Comparison of sleep quality between hemodialysis and peritoneal dialysis patients

The impact of photobiomodulation on sleep and life quality in hemodialysis patients: A randomized controlled trial

The quality of life (QoL) and sleep quality are closely linked to the physical and psychological health of end-stage renal disease (ESRD) patients, especially those underwent hemodialysis (HD) therapy. This study aims to investigate the impact of 830 nm laser treatment on improving QoL and sleep quality in HD patients. Forty ESRD patients participated in this study. 830 nm laser was used to radiate on the palm (at dose of 256.10 J/cm2), ST 36 and KI 1 acupoints (at dose of 109.76 J/cm2) of HD patients, and QoL and sleep quality questionnaires were utilized to assess changes following the treatment. After 830 nm laser radiation, lower global Pittsburgh Sleep Quality Index and Athens Insomnia Scale scores were observed, accompanied by higher physical and mental component summary scores in MOS 36-item short-form health survey version 2 and a global World Health Organization Quality of Life Brief Version score. The laser group also showed significant improvements in QoL and sleep quality indicators. Additionally, pain levels decreased on the third day and after one month according to visual analogue scale. This study revealed the positive effects of 830 nm laser on palm, KI 1 and ST 36 acupoints for improving the QoL and sleep quality in ESRD patients underwent HD treatment. The results suggest that 830 nm laser applied to specific targets could be used as a complementary and alternative approach to increase the QoL and sleep quality in ESRD patients.

Association between sleep quality and cardiovascular disease in maintenance hemodialysis patients: a prospective cohort study

OBJECTIVE

This study aimed to analyze the association between sleep quality and cardiovascular disease in patients on maintenance hemodialysis (MHD).

METHODS

A total of 601 patients with MHD in the second affiliated hospital of Nanjing Medical University, were prospectively enrolled in this cohort study from January 2019 to December2019. The global Pittsburgh sleep quality index (PSQI) score > 7 indicates that a person with poor sleep quality. Patients were divided into two groups according to the PSQI score. Follow-up was conducted about 3 years with all-cause death and major adverse cardiovascular events (MACEs) as the endpoint events.

RESULTS

Of the 601 patients, 595 patients completed the PSQI assessment, with 278 patients having poor sleep quality. Patients in the PSQI > 7 group were older and had a higher proportion of cardiovascular disease or diabetes. Years of education, diastolic blood pressure, and heart rate were lower in the PSQI > 7 group. At a mean follow-up period of 3 years, 116 patients died, 64 patients were lost to follow-up, and 115 patients experienced MACEs. After adjusting for confounding factors such as age, gender, dialysis age, and previous cardiovascular disease, the risk of MACE in patients with poor sleep quality was twice that of patients with good sleep quality (HR = 2.037 (1.339, 3.097), p = 0.001). There was no significant difference in the risk of all-cause death between the two groups.

CONCLUSION

The prevalence of poor sleep quality was 46.7% in patients with MHD. Poor sleep quality was an independent risk factor for MACEs in patients with MHD.

What are the sleep characteristics among early kidney transplant recipients? An objective and subjective measurement from China

OBJECTIVE

To evaluate the sleep quality by self-reported questionnaires and polysomnography (PSG) among early kidney transplant recipients (KTRs) and to further explore their correlation.

DESIGN

This was a prospective and cross-sectional analysis of the sleep characteristics among early kidney transplant recipients through an objective and subjective measurement.

PARTICIPANTS

Patients with end stage renal disease on the transplant waiting list and after kidney transplantation were from a major organ transplantation center in Southern China (n = 83).

PRIMARY AND SECONDARY OUTCOME MEASUREMENTS

Objective outcomes: PSG, noise and light. Subjective outcomes: demographic and clinical questionnaires, self-reported pain and Richards Campbell sleep questionnaire (RCSQ). After agreement with the informed consent, participants first completed demographic and clinical questionnaires, then worn the PSG within 5-10 days after kidney transplantation. Both noise, light and self-reported pain were monitored during sleep. After completion of PSG, the RCSQs were filled out next morning.

RESULTS

A total of 298 patients were recruited and 83 participants were finally analyzed. The total RCSQ mean score was 51.0±18.9mm. The prevalence of poor sleep quality among early KTRs was 45.1%. Most of PSG characteristics were significantly correlated with their corresponding RCSQ items. And the total RCSQ scores were significantly correlated with the number of awakenings, the N2 percentage and the total sleep time (r = 0.79, 0.47 and 0.40, P<0.05) respectively. Noise was a statistically significant factor affecting the subjective sleep quality.

CONCLUSIONS

The sleep quality in early KTRs measured by both PSG and RCSQ exhibits consistency with each other. Sleep disruption always remains a substantial problem and is affected by self-reported noise among early KTRs. The RCSQ is easily applicable and interpretable so that it can be used for future daily clinical practice.

Epidemiology of peritoneal dialysis outcomes

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes.

Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy.

Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes.

PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems).

Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.

Association Between Sleep Disorders and Cognitive Impairment in Middle Age and Older Adult Hemodialysis Patients: A Cross-Sectional Study

Objective: The aims of the current study were to (1) explore the features of overall poor sleep and specific sleep disorders in Chinese middle age and older adult hemodialysis patients; (2) examine the association between sleep disorders and cognitive impairment (CI) in middle age and older patients undergoing hemodialysis in China.

Methods: Data of patients undergoing maintenance hemodialysis were collected from the prospective cohort study of CI in Chinese patients undergoing hemodialysis (Registered in Clinical Trials.gov, ID: NCT03251573). We included 613 patients (mean age = 63.7; SD = 7.8) in this study. We assessed sleep conditions using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and cognitive function by the Chinese Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) scale. Then the association between sleep disorders and CI was evaluated using multivariate logistic regression analysis.

Results: The prevalence of sleep disorders in this group of 613 hemodialysis patients was 77.0%. Patients with CI were more inclined to have sleep disorders in specific aspects of sleep latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction (p < 0.05). In multivariate logistic regression analyses, every 1-point increase in global PSQI score was associated with a 1.2-fold increased risk of CI (adjusted OR = 1.201; 95%CI = 1.123–1.284, p < 0.001). For each specific PSQI, every 1-point increase in sleep disturbances score was associated with a 2.6-fold increased risk of CI (adjusted OR = 2.624; 95%CI = 1.891–3.640, p < 0.001), and every 1-point increase in daytime dysfunction score was associated with a 3.7-fold increased risk of CI (adjusted OR = 3.709; 95%CI = 2.653–5.184, p < 0.001), whereas every 1-point increase in sleep duration score was associated with a decreased risk of CI (adjusted OR = 0.600; 95%CI = 0.434–0.830, p = 0.002).

Conclusion: Poor sleep quality especially sleep disturbances, daytime dysfunction, and long sleep duration are associated with CI in middle age and older adult hemodialysis patients. Thus, the early detection of sleep disorders may help identify patients with cognitive impairment among hemodialysis individuals.

Clinical Trial Registration: [Clinical Trials.gov], identifier [NCT03251573]

Dietary nutrients' intake and sleep quality in peritoneal dialysis patients

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.

Short sleep duration is related to kidney-related biomarkers, but not lipid profile and diet quality in diabetic nephropathy patients

Objectives: Diabetic nephropathy may adversely influence on sleep duration. The quality of diet may also be affected by both sleep duration and diabetes nephropathy. Therefore, lower diet quality in short sleepers-diabetic nephropathy patients might be related to higher metabolic abnormalities. In the present study, we investigated if sleep duration is related to diet quality indices and biochemical markers in diabetic nephropathy patients. Method: This cross-sectional study was conducted among 237 diabetic nephropathy patients, randomly selected from patients attending in the Alzahra University Hospital, Isfahan, Iran. Usual dietary intake was assessed using validated food frequency questionnaire. Diet quality indices (including diet diversity score, dietary energy density, mean adequacy ratio, and nutrient adequacy ratio) were calculated based on standard definitions. Sleep duration was estimated using self-reported nocturnal hours of sleep. Results: Short sleepers (5-6 h) had higher blood urea nitrogen and creatinine compared with those who slept more than 7.5 h (20.26 + 0.23 mg/dl vs. 17.61 + 0.30 mg/dl, P < 0.0001, and 1.98 + 0.27 mg/dl vs. 1.90 + 0.24 mg/dl, P = 0.03, respectively). Serum triglyceride levels were positively correlated with sleep duration (P = 0.02). Diet quality indices were not significantly associated with sleep duration. Conclusion: Higher sleep duration is significantly related to lower kidney-related biomarkers in diabetic nephropathy patients. Diet quality indices were not associated with sleep duration in diabetic nephropathy patients. More longitudinal studies are required to evaluate the associations of sleep duration, diet quality and biochemical markers in diabetic nephropathy patients.

Impact of Sleep and Dialysis Mode on Quality of Life in a Mexican Population

BACKGROUND

Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD.

METHODS

121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale.

RESULTS

Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD.

CONCLUSIONS

Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

Objective and subjective sleep disorders in automated peritoneal dialysis

Background

Automated peritoneal dialysis (APD) is one of the fastest growing dialysis modalities. It is unknown whether sleep and mood are disturbed while performing repeated overnight exchanges.

Objectives

In this report, we aim to describe and compare the prevalence of sleep-disordered breathing (SDB), periodic limb movements (PLMS), poor sleep quality (SQ), and depression among APD patients compared with stages 3b–5 (estimated glomerular filtration rate ≤44 ml/min/1.73 m2) chronic kidney disease (CKD) and hemodialysis (HD) patients.

Design

This is a cross-sectional, descriptive study.

Setting

Study participants were recruited from outpatient nephrology clinics, local dialysis centers, and the Thomas E. Starzl Transplant Institute in Western Pennsylvania between April 2004 and July 2009.

Patients

There were 186 participants in this study including 22 APD patients, 89 CKD patients, and 75 HD patients.

Measurements

In-home polysomnography was performed and two questionnaires were completed, the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9).

Methods

SDB and PLMS were quantified by in-home unattended polysomnography; poor SQ was defined by a score >5 on the PSQI, and the presence of moderate to severe depression was defined by a score >5 on the PHQ-9.

Results

The APD patients had a median age of 37.5 years, were predominantly female (72.7 %), and had a median body mass index (BMI) of 23.8 kg/m2. In univariate analyses, APD patients had significantly lower apnea-hypopnea index compared to HD patients by 12.2 points (likelihood ratio test p = 0.008) and revealed the least percent of TST with nocturnal hypoxemia compared to CKD patients by 2.7 points, respectively (likelihood ratio test p = 0.01). The APD group had also significantly greater stages 3 to 4 sleep compared to the CKD patients by 8.6 points (likelihood ratio test p = 0.009). In multivariate analyses and after adjustment for age, gender, race, and BMI, both APD and HD patients had higher average PSQI scores than CKD patients by 2.54 and 2.22 points, respectively (likelihood ratio test p = 0.005). No other comparisons of sleep parameters among groups reached statistical significance.

Limitations

The limitations of this study are the small sample size of the APD population and the demographic and clinical differences among the three study groups.

Conclusions

Despite differences in univariate analyses, after multivariate adjustment, APD patients had similar sleep parameters and sleep architecture and as poor SQ and symptoms of depression as HD patients. Future studies with larger APD cohorts are needed.

Sleep apnea syndrome and restless legs syndrome in kidney transplant recipients

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.

Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines.

Quality of life and stressors in patients with chronic kidney disease depending on treatment

This study evaluated health-related quality of life (HRQOL) in a Spanish sample of chronic kidney disease patients (n = 90) undergoing different renal replacement therapies, considering the influence of treatment stressors, mood, anxiety and quality of sleep. While all patients had worse physical functioning than controls (p < .01), only those undergoing haemodialysis (HD) showed worse physical well-being, occupational functioning, spiritual fulfillment and more health interference with work (p < .05). They also obtained higher depression scores than renal transplant patients (TX) (p = .005). Those TX receiving the immunosuppressor sirolimus exhibited more cardiac/renal, cognitive and physical limitations than the rest (p < .05). Dialysis vintage correlated positively with sleep disturbances and depression scores and negatively with total Quality of Life (QLI) (p < .05). HD patients experienced more psychological distress than peritoneal dialysis patients (PD) (p = .036). Regression models including sleep, anxiety and depression were estimated for subscales of HRQOL. In TX patients, low depressive scores related to an optimal QLI in almost all subscales, while in HD patients they explained part of the variability in psychological well-being, interpersonal functioning and personal fulfillment. HD condition results in a QLI more distant to the standards of controls.

[Analysis of the physical aspects of quality of life of kidney recipients]

OBJECTIVE

To identify the main factors of the physical domain modified after kidney transplantation and analyze the influence of those aspects in the perception of Overall quality of life (QOL).

METHOD

Longitudinal study, conducted with 63 chronic kidney patients, evaluated before and after kidney transplant, using the quality of life scale proposed by the World Health Organization.

RESULTS

We observed significant improvement in the physical aspects of QOL after kidney transplantation. Significant correlations were observed between physical aspects and the Overall QOL.

CONCLUSION

The kidney transplant generated improvement in all physical aspects of QOL. The factors that showed stronger correlation with the Overall QOL before the transplant were the capacity to work and pain. After the transplant, the perception of need for treatment was the factor that showed stronger correlation with the Overall QOL.

Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients

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.

Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established.

Association between sleep quality and cardiovascular damage in pre-dialysis patients with chronic kidney disease

Background

Poor sleep quality, a novel risk factor of cardiovascular diseases (CVD), is highly prevalent in patients with chronic kidney disease (CKD). The association between poor sleep quality and cardiovascular damage in patients with CKD is unclear. This study is aimed to assess the prevalence and related risk factors of sleep disturbance and determine the relationship between sleep quality and cardiovascular damage in Chinese patients with pre-dialysis CKD.

Methods

A total of 427 pre-dialysis CKD patients (mean age = 39 ± 15 years, 260 male/167 female) were recruited in this study. The demographics and clinical correlates were collected. The sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI), whereas the cardiovascular damage indicators (the Early/late diastolic peak flow velocity (E/A) ratio and left ventricular mass index (LVMI)) were determined by an echocardiographic examination.

Results

Of the CKD patients, 77.8% were poor sleepers as defined by a PSQI score > 5. Median estimated glomerular filtration rate (eGFR) was 69.4(15.8-110.9) ml/min/1.73 m². Logistic regression analysis revealed that left ventricular hypertrophy (LVH) was independently associated with the PSQI score (OR = 1.092, 95% CI = 1.011-1.179, p = 0.025), after adjustment for age, sex and clinical systolic blood pressure, diastolic blood pressure, Phosphate, Intact parathyroid hormone (iPTH), Hemoglobin and eGFR. The linear regression analysis showed that the E/A ratios were independently associated with the PSQI score (β = -0.115, P = 0.028) after adjustment for a series of potential confounding factors.

Conclusions

Poor sleep quality, which is commonly found in pre-dialysis CKD patients, is an independent factor associated with cardiovascular damage in CKD patients. Our finding implies that the association between poor sleep and CVD might be mediated by cardiac remodeling.

Quality of sleep and its relationship to quality of life in hemodialysis patients

INTRODUCTION

Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients' quality of life (QOL). This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients.

METHODS

By using a descriptive and correlational design, this study was conducted on 245 hemodialysis patients in 2012. Patients were selected by convenience sampling from the hemodialysis ward of four training hospitals of Tabriz and Maragheh. Quality of sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), and the quality of life for patients was measured by the Kidney Disease Quality Of Life questionnaire (KDQOL-SF).

RESULTS

83.3% of hemodialysis patients had poor quality of sleep. Poor quality of life was significantly associated with poor quality of sleep. There was a significant negative correlation between global PSQI and important aspects of quality of life including physical health, symptoms and problems, the impact of kidney disease on daily life, burden of kidney disease, mental health, social support, and sexual function.

CONCLUSION

The low quality of sleep in hemodialysis patients has an effect on the deterioration of their quality of life. Therefore, training, counseling, and advocacy programs should be developed to improve the patients' quality of sleep and quality of life, especially those with lower education level and income, and older people.

Health-related qualıty of lıfe, sleep qualıty, and depressıon in peritoneal dialysis and hemodıalysıs patıents

Health-related quality of life (HRQoL) and sleep quality (SQ) were impaired in patients with end-stage renal disease (ESRD). The impairment of both HRQoL and SQ and being in a depressive mood were found to be associated with increased morbidity and mortality in dialysis patients. We aimed to investigate the association between SQ, HRQoL, and depression, and to define independent predictors of SQ and depression in peritoneal dialysis (PD) and hemodialysis (HD) patients. Ninety HD patients (41 females, 49 males with mean age 50 ± 15.7 years) and 64 PD patients (27 females, 37 males with mean age 52.4 ± 15.3 years) receiving renal replacement therapy for at least 3 months were screened for the assessment of SQ, HRQoL, and depression in this cross-sectional study. A modified postsleep inventory, Short Form of Medical Outcomes Study (SF-36) and Beck depression inventory (BDI) were applied to all patients for evaluating SQ, HRQoL, and depression, respectively. HD and PD patients had similar total SQ scores. Physical and mental component scale of HRQoL were found to be significantly higher in HD patients (p < 0.001). PD patients were found to be much more in depressive mood when compared with HD patients (p < 0.001). Independent predictors of depression in patients were mental component scale of HRQoL, gender (being female), and dialysis modality (being PD patient). Physical component scale was also found to be an independent predictor of SQ. This study showed that despite similar SQ scores between two groups, HD patients had better HRQoL and less depression than PD patients.

The perception of sleep quality in kidney transplant patients during the first year of transplantation

OBJECTIVE

Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation.

METHODS

Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1) and between 12 and 15 months (Phase 2). The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was 36.7% in Phase 1 and 38.3% in Phase 2 of the study.

RESULTS

There were no significant differences between patients with and without changes in sleep quality between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2.

CONCLUSION

Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.

Are sleep and life quality of family caregivers affected as much as those of hemodialysis patients?

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.

Obstructive sleep apnea in incremental hemodialysis: determinants, consequences, and impact on survival

Sleep disorders are common in hemodialysis patients, although causes and consequences remain unclear. We sought to establish prevalence, determinants, and outcomes of sleep disturbances in patients receiving incremental dialysis. One hundred two unselected patients undergoing incremental high-flux hemodialysis or hemodiafiltration underwent limited overnight sleep study. Large subsets underwent echocardiography, interdialytic ambulatory blood pressure monitoring, and brain natriuretic peptide measurements. Patients were followed up to 44 months. Full sleep data were obtained in 91 patients. All had sleep disturbance as evidenced by an apnea-hypopnea index >5/min. We defined major obstructive sleep apnea (MOSA) as an apnea-hypopnea index ≥ 15, together with either significant oxygen desaturation or symptoms of daytime sleepiness. Forty patients met these criteria. Significant independent predictors of MOSA were age <65 years, male gender, has diabetes, and has a brain natriuretic peptide >2500 pg/mL. Mean ambulatory blood pressure and left ventricular mass index were significantly higher in these patients. In a model controlling for body mass index, high C-reactive protein, and the presence of cancer, MOSA was associated with a twofold increased risk of mortality, although this did not reach statistical significance. MOSA was common, and was associated with hypertension and high left ventricular mass index. Whether obstructive sleep apnea contributes to the high mortality remains to be firmly established.

The association between sleep problems and perceived health status: a Japanese nationwide general population survey

OBJECTIVE

Sleep problems in humans have been reported to impact seriously on daily function and to have a close association with well-being. To examine the effects of individual sleep problems on physical and mental health, we conducted a nationwide epidemiological survey and examined the associations between sleep problems and perceived health status.

METHODS

Cross-sectional surveys with a face-to-face interview were conducted in August and September, 2009, as part of the Nihon University Sleep and Mental Health Epidemiology Project (NUSMEP). Data from 2559 people aged 20 years or older were analyzed (response rate 54.0%). Participants completed a questionnaire on perceived physical and mental health statuses, and sleep problems including the presence or absence of insomnia symptoms (i.e., difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], and early morning awakening [EMA]), excessive daytime sleepiness (EDS), poor sleep quality (PSQ), short sleep duration (SSD), and long sleep duration (LSD).

RESULTS

The prevalence of DIS, DMS, and EMA was 14.9%, 26.6%, and 11.7%, respectively, and 32.7% of the sample reported at least one of them. At the complaint level, the prevalence of EDS, PSQ, SSD, and LSD was 1.4%, 21.7%, 4.0%, and 3.2%, respectively. Multiple logistic regression analyses revealed that DMS, PSQ, SSD, and LSD were independently associated with poor perceived physical health status; DIS, EDS, and PSQ were independently associated with poor perceived mental health status.

CONCLUSIONS

This study has demonstrated that sleep problems have individual significance with regard to perceived physical or mental health status.

Insomnia severity in chronic kidney disease patients with various therapies

The 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.

Quality of sleep and day-time sleepiness in chronic hemodialysis: a study of 400 patients

OBJECTIVE

Impaired sleep has potential health consequences in chronic hemodialysis patients. To date, this issue has not been examined in studies involving a large number of subjects. This study aimed to identify factors associated with poor sleep quality and excessive day-time sleepiness (EDS) in dialysis patients.

MATERIAL AND METHODS

This cross-sectional observational study involved 400 patients (59% male) from three hemodialysis centers (SD-HEMOFOR). Quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI), EDS by the Epworth Sleepiness Scale (ESS), risk of obstructive sleep apnea (OSA) by the Berlin questionnaire and comorbidity severity by the Charlson Comorbidity Index (CCI).

RESULTS

Poor sleep quality (PSQI >5) was found in 227 individuals (57%) and was associated with older age (p = 0.001), diabetes (p = 0.03), heart failure (p < 0.005), hypoalbuminemia (p = 0.01), low transferrin saturation (TSAT) (p = 0.009), higher CCI score (p = 0.01) and depression (p < 0.005). Independent factors were older age, heart failure, low TSAT and depressive symptoms. Day-time somnolence was present in 108 patients (27%) and was independently associated with stroke [odds ratio (OR) = 2.84, CI 1.03-7.76), lower hemoglobin concentration (OR = 2.45, CI 0.95-3.03) and high risk of OSA (OR = 1.65, CI 1.03-2.63). High risk of OSA (n = 120; 30%), was associated with hypertension (p < 0.001), overweight/obesity (p = 0.001), older age (p = 0.003) and symptoms of depression (p = 0.01).

CONCLUSIONS

Poor sleep quality and EDS were prevalent on chronic hemodialysis. Heart failure, low TSAT and depressive symptoms were independently associated with poor sleep quality. Stroke, anemia and high risk of OSA were independently associated with EDS. These results provide new insight into possible treatment strategies.

The subjective sleep quality and heart rate variability in hemodialysis patients

INTRODUCTION

Sleep disturbances and cardiovascular autonomic dysfunction are major complications of hemodialysis (HD). The goal of this study is to identify clinical, heart rate variability (HRV) or laboratory parameters that are independently associated with subjective sleep quality.

PATIENT AND METHODS

Forty-six stable HD patients filled out sleep questionnaires - Pittsburgh sleep quality index (PSQI), Athens insomnia scale (AIS), and Epworth sleepiness scale (ESS). In addition, they received analyses of 5-minute HRV twice, in lying posture before and after HD. We also recruited 50 healthy subjects who received 5-min HRV.

RESULTS

The patients with end-stage renal disease have a high rate of poor sleep quality according to PSQI, AIS, and ESS. The activities of total power (0-0.5 Hz), high-frequency power (HF, 0.15-0.40 Hz), low-frequency power (0.04-0.15 Hz), and very-low-frequency power (0.003-0.04 Hz) in HD patients are obviously lower than that in the healthy people. The poor sleepers (PSQI > 5) show lower heart rate, higher HF and variance before HD, but did not show a significant difference after HD. There is no significant difference between HRV and global score of AIS, but the insomnia group (AIS > 5) has higher BMI. These patients with sleepiness (ESS > 9) only reveal lower hemoglobin, although the global score of ESS reveals no significant relationship with HRV.

CONCLUSION

HD patients have a high rate of poor sleep quality and autonomic dysfunction. Greater attention for the evaluation of sleep quality is needed for the better care of HD patients.

Sleep disorders and home dialysis

Sleep disorders, such as restless legs, periodic limb movements and sleep apnea, and sleep complaints such as insomnia and daytime sleepiness, are very common in end-stage renal disease patients despite treatment with 3-times-a-week conventional hemodialysis. If left untreated, they are likely to impair quality of life and may alter cardiovascular outcomes in this patient population. Home dialysis has the potential to improve sleep disorders by offering more effective dialysis than conventional modalities. Although there has been little direct comparison between the impact of home dialysis and conventional dialysis on sleep disorders, there is evidence that both nocturnal peritoneal dialysis and nocturnal hemodialysis improve sleep apnea. The impact of home dialysis on other sleep disorders and sleep complaints is less impressive, but the data, thus far, have been limited. Further research is required to evaluate the impact of home dialysis on all sleep disorders and sleep complaints in this patient population and to determine whether this improves quality of life and cardiovascular morbidity and mortality.