim of this study was to examine if dialysis modality and membrane permeability is associated with the frequency and severity of insomnia in haemodialysis patients. METHODS In our cross-sectional study, we evaluated 122 patients who were divided into three groups: on-line haemodiafiltration, high flux haemodialysis and low flux haemodialysis. The frequency and severity of insomnia was evaluated with the Insomnia Severity Index. RESULTS Insomnia was present in 47.5% of all patients. The majority of patients who reported insomnia were receiving low flux haemodialysis (80%), followed by patients on high flux haemodialysis (43.6%) and haemodiafiltration (20.9%). Patients using low flux membranes, had a significantly higher Insomnia Severity Index (11.9 ± 6.6) compared with patients receiving high flux haemodialysis (6.8 ± 6.3) and haemodiafiltration (5.2 ± 7.0). The insomnia severity index did not differ between patients receiving high flux haemodialysis compared with on-line haemodiafiltration. CONCLUSION This study indicates that different haemodialysis modalities are associated with insomnia and suggests a potential benefit of using high flux membranes.
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Umlauf MG, Bolland AC, Bolland KA, Tomek S, Bolland JM. The Effects of Age, Gender, Hopelessness, and Exposure to Violence on Sleep Disorder Symptoms and Daytime Sleepiness Among Adolescents in Impoverished Neighborhoods. J Youth Adolesc 2014; 44:518-42. [DOI: 10.1007/s10964-014-0160-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
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22
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Palagini L, Tani C, Bruno RM, Gemignani A, Mauri M, Bombardieri S, Riemann D, Mosca M. Poor sleep quality in systemic lupus erythematosus: does it depend on depressive symptoms? Lupus 2014; 23:1350-7. [DOI: 10.1177/0961203314540762] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives Sleep disturbances are frequently observed in rheumatic diseases including systemic lupus erythematosus (SLE). This study aimed at evaluating the prevalence of insomnia, poor sleep quality and their determinants in a cohort of SLE patients. Methods Eighty-one consecutive SLE female patients were evaluated in a cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI) and the Self-rating Anxiety Scale (SAS) were administered. Patients with previous diagnosis of obstructive sleep apnea or restless legs syndrome were excluded. Fifty-three women with hypertension (without SLE) were enrolled as control group (H). Results In the SLE cohort poor sleep quality (65.4% vs 39.6%, p < 0.01) and difficulty in maintaining sleep and/or early morning awakening (65.4% vs 22.6%, p < 0.001), but not insomnia (33.3% vs 22.6%, p = ns), were more prevalent than in H. Depressive symptoms were present in 34.6% of SLE vs 13.2% H patients ( p < 0.001) while state anxiety was more common in H patients (H 35.8% vs SLE 17.3%, p < 0.005). SLE was associated with a 2.5-times higher probability of presenting poor sleep quality in comparison to H (OR 2.5 [CI 1.21–5.16]). After adjusting for confounders, both depressive symptoms (OR 4.4, [1.4–14.3]) and use of immunosuppressive drugs (OR 4.3 [CI 1.3–14.8]) were significantly associated with poor sleep quality in SLE patients. Furthermore, poor sleep quality was not associated either with disease duration or activity. Conclusions In a cohort of SLE women, insomnia and poor sleep quality, especially difficulties in maintaining sleep, were common. Depressive symptoms might be responsible for the higher prevalence of poor sleep quality in SLE.
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Affiliation(s)
- L Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - C Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - R M Bruno
- Institute of Clinical Physiology – CNR, Pisa, Italy
| | - A Gemignani
- Psychology Unit, Department of Surgery, Medical, Molecular & Critical Area Pathology, School of Medicine, University of Pisa, Pisa, Italy
| | - M Mauri
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - S Bombardieri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - D Riemann
- Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | - M Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
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Jaar BG, Chang A, Plantinga L. Can We Improve Quality of Life of Patients on Dialysis? Clin J Am Soc Nephrol 2013; 8:1-4. [DOI: 10.2215/cjn.11861112] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Celik G, Annagur BB, Yılmaz M, Demir T, Kara F. Are sleep and life quality of family caregivers affected as much as those of hemodialysis patients? Gen Hosp Psychiatry 2012; 34:518-24. [PMID: 22401704 DOI: 10.1016/j.genhosppsych.2012.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine and compare the quality of sleep, quality of life, and anxiety and depression symptoms reported by hemodialysis (HD) patients and family caregivers of HD patients. METHODS The study included 142 pairs of HD patients and their caregivers. To assess quality of sleep, quality of life, and anxiety and depressive symptoms, the 36-item Short Form, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale, respectively, were used. RESULTS For the patients, 73.9% were poor sleepers. Low Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were found in 89.1% and 76.3% of HD patients, respectively. For the caregivers, 88% were poor sleepers. Low PCS and MCS scores were found in 62% and 70.4% of the caregivers, respectively. Mean PSQI scores, subjective sleep quality scores, sleep latency, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction scores of the caregivers were significantly higher than the scores of the HD patients (P<.001). CONCLUSIONS Caregivers of dialysis patients experience adverse effects on their quality of sleep and quality of life. Educational, social, and psychological support interventions should be considered to improve their ability to cope.
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Affiliation(s)
- Gülperi Celik
- Department of Internal Medicine, Division of Nephrology, Selçuklu Faculty of Medicine, Selcuk University, 42075 Konya, Turkey.
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Burrowes JD, Russell GB, Unruh M, Rocco MV. Is Nutritional Status Associated With Self-reported Sleep Quality in the HEMO Study Cohort? J Ren Nutr 2012; 22:461-71. [DOI: 10.1053/j.jrn.2011.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/13/2011] [Accepted: 08/19/2011] [Indexed: 11/11/2022] Open
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Effects of dosing interval on the pharmacokinetic and pharmacodynamic interactions between the oral adsorbent AST-120 and triazolam in humans. Eur J Clin Pharmacol 2012; 68:1605-10. [DOI: 10.1007/s00228-012-1301-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
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Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, Bixler EO. Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med 2012; 13:346-53. [PMID: 22425576 DOI: 10.1016/j.sleep.2011.10.033] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/02/2011] [Accepted: 10/10/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The few population-based, prospective studies that have examined risk factors of incident insomnia were limited by small sample size, short follow-up, and lack of data on medical disorders or polysomnography. We prospectively examined the associations between demographics, behavioral factors, psychiatric and medical disorders, and polysomnography with incident chronic insomnia. METHODS From a random, general population sample of 1741 individuals of the adult Penn State Sleep Cohort, 1395 were followed-up after 7.5 years. Only subjects without chronic insomnia at baseline (n = 1246) were included in this study. Structured medical and psychiatric history, personality testing, and 8-h polysomnography were obtained at baseline. Structured sleep history was obtained at baseline and follow-up. RESULTS Incidence of chronic insomnia was 9.3%, with a higher incidence in women (12.9%) than in men (6.2%). Younger age (20-35 years), non-white ethnicity, and obesity increased the risk of chronic insomnia. Poor sleep and mental health were stronger predictors of incident chronic insomnia compared to physical health. Higher scores in MMPI-2, indicating maladaptive personality traits, and excessive use of coffee at baseline predicted incident chronic insomnia. Polysomnographic variables, such as short sleep duration or sleep apnea, did not predict incident chronic insomnia. CONCLUSION Mental health, poor sleep, and obesity, but not sleep apnea, are significant risk factors for incident chronic insomnia. Focusing on these more vulnerable groups and addressing the modifiable risk factors may help reduce the incident of chronic insomnia, a common and chronic sleep disorder associated with significant medical and psychiatric morbidity and mortality.
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Affiliation(s)
- Ravi Singareddy
- Sleep Research & Treatment Center, Penn State University College of Medicine, Hershey, PA, United States.
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Abstract
AbstractThe prevalence of insomnia is greater in end-stage renal disease. The aim of our study was to determine the frequency of insomnia and subclinical insomnia in patients with various dialysis therapy and kidney transplant recipients, in order to assess the severity of insomnia and examine whether there is a difference in severity among groups. In cross-sectional study, we evaluated 120 patients with terminal renal failure. Based on therapy, patients were divided into four groups: hemodiafiltration, standard bicarbonate dialysis, peritoneal dialysis and kidney transplant recipients. The severity of insomnia was evaluated through the use of the Insomnia Severity Index (ISI). Most patients who reported any kind of insomnia problems with ISI were on conventional dialysis (80%), followed by hemodiafiltration (76.7%) and peritoneal dialysis (63.3%). Transplant recipients had least difficulties with insomnia (46.7%). Insomnia Severity Index showed that insomnia in end-stage renal patients is not very severe. Most of the patients had “no clinically significant insomnia”. Our findings indicate that patients on hemodiafiltration and transplant recipients have a significantly lower score on Insomnia Severity Index. Patients with end-stage renal disease have high frequency insomnia problems. However, our study shows that insomnia in these patients is not severe. Insomnia is the most frequent and severest in patients on standard bicarbonate dialysis.
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Kutner NG, Zhang R, Huang Y, Bliwise DL. Racial differences in restless legs symptoms and serum ferritin in an incident dialysis patient cohort. Int Urol Nephrol 2012; 44:1825-31. [PMID: 22219175 DOI: 10.1007/s11255-011-0108-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 12/16/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Restless legs syndrome (RLS), a debilitating sleep disorder that is frequently reported by CKD patients on dialysis, may be more common in whites than in non-whites. Iron deficiency is associated with RLS, and serum ferritin is higher among African Americans compared to Caucasians in the general population. No prior studies have compared restless legs symptoms and serum ferritin levels of African-American and those of the Caucasian patients on dialysis. METHODS In a multicenter observational study that included in-person interviews and medical chart review, we studied 210 patients who had recently started renal dialysis. Predictors of restless legs symptoms were examined in a multivariable logistic regression model. RESULTS African Americans had a reduced risk of restless legs complaint compared to Caucasian patients (OR, 0.44 [95% CI 0.21-0.93]; P=0.03). African-American patients were also less likely than Caucasian patients to have low serum ferritin values (<100 ng/ml), and among patients with serum ferritin≥100 ng/ml, the average serum ferritin of African-American patients was higher than that of Caucasian patients. CONCLUSIONS Further study of racial and iron status relationships could advance the understanding of RLS pathophysiology, and RLS is an important patient outcome to monitor, as revised anemia and iron protocols are implemented in the clinical setting.
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Affiliation(s)
- Nancy G Kutner
- Department of Rehabilitation Medicine, School of Medicine, Emory University, CRM-1441 Clifton Rd. N.E., Atlanta, GA 30322, USA.
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Ahmed SB, Ronksley PE, Hemmelgarn BR, Tsai WH, Manns BJ, Tonelli M, Klarenbach SW, Chin R, Clement FM, Hanly PJ. Nocturnal hypoxia and loss of kidney function. PLoS One 2011; 6:e19029. [PMID: 21559506 PMCID: PMC3084745 DOI: 10.1371/journal.pone.0019029] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 03/15/2011] [Indexed: 11/18/2022] Open
Abstract
Background Although obstructive sleep apnea (OSA) is more common in patients with kidney disease, whether nocturnal hypoxia affects kidney function is unknown. Methods We studied all adult subjects referred for diagnostic testing of sleep apnea between July 2005 and December 31 2007 who had serial measurement of their kidney function. Nocturnal hypoxia was defined as oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time. The primary outcome, accelerated loss of kidney function, was defined as a decline in estimated glomerular filtration rate (eGFR) ≥4 ml/min/1.73 m2 per year. Results 858 participants were included and followed for a mean study period of 2.1 years. Overall 374 (44%) had nocturnal hypoxia, and 49 (5.7%) had accelerated loss of kidney function. Compared to controls without hypoxia, patients with nocturnal hypoxia had a significant increase in the adjusted risk of accelerated kidney function loss (odds ratio (OR) 2.89, 95% confidence interval [CI] 1.25, 6.67). Conclusion Nocturnal hypoxia was independently associated with an increased risk of accelerated kidney function loss. Further studies are required to determine whether treatment and correction of nocturnal hypoxia reduces loss of kidney function.
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Affiliation(s)
- Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction. Int J Impot Res 2011; 23:27-31. [DOI: 10.1038/ijir.2010.32] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Quality of sleep in patients undergoing hemodialysis. Int Urol Nephrol 2010; 44:557-67. [DOI: 10.1007/s11255-010-9881-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
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Rodrigue JR, Mandelbrot DA, Hanto DW, Johnson SR, Karp SJ, Pavlakis M. A cross-sectional study of fatigue and sleep quality before and after kidney transplantation. Clin Transplant 2010; 25:E13-21. [DOI: 10.1111/j.1399-0012.2010.01326.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hirotsu C, Tufik S, Bergamaschi CT, Tenorio NM, Araujo P, Andersen ML. Sleep pattern in an experimental model of chronic kidney disease. Am J Physiol Renal Physiol 2010; 299:F1379-88. [PMID: 20826571 DOI: 10.1152/ajprenal.00118.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The prevalence of sleep disorders is significantly elevated in chronic kidney disease (CKD) patients. Numerous factors likely contribute to the high prevalence of sleep problems in uremic patients. The objective of this study was to evaluate the long-term sleep pattern changes in uremic rats during disease progression. Sleep recordings of the rats were monitored during light and dark periods that lasted 12 h each. These recordings were performed on days 7, 30, 60, and 90 after CKD induction. Cardiovascular, hormonal, and biochemical changes were evaluated at these same time points in control and uremic rats. CKD progression was reflected by the presence of hypertension and progressive increases in urea, creatinine, and cholesterol levels. We also observed hormonal fluctuations of corticosterone and ACTH, which indicated a potential alteration in the hypothalamic-pituitary-adrenal axis in diseased rats. In addition, rats with CKD demonstrated fragmented sleep with a greater number of arousals and decreased sleep efficiency in the light period during disease progression. In the dark period, there was an initial increase in sleep efficiency in CKD rats, but after 90 days of CKD, these animals slept less compared with the control group. Collectively, these metabolic and cardiovascular changes were associated with the persistent alterations in sleep architecture observed in CKD rats.
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Affiliation(s)
- Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Sao Paulo, Brazil
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Gawlikowska-Sroka A, Dzieciolowska E, Szczurowski J, Kamienska E, Czerwinski F. Tobacco abuse and physical activity among medical students. Eur J Med Res 2009; 14 Suppl 4:86-9. [PMID: 20156733 PMCID: PMC3521348 DOI: 10.1186/2047-783x-14-s4-86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This lifestyle is mainly determined during childhood and connected with poor public prophylactic health policy. The aim of this study was to estimate physical activity and level of tobacco abuse, as well as knowledge about health behaviours, among medical students. Methods Questionnaires were completed by Polish (243) and foreign medical students (80). Results It was stated that about 20% of the students smoked cigarettes. Female students from Norway took up smoking significantly more often than other participants, whereas there were more smokers among those from Poland. There was a significantly larger percentage of smoking males from Norway than among male Polish students. The same students presented a low level of physical activity. The smallest level of physical activity was characteristic of the Polish women. Conclusion This situation requires an intensification of activities aimed at supporting pro-health lifestyles and the elimination of unfavourable effects, especially among medical students.
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Affiliation(s)
- A Gawlikowska-Sroka
- Department of Normal and Clinicial Anatomy, Pomeranian Medical University, Al. Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland.
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Portaluppi F, Cortelli P, Buonaura GC, Smolensky MH, Fabbian F. Do restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) play a role in nocturnal hypertension and increased cardiovascular risk of renally impaired patients? Chronobiol Int 2009; 26:1206-21. [PMID: 19731113 DOI: 10.3109/07420520903245276] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertension can cause or promote renal failure and is related to cardiovascular mortality, the major cause of death in patients with renal impairment. Changes in the circadian BP pattern, particularly the blunting or reversal of the nocturnal decline in BP, are common in chronic renal failure. These changes in turn are among the major determinants of left ventricular hypertrophy. Using a chronobiological approach, it is possible to obtain better insight into the reciprocal relationship between hypertension, renal disease, and increased cardiovascular risk of renal patients. Disruption of the normal circadian rhythm of rest/activity may be hypothesized to underlie the high cardiovascular morbidity and mortality of such patients. Epidemiological studies reveal that hemodialysis patients experience poor subjective sleep quality and insomnia and, in comparison to healthy persons, are more likely to show shorter sleep duration and lower sleep efficiency. Sleep apnea may be present and is usually investigated in these patients; however, the prevalence of restless legs syndrome (RLS), which is high in dialysis patients and which has been associated with increased risk for cardiovascular disease in the general population, could also play a role in the pathogenesis of sleep-time hypertension in renal patients. Careful assessment of sleep quality, in particular, diagnostic screening for RLS and periodic limb movements (PLM) in renal patients, is highly recommended. In renal failure, attention to sleep quality and related perturbations of the sleep/wake cycle may help prevent the occurrence and progression of cardiovascular disease.
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Affiliation(s)
- Francesco Portaluppi
- Hypertension Center and Clinica Medica, University Hospital S. Anna of Ferrara, Ferrara, Italy.
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Abstract
Chronic renal failure affects various body systems, one of which is the respiratory system. Because respiration is the prime source for speech, vocal dysfunctions are expected to be present in patients with chronic renal failure. The present study attempts to shed light on the changes in acoustic and aerodynamic characteristics of voice, if any, in patients with chronic renal failure. Phonation of sustained vowel /a/ was subjected to acoustic analysis using VAGHMI software (Voice and Speech Systems, Bangalore, Karnataka, India). Sustained phonation of /a/, /s/, and /z/ was recorded for the purpose of aerodynamic analysis. Independent t test was used to find the significant difference between the two groups. Chronic renal failure subjects showed significant deviation in frequency, perturbation, and aerodynamic measures when compared with normal subjects. These results are discussed with respect to the underlying pathophysiology.
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Affiliation(s)
- Radish B Kumar
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Karnataka, India.
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Tsutsui H, Koike T, Yamazaki C, Ito A, Kato F, Sato H, Tawada H, Oshida Y. Identification of hemodialysis patients' common problems using the International Classification of Functioning, Disability and Health. Ther Apher Dial 2009; 13:186-92. [PMID: 19527464 DOI: 10.1111/j.1744-9987.2009.00683.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to identify the common health problems of Japanese patients on hemodialysis (HD) using the International Classification of Functioning, Disability and Health (ICF). The participants of this study had been on HD for at least five years when they were interviewed. The ICF checklist was used to initially interview 32 HD patients. Fifty-seven categories of the ICF Checklist were identified as impaired; another 35 ICF categories, chosen based on interviews and expert discussion, as well as 8 categories relevant to HD, were included in the final checklist. This final checklist was then used to interview 104 patients. Overall, 10 categories in "Body functions" and 3 categories in "Body structures" were reported as problems by more than 50% of patients. Two categories in "Activities and participation" and 4 categories in "Environmental factors" were reported as restricted or a barrier for more than 30% of patients. A higher percentage of patients who started HD before 50 years of age and had a longer duration of HD reported problems in "Body functions" and "Body structures", while more patients with a shorter duration of HD reported problems in relationships with their family. Japanese patients on maintenance HD have various physical and psychosocial problems. In addition, HD duration and the age when HD was started affect patients' reports of physical and psychosocial problems.
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Affiliation(s)
- Hideyo Tsutsui
- Department of Sports Medicine, Nagoya University Graduate School of Medicine, Tawada Hospital, Nagoya, Japan
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Liakopoulos V, Sakkas GK, Giannaki CD, Giannopoulou M, Eleftheriadis T, Stefanidis I. Factors Affecting Quality of Sleep in Dialysis Patients: Preliminary Polysomnographic Evidence. Ren Fail 2009; 30:475-6. [DOI: 10.1080/08860220801964244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Common medical problems are often associated with abnormalities of sleep. Patients with chronic medical disorders often have fewer hours of sleep and less restorative sleep compared to healthy individuals, and this poor sleep may worsen the subjective symptoms of the disorder. Individuals with lung disease often have disturbed sleep related to oxygen desaturations, coughing, or dyspnea. Both obstructive lung disease and restrictive lung diseases are associated with poor quality sleep. Awakenings from sleep are common in untreated or undertreated asthma, and cause sleep disruption. Gastroesophageal reflux is a major cause of disrupted sleep due to awakenings from heartburn, dyspepsia, acid brash, coughing, or choking. Patients with chronic renal disease commonly have sleep complaints often due to insomnia, insufficient sleep, sleep apnea, or restless legs syndrome. Complaints related to sleep are very common in patients with fibromyalgia and other causes of chronic pain. Sleep disruption increases the sensation of pain and decreases quality of life. Patients with infectious diseases, including acute viral illnesses, HIV-related disease, and Lyme disease, may have significant problems with insomnia and hypersomnolence. Women with menopause have from insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia. Patients with cancer or receiving cancer therapy are often bothered by insomnia or other sleep disturbances that affect quality of life and daytime energy. The objective of this article is to review frequently encountered medical conditions and examine their impact on sleep, and to review frequent sleep-related problems associated with these common medical conditions.
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Affiliation(s)
- James M Parish
- Sleep Disorders Center, Division of Pulmonary Medicine, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ.
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Sleep disorders and quality of life in renal transplant recipients. Int Urol Nephrol 2009; 41:373-82. [DOI: 10.1007/s11255-009-9527-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 01/08/2009] [Indexed: 12/31/2022]
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Casey KR, Brown LK. Sleep-disordered breathing and renal failure: A search for fundamental mechanisms. Sleep Med 2009; 10:15-8. [DOI: 10.1016/j.sleep.2008.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 02/15/2008] [Indexed: 12/27/2022]
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Current World Literature. Curr Opin Pulm Med 2008; 14:600-2. [DOI: 10.1097/mcp.0b013e328316ea6b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kutner NG. Promoting functioning and well-being in older CKD patients: review of recent evidence. Int Urol Nephrol 2008; 40:1151-8. [DOI: 10.1007/s11255-008-9469-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
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Vonend O, Rump LC, Ritz E. Sympathetic overactivity--the Cinderella of cardiovascular risk factors in dialysis patients. Semin Dial 2008; 21:326-30. [PMID: 18627567 DOI: 10.1111/j.1525-139x.2008.00456.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiovascular morbidity and mortality is exceedingly high in patients with chronic renal failure. Sympathetic overactivity is an important pathomechanism contributing to progression of renal disease as well as cardiovascular complications. For more than 30 years it has been known that plasma levels of norepinephrine are elevated in chronic renal failure pointing to increased sympathetic nerve activity. The kidneys are richly innervated by efferent sympathetic and afferent sensory nerves. They participate in many reflex adjustments of renal function. Initially, this finding had not been attributed to increased efferent sympathetic drive, but rather to reduced renal clearance and defective neuronal reuptake of norepinephrine. At this time, however, the evidence for increased sympathetic drive is solid. Interventions to reduce sympathetic overactivity will provide new therapeutic approaches. The available experimental and clinical evidence to suggest such a pathophysiological role of sympathetic overactivity is summarized in this current review.
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Affiliation(s)
- Oliver Vonend
- Department of Nephrology, Heinich-Heine University of Duesseldorf, Germany
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