Is Nutritional Status Associated With Self-reported Sleep Quality in the HEMO Study Cohort?

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.

Dietary Factors and Sleep Quality Among Hemodialysis Patients in Malaysia

OBJECTIVES

Poor sleep quality is a commonly seen problem in hemodialysis patients. This study investigated the associations between dietary factors and sleep quality among hemodialysis patients.

DESIGN AND METHODS

This is a cross-sectional study conducted among 184 eligible hemodialysis patients at four dialysis units in Malaysia. Three days dietary recall were used in the analysis of dietary intake and behavior. Sleep quality was assessed through Pittsburgh Sleep Quality Index.

RESULTS

More than half of the patients were poor sleepers. Among the sleep components, sleep latency affected patients the most, with the use of sleep medications was relatively low. A majority of the patients had inadequate dietary intake of energy (88%) and protein (75%). Dietary protein, potassium adjusted for body weight, and sodium intake were significantly increased in poor sleepers. Lower percentage of energy from carbohydrates; higher percentage of energy from fats; higher intakes of dietary protein, fat, phosphorus, and sodium were correlated with poorer sleep quality and its components. Skipping dinner on non-dialysis days and having supper on dialysis days were associated with poor sleep quality.

CONCLUSION

Poor sleep is prevalent among hemodialysis patients. Sleep quality of hemodialysis patients was highly associated with certain dietary factors. Periodical assessment of sleep quality and dietary intake is necessary to identify poor sleepers with inappropriate dietary intake to allow effective clinical and nutritional interventions to improve the sleep quality and nutritional status of these patients.

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.

Effect of extended hours dialysis on sleep quality in a randomized trial

AIM

Poor sleep quality is common in haemodialysis patients and associated with worse outcomes. In this pre-specified analysis, we examined the impact of extended hours haemodialysis on sleep quality.

METHODS

The ACTIVE Dialysis trial randomized 200 participants to extended (≥24 h/week) or standard (target 12-15 h) hours haemodialysis over 12 months. Sleep quality was measured in the Kidney Disease Quality of Life Short Form 1.3 (KDQOL-SF) by overall sleep quality score (0-10, 10 = 'very good') and the sleep subscale (0-100, 100 = 'best possible sleep') every 3 months via blinded telephone interview. The average intervention effect was calculated by mixed linear regression adjusted by time point and baseline score. Factors predicting sleep quality were assessed by multivariate regression analysis.

RESULTS

Overall sleep quality score and sleep subscale at baseline were similar in both groups (5.9 [95%CI 5.4-6.4] vs. 6.3 [5.9-6.8]; 65.0 [60.9-69.1] vs. 63.2 [59.1-67.3]; extended and standard hours, respectively). Extended hours haemodialysis led to a non-significant improvement in overall sleep quality score (average intervention effect 0.44 (-0.01 to 0.89), P = 0.053) and sleep subscale (average intervention effect 3.58 (-0.02 to 7.18), P = 0.051). Poor sleep quality was associated with being female and with current smoking. Sleep quality was positively associated with EuroQol-5D (EQ5D) and the SF-36 Physical Component and Mental Component Summary Scores but not with hospitalizations.

CONCLUSION

Sleep quality was not significantly improved by extended hours dialysis in this study. Sleep quality is positively correlated with quality of life in haemodialysis patients and is poorer in women and current smokers.

Diet quality in patients with end-stage kidney disease undergoing dialysis

BACKGROUND

People on haemodialysis (HD) are at risk of consuming a poor quality diet. This includes inadequate intake of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA).

OBJECTIVE

This study aims to investigate diet quality, with a particular focus on n-3 LCPUFA intake, in a population of incentre HD patients.

DESIGN

Dietary intake was measured using three 24 hour recalls; the Polyunsaturated food frequency questionnaire (PUFA FFQ) and the Total Diet Score (TDS). Dietary intake was also compared to evidence based practice guidelines (EBPG). Nutritional status was assessed using the Patient Generated Subjective Global Assessment (PG SGA).

SUBJECTS

A total of 32 dialysis patients were recruited, from two regional HD centres in New South Wales, Australia.

MAIN OUTCOME MEASURE

Diet quality was the main outcome measure.

RESULTS

Diet quality of study participants was poor, with the majority not meeting the EBPG for energy, protein and potassium. All participants exceeded the recommended amount of saturated fat. The mean TDS of the dialysis cohort was 10.2, which was significantly higher than the TDS of 9.3 of a healthy disease free cohort (p < 0.05). Positive correlations were found between TDS and LC omega-3 intake (r = 0.392) and TDS and total omega-6 intake (r = 0.363). Only 22% of participants met the suggested dietary target for n-3 LCPUFA intake.

CONCLUSION

Dialysis patients in this study had suboptimal diet quality. Improvements are required for better adherence to the EBPG. Increased consumption of n-3 LCPUFA fatty acids may also be of benefit.

What to eat for a better sleep in haemodialysis patients: Potential role of B vitamins intake and appetite

Objective:

Sleeping disorders are common among Haemodialysis-HD patients. In addition to well-known factors, food consumption impact on sleep quality needs being discovered. Aim was to examine the nutrition-related factors that may influence sleep quality in HD patients.

Methods:

One hundred and three patients in three HD centres participated. Data were collected with Pittsburgh Sleep Quality Index-PSQI and Questionnaire Form about socio-demographic characteristics and appetite. Biochemical findings were obtained; food consumption for three consecutive days was recorded. Independent Samples t/Mann Whitney U tests for mean comparison; Logistic Regression Analysis for determining variables affecting sleep quality, were used.

Results:

Mean age was 59.19±14.57 years. 51.5% were women. 37.9% had good (PSQI<5) and 62.1% had poor (PSQI≥5) sleep quality. Appetite had significant impact on sleep quality; poor sleeping risk was 4.194 fold higher in patients with bad appetite than those with good appetite (p=0.038). Biochemical findings of poor and good sleepers were similar, except for potassium and creatinine. Vitamins B₁, B₆ and folate intake of good and poor sleepers were significantly different. Patients with good sleep quality consumed significantly higher amounts of above B vitamins (p=0.030, p=0.036, p=0.034, respectively).

Conclusions:

Favourable effect of appetite and certain nutrients intake on sleep quality in HD patients was shown. Improving nutritional status of HD patients has potential to increase their sleep quality.

Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis

BACKGROUND

Depression affects approximately one-quarter of people treated with dialysis and is considered an important research uncertainty by patients and health professionals. Treatment for depression in dialysis patients may have different benefits and harms compared to the general population due to different clearances of antidepressant medication and the severity of somatic symptoms associated with end-stage kidney disease (ESKD). Guidelines suggest treatment of depression in dialysis patients with pharmacological therapy, preferably a selective serotonin reuptake inhibitor. This is an update of a review first published in 2005.

OBJECTIVES

To evaluate the benefit and harms of antidepressants for treating depression in adults with ESKD treated with dialysis.

SEARCH METHODS

We searched Cochrane Kidney and Transplant's Specialised Register to 20 January 2016 through contact with the Information Specialist using search terms relevant to this review.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing antidepressant treatment with placebo or no treatment, or compared to another antidepressant medication or psychological intervention in adults with ESKD (estimated glomerular filtration rate < 15 mL/min/1.73 m(2)).

DATA COLLECTION AND ANALYSIS

Data were abstracted by two authors independently onto a standard form and subsequently entered into Review Manager. Risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data were calculated with 95% confidence intervals (95% CI).

MAIN RESULTS

Four studies in 170 participants compared antidepressant therapy (fluoxetine, sertraline, citalopram or escitalopram) versus placebo or psychological training for 8 to 12 weeks. In generally very low or ungradeable evidence, compared to placebo, antidepressant therapy had no evidence of benefit on quality of life, had uncertain effects on increasing the risk of hypotension (3 studies, 144 participants: RR 1.72, 95% CI 0.75 to 3.92), headache (2 studies 56 participants: RR 2.91, 95% CI 0.73 to 11.57), and sexual dysfunction (2 studies, 101 participants: RR 3.83, 95% CI 0.63 to 23.34), and increased nausea (3 studies, 114 participants: RR 2.67, 95% CI 1.26 to 5.68). There were few or no data for hospitalisation, suicide or all-cause mortality resulting in inconclusive evidence. Antidepressant therapy may reduce depression scores during treatment compared to placebo (1 study, 43 participants: MD -7.50, 95% CI -11.94 to -3.06). Antidepressant therapy was not statistically different from group psychological therapy for effects on depression scores or withdrawal from treatment and a range of other outcomes were not measured.

AUTHORS' CONCLUSIONS

Despite the high prevalence of depression in dialysis patients and the relative priority that patients place on effective treatments, evidence for antidepressant medication in the dialysis setting is sparse and data are generally inconclusive. The relative benefits and harms of antidepressant therapy in dialysis patients are poorly known and large randomised studies of antidepressants versus placebo are required.

Sleep quality among Iranian hemodialysis patients: a multicenter study

Background:

Sleep disorders are prevalent complication in patients with end-stage renal disease undergoing hemodialysis (HD). The factors affecting sleep quality (SQ) of patients on HD have not been completely recognized yet. In addition, some studies have shown that poor SQ increases the risk of mortality in patients on HD.

Objectives:

This study aimed to identify the prevalence of poor SQ and its associated risk factors in Iranian patients on HD.

Patients and Methods:

This cross-sectional and multicenter study was conducted on 6878 patients on HD from 132 dialysis centers in Iran. Sleep domain of disease specific core of KDCS-SF questionnaire and generic core of this questionnaire (SF-36) were used to assess patients’ SQ and quality of life (QoL), respectively. A poor SQ was defined as a score of ≤ 61.2. Logistic and linear regression analyses were applied to assess predictors of SQ and their associations.

Results:

The mean age of patients was 54.4 ± 17.1 years and 39.7% of patients were > 60 years old. The majority of our patients had poor SQ (60.6%). Patients with diabetes mellitus were significantly more likely to have poor quality of sleep (63.4%). In logistic regression analysis, there were significant correlation between good SQ and younger age, shorter dialysis vintage, less muscle cramp, high QoL, high cognitive function score, and high sexual function. In addition, linear regression showed a significant association among SQ, QoL, and hospital stay as an outcome.

Conclusions:

With improving some factors and QoL of patients on HD, we can promote SQ in these patients that it might lead to reduction in length of hospital stay.