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Gela YY, Limenh LW, Simegn W, Ayenew W, Chanie GS, Seid AM, Beyna AT, Esubalew D, Mitku ML, Mengesha AK, Melese M. Poor sleep quality and associated factors among adult chronic kidney disease patients. Front Med (Lausanne) 2024; 11:1366010. [PMID: 38751978 PMCID: PMC11094326 DOI: 10.3389/fmed.2024.1366010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Background Poor sleep quality is a common concern in chronic kidney disease (CKD) patients, which can accelerate the progression of chronic renal disease and negatively impact their health-related quality of life, potentially leading to greater morbidity and mortality rates. It can also have an effect on the immune system, cognitive function, and emotional well-being of CKD patients. Furthermore, poor sleep quality may contribute to drug noncompliance and decreased participation in the entire treatment plan. Nonetheless, no research has been undertaken in Ethiopia on the prevalence of poor sleep quality and its associated factors among CKD patients. Objective This study aimed to assess the prevalence of poor quality of sleep and associated factors among chronic kidney disease patients at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals in 2020. Methods A cross-sectional study design was implemented at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals between February and April 2020. The study participants were chosen through systematic random sampling techniques. The Pittsburgh Sleep Quality Index (PSQI), a validated assessment tool, was utilized to measure sleep quality. A PSQI total score > 5 was used as an indicator of poor sleep quality. Subsequently, the data obtained were entered into Epi Data version 3.0 and then transferred to STATA 14 for analysis. Both bivariable and multivariable binary logistic regression analyses were performed to recognize factors associated with poor sleep quality. In the multivariable logistic regression analysis, variables demonstrating a p-value of ≤0.05 were considered statistically associated to poor sleep quality. Results In this study, 424 CKD patients were included. Among screened CKD patients, 42.9% tested positive for poor sleep quality with a 95% CI (38 to 47%). Independent predictors of poor sleep quality among CKD patients were common mental disorder [AOR = 1.8, 95% CI (1.19-2.89)], anemia [AOR = 2.7, 95% CI (1.71-4.36)], declined eGFR between 60 and 89.9 [AOR = 1.6; 95% CI (2.28-5.54)], 30-59.9 [AOR = 2.6, 95% CI (1.53-4.43)], and ≤ 30 [AOR = 3.8, 95% CI (1.17-12.61)], age > 50 years [AOR = 1.7(1.11-2.69)] and duration of disease 2.9 [AOR = 2.9, 95% CI (1.77-4.90)]. Conclusion In our study, almost 1 out of 2 CKD patients assessed for poor sleep quality tested positive. It was noted that poor sleep quality was more frequent among CKD patients with common mental disorders, anemia, decreased eGFR levels, individuals aged over 50 years, and those with a longer duration of the disease. Consequently, it's advised to regularly screen these CKD patients for poor sleep quality.
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Affiliation(s)
- Yibeltal Yismaw Gela
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Liknaw Workie Limenh
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondim Ayenew
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Sisay Chanie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdulwase Mohammed Seid
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemante Tafese Beyna
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Melese Legesse Mitku
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Assefa Kebad Mengesha
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihret Melese
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tian H, Wang L, He Q, Xu X, Zhang Y, Yang J, Ye H, Jiang L. Association between sleep quality and cardiovascular disease in maintenance hemodialysis patients: a prospective cohort study. Ren Fail 2023; 45:2278310. [PMID: 37936488 PMCID: PMC10653692 DOI: 10.1080/0886022x.2023.2278310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
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.
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Affiliation(s)
- Han Tian
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lulu Wang
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingyun He
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinxin Xu
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Zhang
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junwei Yang
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong Ye
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Jiang
- Center for Kidney Disease, The second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Hori S, Torimoto K, Tomizawa M, Yoneda T, Inoue K, Morizawa Y, Gotoh D, Nakai Y, Miyake M, Tanaka N, Fujimoto K. Impact of Nocturnal Polyuria and Sleep Quality in Kidney Transplant Recipients With Nocturia. Transplant Proc 2023:S0041-1345(23)00100-8. [PMID: 36934056 DOI: 10.1016/j.transproceed.2023.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND To investigate the quality of life (QOL) of patients with nocturia after kidney transplantation (KT) and the association between nocturnal polyuria and sleep quality. METHODS In a cross-sectional study, a patient who consented was evaluated using the following items: international prostate symptom QOL score, nocturia-quality of life score, overactive bladder symptom score, Pittsburgh sleep quality index, bladder diary, uroflowmetry, and bioimpedance analysis. Clinical and laboratory data were obtained from medical charts. RESULTS Forty-three patients were included in the analysis. Approximately 25% of patients urinated once at night, and 58.1% had nocturia twice. Nocturnal polyuria was observed in 86.0% of patients, and overactive bladder was observed in 23.3% of patients. According to the Pittsburgh sleep quality Index, 34.9% of patients had poor sleep quality. Multivariate analysis revealed that patients with nocturnal polyuria tended to have a high estimated glomerular filtration rate (P = .058). On the other hand, multivariate analysis for poor sleep quality revealed that high body fat percentage and low nocturia-quality of life total score were independently correlated factors (P = .008 and P = .012, respectively). Furthermore, the patients with nocturia ≥3/night were significantly older than those with nocturia ≤2/night (P = .022). CONCLUSION Nocturnal polyuria, poor sleep quality, and aging may decrease the QOL of patients with nocturia after KT. Further investigations, including optimal water intake and interventions, can lead to better management after KT.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | | | | | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Nara, Japan
| | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Nara, Japan; Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan
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Tan LH, Chen PS, Chiang HY, King E, Yeh HC, Hsiao YL, Chang DR, Chen SH, Wu MY, Kuo CC. Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis. Kidney Med 2022; 4:100458. [PMID: 35518837 PMCID: PMC9065912 DOI: 10.1016/j.xkme.2022.100458] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Rationale & Objective Poor sleep quality and insomnia are pervasive among patients with advanced chronic kidney disease (CKD); however, these health issues have not been systematically evaluated. Study Design Systematic review and meta-analysis. Setting & Study Populations Adult patients with CKD not receiving kidney replacement therapy (KRT), as well as adults receiving KRT, including hemodialysis, peritoneal dialysis, and kidney transplantation. Selection Criteria for Studies A systematic literature search using PubMed, Embase, and PsycNET, was conducted for articles published between January 1, 1990, and September 28, 2018. Data Extraction Data on the prevalences of poor sleep quality and insomnia in patients with CKD, including those receiving and not receiving KRT, were extracted. Analytical Approach Pooled prevalences were estimated using a random-effects meta-analysis and were stratified according to age, CKD stage, World Health Organization region, risk of bias, Pittsburgh Sleep Quality Index score, and the different criteria for insomnia that were used at diagnosis. Results Of 3,708 articles, 93 were selected, and significant methodological heterogeneity was present. The pooled prevalences of poor sleep quality for CKD without KRT, hemodialysis, peritoneal dialysis, and kidney transplantation were 59% (95% CI, 44%-73%), 68% (95% CI, 64%-73%), 67% (95% CI, 44%-86%), and 46% (95% CI, 34%-59%), respectively. The corresponding prevalences of insomnia were 48% (95% CI, 30%-67%), 46% (95% CI, 39%-54%), 61% (95% CI, 41%-79%), and 26% (95% CI, 9%-49%), respectively. Insomnia was significantly more prevalent among patients aged 51-60 years and those aged >60 years than among those aged <50 years. The prevalence of insomnia in the European region was the lowest of all World Health Organization regions. Limitations High interstudy heterogeneity. Conclusions Approximately half of the patients with advanced CKD had poor sleep quality or insomnia, and the prevalence was even higher among those who received KRT. Kidney transplantation may reduce the burden of poor sleep quality and insomnia.
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Affiliation(s)
- Lek-Hong Tan
- Department of Urology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Emily King
- Department of Medical Media Design and Application, Saint Bear Incorporated, Taichung, Taiwan
| | - Hung-Chieh Yeh
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - David Ray Chang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Hsuan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Min-Yen Wu
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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Diaz S, Abad K, Patel SR, Unruh ML. Emerging Treatments for Insomnia, Sleep Apnea, and Restless Leg Syndrome Among Dialysis Patients. Semin Nephrol 2022; 41:526-533. [PMID: 34973697 DOI: 10.1016/j.semnephrol.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sleep disturbances are highly prevalent in patients with predialysis chronic kidney disease, end-stage kidney disease, and after a kidney transplant. They contribute to impairment in daily function and are associated with a high burden of physical and psychiatric symptoms, decreased quality of life, and increased morbidity and mortality. Sleep disturbances also may precipitate and accelerate kidney disease progression. They often evolve across the spectrum of kidney dysfunction and may persist or re-emerge in kidney transplant recipients. Investigation into the multifaceted and dynamic relationships between sleep disturbance and chronic kidney disease requires consideration of myriad contributors including the progression of kidney disease itself, the role of treatment via dialysis and kidney transplant, psychosocial factors, and underlying sleep disorders. Despite sleep disturbance being identified as a priority to address by patients and caregivers, sleep disorders including insomnia, sleep apnea, and restless leg syndrome remain under-recognized and undertreated, and innovation in their management remains modest. In this article, we review the relationships between sleep disturbance and kidney disease, the impact of sleep disturbance and sleep disorders on symptom burden and mental health, and treatment opportunities that may address overlapping symptoms across the spectrum of kidney disease and that could improve patient-related and clinical outcomes.
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Affiliation(s)
- Shanna Diaz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Kashif Abad
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Sanjay R Patel
- Pulmonary, Sleep and Critical Care, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mark L Unruh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM; Nephrology Section, New Mexico Veterans Hospital, Albuquerque, NM.
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Xiong G, Hu L, Hu C, Yao Y. The effect of acupoint therapy on sleep quality of hemodialysis patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28182. [PMID: 34941075 PMCID: PMC8701858 DOI: 10.1097/md.0000000000028182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hemodialysis patients usually have sleep disturbance at varying degrees, which seriously affects the therapeutic efficacy and quality of life. Therefore, improving the sleep quality of hemodialysis patients is the key during treatment. Acupoint therapy can improve the sleep quality of patients. However, guidelines for improving sleep quality of hemodialysis patients by acupoint therapy are scant. This study aims to evaluate the effect of acupoint therapy on sleep quality in hemodialysis patients through a meta-analysis, providing clinical evidences. METHODS Randomized controlled trials (RCTs) reporting the effect of acupoint therapy on sleep quality in hemodialysis patients published before November 2021 will be searched in the China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang database, the Chinese Scientific Journal Database, PubMed, Embase, The Cochrane Library, and Web of Science databases. Eligible literatures will be screened according to inclusion and exclusion criteria and assessed for quality using the Cochrane Risk of Bias Assessment Tool. Meta-analysis will be performed using Revman 5.4 software. RESULTS This study will evaluate the effect of acupoint therapy on sleep quality in hemodialysis patients using the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION This study will provide a reliable evidence-based basis for conducting acupoint therapy to improve sleep quality in hemodialysis patients.
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Affiliation(s)
- Gang Xiong
- Emergency Intensive Care Unit, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Lijun Hu
- Emergency Intensive Care Unit, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Chenglian Hu
- Emergency Intensive Care Unit, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
| | - Yunhua Yao
- Hospital Office, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei Province, China
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Li H, Zuo L, Long S, Li B. Effects of nonpharmacological intervention on sleep quality in hemodialysis patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26401. [PMID: 34232172 PMCID: PMC8270589 DOI: 10.1097/md.0000000000026401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nonpharmacological intervention can improve the sleep quality of hemodialysis patients. However, there are many types of nonpharmacological interventions, which makes it difficult to determine the best one. Therefore, this study carried out network meta-analysis to evaluate the effects of nonpharmacological intervention on sleep quality of hemodialysis patients, so as to provide evidence for the selection of the optimal nonpharmacological intervention for the improvement of sleep quality of hemodialysis patients clinically. METHODS Randomized controlled trials on the effects of nonpharmaceutical interventions on sleep quality in hemodialysis patients were conducted by searching English databases (PubMed, Cochrane Library, EMBASE, and Web of Science) and Chinese databases (Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, and China Biomedical Literature Database) on computer. The retrieval time was from the establishment of the database to May 2021. Literature screening, data extraction, and evaluation of the risk of bias in the included studies were conducted independently by two researchers. Data analysis was performed with STATA14.0 and GEMTC 0.14.3 software. RESULTS We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSIONS This study will provide the best evidence-based evidence to support the effects of non-pharmacological interventions on sleep quality in hemodialysis patients. ETHICS AND DISSEMINATION Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/4BPKT.
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Han Q, Liu B, Lin S, Li J, Liang P, Fu S, Zheng G, Yang S, Li B, Yang Q. Pittsburgh Sleep Quality Index score predicts all-cause mortality in Chinese dialysis patients. Int Urol Nephrol 2021; 53:2369-2376. [PMID: 33788131 DOI: 10.1007/s11255-021-02842-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between Pittsburgh Sleep Quality Index (PSQI) score and survival of dialysis patients has not been well studied. The aim of this study was to explore the association between PSQI score and all-cause mortality in dialysis patients. METHODS Fifty-one hemodialysis and 58 peritoneal dialysis patients were enrolled in this study. PSQI score > 5 and ≤ 5 indicated "poor sleepers" and "good sleepers", respectively. The primary outcome was all-cause mortality. Kaplan-Meier survival curve and Cox proportional hazards regression analysis were performed. RESULTS The median PSQI score was 7.0 (4.0-10.0). Sixty-seven (61.5%) patients had poor sleep quality (SQ). Compared with good sleepers, poor sleepers had significantly lower levels of hemoglobin [74.0 (61.0, 85.0) vs. 78.0 (68.0, 97.0), P = 0.03] and serum bicarbonate (18.0 ± 4.5 vs. 20.0 ± 3.7, P = 0.022). The follow-up time was 69.1 ± 29.9 months. By multivariate Cox proportional hazards analysis, PSQI total score was the independent risk factor of all-cause mortality [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.05-1.36, P = 0.007]. Restricted cubic spline (RCS) analysis showed that 7 was the cutoff value at which the effect of PSQI score on mortality changed. Patients with a PSQI score > 7 had a 2.96-fold increased risk of all-cause mortality (HR 2.96, 95% CI 1.15-7.61, P = 0.025). CONCLUSIONS PSQI score can be used as a predictor of all-cause mortality in dialysis patients, and those with PSQI > 7 were associated with increased odds of mortality.
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Affiliation(s)
- Qianqian Han
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Bo Liu
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Shumin Lin
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Jiajia Li
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Peifen Liang
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Sha Fu
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Guiqiong Zheng
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Suqiong Yang
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China
| | - Bin Li
- Clinical Trials Unit, the First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China.
| | - Qiongqiong Yang
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou, Guangdong, People's Republic of China.
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Tammadon MR, Nobahar M, Hydarinia-Naieni Z, Ebrahimian A, Ghorbani R, Vafaei AA. The Effects of Valerian on Sleep Quality, Depression, and State Anxiety in Hemodialysis Patients: A Randomized, Double-blind, Crossover Clinical Trial. Oman Med J 2021; 36:e255. [PMID: 33936782 PMCID: PMC8077445 DOI: 10.5001/omj.2021.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Our study sought to determine the effects of valerian on sleep quality, depression, and state anxiety in hemodialysis (HD) patients. METHODS This randomized, double-blind, placebo-controlled, crossover clinical trial was conducted on 39 patients undergoing HD allocated into a valerian and placebo group. In the first phase of the study, group A (n = 19) received valerian and group B (n = 20) received a placebo one hour before sleep every night for a total of one month. Sleep quality, state anxiety, and depression were assessed in the patients at the beginning and end of the intervention using the Pittsburgh Sleep Quality Index, the Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory. In the second phase, the two groups' treatment regimen was swapped. After a one-month washout period, the same process was repeated on the crossover groups (i.e., group A received placebo and group B received valerian). RESULTS In the first phase, the mean sleep quality, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly higher in group A compared to group B (7.6 vs. 3.2, p< 0.001; 6.5 vs. 2.3, p =0.013; 14.6 vs. 7.3, p =0.003, respectively). In the second phase, the mean sleep disorder, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly lower in group A compared to group B (1.4 vs. 4.6, p< 0.001; 1.2 vs. 3.8, p =0.002; 1.5 vs. 6.2, p< 0.001, respectively). CONCLUSIONS Valerian significantly improved sleep quality, the symptoms of state anxiety, and depression in HD patients.
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Affiliation(s)
- Mohammad Reza Tammadon
- Department of Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
- Corresponding author:
| | - Zaynab Hydarinia-Naieni
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbasali Ebrahimian
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Ali Vafaei
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran
- Faculty of Medicine, Department of Physiology, Semnan University of Medical Sciences, Semnan, Iran
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Derya Ister E, Citlik Saritas S. The Effect of Acupressure on Daytime Sleepiness and Sleep Quality in Hemodialysis Patients. Holist Nurs Pract 2021; 35:71-80. [PMID: 33555720 DOI: 10.1097/hnp.0000000000000436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was carried out to evaluate the effect of acupressure applied to hemodialysis patients on the level of daytime sleepiness and sleep quality. The data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. In the study, a total of 12 sessions of acupressure were applied to the Shenmen (HT7), Sanyingjao (Sp6), and Yungquan (KI1) points in the experimental group for 4 weeks. No intervention was applied to the control group. After the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group and that daytime sleepiness was less compared with the control group. After the acupressure, it was determined that the sleep latency of the experimental group was statistically significantly less and their total sleep duration was higher compared with the control group (P < .05). Although there was a decrease in the sleep quality of the experimental group 1 month after the cessation of the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group (P < .05). It was concluded that acupressure was an effective nursing intervention in increasing sleep quality and decreasing daytime sleepiness of hemodialysis patients.
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Affiliation(s)
- Emine Derya Ister
- Nursing Department, Faculty of Health Sciences, Kahramanmaras Sutcu Imam Universıty, Kahramanmaraş, Turkey (Dr Derya Ister); and Department of Internal Medicine Nursing, Nursing Faculty, Inonu University, Malatya, Turkey (Dr Citlik Saritas)
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11
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Cheng E, Evangelidis N, Guha C, Hanson CS, Unruh M, Wilkie M, Schell J, Hecking M, Gonzalez AM, Ju A, Eckert DJ, Craig JC, Tong A. Patient experiences of sleep in dialysis: systematic review of qualitative studies. Sleep Med 2021; 80:66-76. [PMID: 33571871 DOI: 10.1016/j.sleep.2021.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVE Sleep problems affect more than half of patients receiving dialysis and are associated with increased risk of mortality, cardiovascular events, depression and impaired functioning and quality of life. Symptoms such as fatigue and exhaustion may be attributed to sleep problems or sleep disorders, as well as the burden of kidney disease and treatment. This study aims to describe the patient perspectives on the reasons, impact and management of sleep problems in dialysis. STUDY DESIGN Systematic review and thematic synthesis of qualitative studies that report patient experience and perspectives on sleep in dialysis. SETTING AND POPULATION Patients receiving dialysis. SEARCH STRATEGY AND SOURCES MEDLINE, Embase, PsycINFO, CINAHL, reference lists and PhD dissertations were searched from inception to August 2019. DATA EXTRACTION All text from the results/conclusion of the primary studies. ANALYTICAL APPROACH Thematic synthesis. RESULTS We included 48 studies involving 1156 participants from 16 countries. We identified six themes: dominating demands of treatment (with subthemes of: demanding and relentless schedule, regret for wasted time); scheduling and control (managing sleep routines, napping and nocturnal sleep disruption, meditative aids); disruptions due to dialysis (unsettled sleep, hypervigilance and worry); symptoms depriving sleep (difficulty falling asleep, constant waking); overwhelmed and without choice (futility of sleep, uncontrollable exhaustion, restlessness is irrepressible); and as a coping mechanism (avoiding anxiety, alleviating symptoms, combating boredom). LIMITATIONS Most studies were conducted in high-income, English-speaking countries. CONCLUSION The treatment and symptom burden of dialysis disrupts and deprives patients of sleep, which leads to overwhelming and uncontrollable exhaustion. Better management of symptoms and effective strategies to manage sleep routines may improve sleep quality for better overall health in patients receiving dialysis.
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Affiliation(s)
- Elaine Cheng
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA; Section of Nephrology, Medicine Service, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Martin Wilkie
- Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jane Schell
- Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, PA, USA
| | - Manfred Hecking
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Danny J Eckert
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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De Silva I, Evangelidis N, Hanson CS, Manera K, Guha C, Scholes-Robertson N, Craig JC, Johnson D, Cho Y, Viecelli AK, Tong A. Patient and caregiver perspectives on sleep in dialysis. J Sleep Res 2020; 30:e13221. [PMID: 33103303 DOI: 10.1111/jsr.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
Sleep disturbances are common among patients receiving dialysis and are associated with an increased risk of mortality and morbidity, and impaired quality of life. Despite being highly prioritised by patients, sleep problems remain under-diagnosed and inadequately managed. The aim of the present study was to describe the perspectives of patients receiving dialysis and their caregivers on sleep. We extracted qualitative data on sleep from 26 focus groups, two international Delphi surveys, and two consensus workshops involving 644 patients and caregivers from 86 countries as part of the Standardised Outcomes in Nephrology-Haemodialysis and -Peritoneal Dialysis (SONG-HD/SONG-PD) initiatives. The responses were from patients aged ≥18 years receiving haemodialysis or peritoneal dialysis, and their caregivers. We analysed the data using thematic analysis with five themes identified: constraining daily living (with subthemes of: battling intrusive tiredness, exacerbating debilitating conditions, broken and incapacitated); roadblocks in relationships (unable to meet family needs, antipathy due to misunderstanding, wreaking emotional havoc); burden on caregivers (stress on support persons, remaining alert to help); losing enjoyment (limiting social contact, disempowerment in life); and undermining mental resilience (aggravating low mood, diminishing coping skills, reducing functional ability). Sleep disturbances are exhausting for patients on dialysis and pervade all aspects of their lives including the ability to do daily tasks, and maintaining relationships, mental and emotional well-being. Better assessment and management of sleep problems in dialysis is needed, which may lead to improvements in overall health and quality of life.
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Affiliation(s)
- Iresha De Silva
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Department of Community Paediatrics, Liverpool Community Health Centre, Liverpool, NSW, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Yeoungiee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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13
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Stergiannis P, Govari M, Jahaj E, Marvaki C, Toulia G, Marvaki K, Chasioti G, Intas G. Sleep Disorders and Restless Legs Syndrome in Hemodialysis Patients in Greece: A Cross-Sectional Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1195:155-162. [PMID: 32468471 DOI: 10.1007/978-3-030-32633-3_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sleep disorders, including insomnia and extreme sleep times, adversely affect the risk of developing illnesses and contribute to increased mortality rates. The aim of the study was to investigate sleep disorders experienced by hemodialysis patients in order to draw useful conclusions and to propose solutions to address this serious problem. MATERIAL AND METHOD This is a cross-sectional study, and the study sample consisted of 120 patients undergoing hemodialysis from February to April 2017 at a general hospital in Greece. The main tools of the survey were the Athens Insomnia Scale, the Berlin Questionnaire, and the RLS (Restless Legs Syndrome) Questionnaire. RESULTS Most of the patients were males (68.3%), aged 68.1 ± 14.1 years. Half of the responders suffered from insomnia. About two thirds were at low risk for sleep apnea. Most of the responders suffered from restless legs syndrome (62.5%). Insomnia was significantly associated with higher BMI (RR: 0.180; 95% CI [0.032, 1.003]), analgesics receiving (RR: 0.125; 95% CI [0.031, 0.513]), hypnotics receiving (RR: 0.072; 95% CI [0.010, 0.533]), and restless legs syndrome (RR: 2.281; 95% CI [1.179, 4.413]) after adjusting for sociodemographic variables.Sleep apnea was significantly linked to analgesics (RR: 0.309; 95% CI [0.093, 1.027]; p = 0.045). RLS was significantly tied to hypnotics (RR: 0.077; 95% CI [0.008, 0.745]; p = 0.027) and insulin (RR: 0.019; 95% CI [0.001, 0.542]; p = 0.020). CONCLUSIONS Sleep disorders are common symptoms among hemodialysis patients. The restless legs syndrome occurs at a lower frequency among hemodialysis patients but is a major problem for them.
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Affiliation(s)
| | | | | | | | - Georgia Toulia
- Faculty of Nursing, University of West Attica, Aigaleo, Greece
| | | | | | - George Intas
- General Hospital of Nikaia "AgiosPanteleimon", Nikaia, Greece.
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It's been a hard day's night: A diary study on hardiness and reduced sleep quality among naval sailors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2019.109635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Mirghaed MT, Sepehrian R, Rakhshan A, Gorji H. Sleep Quality in Iranian Hemodialysis Patients: A Systematic Review and Meta-analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:403-409. [PMID: 31772913 PMCID: PMC6875887 DOI: 10.4103/ijnmr.ijnmr_184_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 05/01/2019] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Background: Hemodialysis is a major therapeutic method for many chronic kidney disease patients that causes complications. One of these complications tends to be sleep disorders. This study was performed through systematic review and meta-analysis to determine the prevalence of low sleep quality in hemodialysis patients in Iran. Materials and Methods: Journal papers written in English and Persian searched from January 2000 to July 2018 were selected. The search keywords included (Prevalence OR Epidemiology) AND (hemorenodialysis OR hemodialysate OR 'intermittent chronic haemodialysis' OR 'intermittent chronic hemodialysis' OR 'intermittent haemodialysis' OR 'intermittent hemodialysis' OR 'kidney dialysis' OR 'renal dialysis') AND ('sleep problem' OR 'sleep disturbance' OR 'sleep disorder' OR 'sleep quality' OR 'chronobiology disorders' OR dyssomnia). To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95 per cent confidence interval. The main international electronic databases were Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID and Irandoc. The data were analysed using the Stata (version 13.0). Results: After searching through the databases and other resources, 21 articles (7 in Persian and 14 in English language) were included. The overall prevalence of low sleep quality in dialysis patients was 75.30 per cent (95 per cent confidence interval, 70.08–82.50). The heterogeneity study showed moderate heterogeneity among studies (I2 = 50.30 per cent, p < 0.05). Conclusions: The results of this study showed that the prevalence of low sleep quality in hemodialysis patients has become a common problem. Thus, patients' sleep quality need to be evaluated periodically.
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Affiliation(s)
- Masood Taheri Mirghaed
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Sepehrian
- School of Health Services Management and Medical Information Science, Department of Health Services Administration, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Rakhshan
- Department of Foreign Language, Tehran University of Medical Sciences, Tehran, Iran
| | - HasanAbolghasem Gorji
- School of Health Services Management and Medical Information Science, Department of Health Services Administration, Iran University of Medical Sciences, Tehran, Iran
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16
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Lin KY, Lin YC, Wang HH. Differential effects of age on quality of sleep and depression in patients receiving maintenance haemodialysis. Psychogeriatrics 2019; 19:465-474. [PMID: 30767321 DOI: 10.1111/psyg.12424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/26/2017] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Poor quality of sleep and depression are common and highly associated with each other in patients on haemodialysis. We aimed to investigate whether they share common risk factors and how age may influence their development. METHODS Cross-sectional observation study on 120 haemodialysis patients with quality of sleep and depression assessed by Pittsburgh Sleep Quality Index (PSQI) and Taiwanese Depression Questionnaire (TDQ), respectively. RESULTS The prevalence of poor quality of sleep and depression was 92.5% and 43.3%, respectively. PSQI scores were associated with age, gender, education and monthly income while TDQ scores were associated with low serum creatinine and albumin levels. Elderly patients at ages older than 65 had the highest average PSQI score (12.26 ± 4.35) than the young group at age 20-44 (8.25 ± 4.39) (P = 0.028) but the average TDQ scores were similar across three age groups. The proportion of those who had high PSQI scores was significantly higher in the elderly group (54.4%, P = 0.017) and the 44-65-years group (51.9%, P = 0.028) than the young group (16.7%). The proportion of those who reported normal quality of sleep was much lower in the elderly group (0.0%) than the other two groups (25.0%, P < 0.001 and 11.7%, P < 0.01). The proportions of those who had different ranges of TDQ scores did not show such a pattern of strong age dependence. CONCLUSIONS Poor quality of sleep in haemodialysis patients is associated with socio-economic factors while depression is more related to biochemistry indicators. A majority of older patients suffer very poor quality of sleep while depression appears equally severe and common across different age groups.
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Affiliation(s)
- Kuan-Yu Lin
- Department of Nursing, School of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yi-Chun Lin
- Department of Nursing, School of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Nursing, National Taiwan University Hospital Hsin-Chu Branch, Hsin Chu City, Taiwan
| | - Hsiu-Ho Wang
- Department of Nursing, School of Nursing, Yuanpei University of Medical Technology, Hsin Chu City, Taiwan
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17
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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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18
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Liao JL, van den Broek-Best O, Smyth B, Hong D, Vo K, Zuo L, Gray NA, Chan CT, de Zoysa J, Perkovic V, Jiang L, Jardine M. Effect of extended hours dialysis on sleep quality in a randomized trial. Nephrology (Carlton) 2018; 24:430-437. [PMID: 29424935 DOI: 10.1111/nep.13236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Jin-Lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | | | - Brendan Smyth
- Renal & Metabolic Division, The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Daqing Hong
- Renal & Metabolic Division, The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.,Renal Department, Sichuan Provincial People's Hospital, Chengdu, China.,Medical School of UESTC, Chengdu, China
| | - Kha Vo
- Statistics Division, The George Institute for Global Health, UNSW, Sydney, Australia.,New South Wales Bureau of Health Information, University of Queensland, Brisbane, Queensland, Australia
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Nicholas A Gray
- The Sunshine Coast Clinical School, University of Queensland, Australia
| | | | - Janak de Zoysa
- Department of Medicine, The University of Auckland, New Zealand
| | - Vlado Perkovic
- Renal & Metabolic Division, The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Lei Jiang
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Meg Jardine
- Renal & Metabolic Division, The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.,Statistics Division, The George Institute for Global Health, UNSW, Sydney, Australia
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Change of sleep quality from pre- to 3 years post-solid organ transplantation: The Swiss Transplant Cohort Study. PLoS One 2017; 12:e0185036. [PMID: 29020112 PMCID: PMC5636098 DOI: 10.1371/journal.pone.0185036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 09/04/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Poor sleep quality (SQ) is common after solid organ transplantation; however, very little is known about its natural history. We assessed the changes in SQ from pre- to 3 years post-transplant in adult heart, kidney, liver and lung recipients included in the prospective nation-wide Swiss Transplant Cohort Study. We explored associations with selected variables in patients suffering persistent poor SQ compared to those with good or variable SQ. METHODS Adult single organ transplant recipients enrolled in the Swiss Transplant Cohort Study with pre-transplant and at least 3 post-transplant SQ assessment data were included. SQ was self-reported pre-transplant (at listing), then at 6, 12, 24 and 36 months post-transplant. A single SQ item was used to identify poor (0-5) and good sleepers (6-10). Between organ groups, SQ was compared via logistic regression analysis with generalized estimating equations. Within the group reporting persistently poor SQ, we used logistic regression or Kaplan-Meier analysis as appropriate to check for differences in global quality of life and survival. RESULTS In a sample of 1173 transplant patients (age: 52.1±13.2 years; 65% males; 66% kidney, 17% liver, 10% lung, 7% heart) transplanted between 2008 and 2012, pre- transplant poor SQ was highest in liver (50%) and heart (49%) recipients. Overall, poor SQ decreased significantly from pre-transplant (38%) to 24 months post-transplant (26%) and remained stable at 3 years (29%). Patients reporting persistently poor SQ had significantly more depressive symptomatology and lower global quality of life. CONCLUSION Because self-reported poor SQ is related to poorer global quality of life, these results emphasize the need for further studies to find suitable treatment options for poor SQ in transplant recipients.
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A single question regarding mobility in the World Health Organization quality of life questionnaire predicts 3-year mortality in patients receiving chronic hemodialysis. Sci Rep 2017; 7:11981. [PMID: 28931925 PMCID: PMC5607280 DOI: 10.1038/s41598-017-12276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/07/2017] [Indexed: 12/25/2022] Open
Abstract
Low quality of life, depression and poor quality of sleep are associated with increased mortality in hemodialysis patients. It is not clear which factor has the highest predictive power and what the core element is to explain the predictability. We thus conducted a prospective cohort study that included 151 hemodialysis adults. Three traits of interest were assessed by World Health Organization Quality of Life questionnaire, an abbreviated version (WHOQOL-BREF), Taiwanese Depression Questionnaire, and Athens Insomnia Scale, respectively. They were followed for more than 3 years and the all-cause mortality was 30.5%. The prevalence of quality of life at the lowest tertile, depression and poor quality of sleep was 19.9%, 43.0% and 74.2%, respectively. Discriminant analysis showed the standardized coefficient of each factor as 0.813, −0.289 and 0.066, indicating the highest discriminating power by quality of life to predict mortality. Question 15 “how well are you able to get around?” in the physical health domain of WHOQOL-BREF independently associated a hazard ratio of mortality 0.623 (95% confidence interval 0.423-0.918). Subjective perception of overall quality of life was more related to psycho-social-environmental factors. In conclusion, mobility is an independent and powerful predictor to long term mortality in patients on chronic hemodialysis.
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Kennedy C, Ryan SA, Kane T, Costello RW, Conlon PJ. The impact of change of renal replacement therapy modality on sleep quality in patients with end-stage renal disease: a systematic review and meta-analysis. J Nephrol 2017; 31:61-70. [DOI: 10.1007/s40620-017-0409-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
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22
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Nochaiwong S, Ruengorn C, Awiphan R, Panyathong S, Noppakun K, Chongruksut W, Chiewchanvit S. Development of a multidimensional assessment tool for uraemic pruritus: Uraemic Pruritus in Dialysis Patients (UP-Dial). Br J Dermatol 2017; 176:1516-1524. [PMID: 28012182 DOI: 10.1111/bjd.15268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dialysis patients with uraemic pruritus (UP) have significantly impaired quality of life. To assess the therapeutic effect of UP treatments, a well-validated comprehensive and multidimensional instrument needed to be established. OBJECTIVES To develop and validate a multidimensional scale assessing UP in patients on dialysis: the Uraemic Pruritus in Dialysis Patients (UP-Dial). METHODS The development and validation of the UP-Dial instrument were conducted in four phases: (i) item generation, (ii) development of a pilot questionnaire, (iii) refinement of the questionnaire with patient recruitment and (iv) psychometric validation. Participants completed the UP-Dial, the visual analogue scale (VAS) of UP, the Dermatology Life Quality Index (DLQI), the Kidney Disease Quality of Life-36 (KDQOL-36), the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) between 15 May 2012 and 30 November 2015. RESULTS The 27-item pilot UP-Dial was generated, with 168 participants completing the pilot scale. After factor analysis was performed, the final 14-item UP-Dial encompassed three domains: signs and symptoms, psychosocial, and sleep. Face and content validity were satisfied through the item generation process and expert review. Psychometric analysis demonstrated that the UP-Dial had good convergent and discriminant validity. The UP-Dial was significantly correlated [Spearman rank coefficient, 95% confidence interval (CI)] with the VAS-UP (0·76, 0·69-0·83), DLQI (0·78, 0·71-0·85), KDQOL-36 (-0·86, -0·91 to -0·81), PSQI (0·85, 0·80-0·89) and BDI (0·70, 0·61-0·79). The UP-Dial revealed excellent internal consistency (Cronbach's α 0·90, 95% CI 0·87-0·92) and reproducibility (intraclass correlation 0·95, 95% CI 0·90-0·98). CONCLUSIONS The UP-Dial is valid and reliable for assessing UP among patients on dialysis. Future research should focus on the cross-cultural adaptation and translation of the scale to other languages.
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Affiliation(s)
- S Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.,Pharmacoepidemiology and Statistics Clinic, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - C Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.,Pharmacoepidemiology and Statistics Clinic, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - R Awiphan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - S Panyathong
- Kidney Center, Nakornping Hospital, Chiang Mai, 50180, Thailand
| | - K Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - W Chongruksut
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - S Chiewchanvit
- Division of Dermatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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23
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Han B, Zhu FX, Shi C, Wu HL, Gu XH. Association between Serum Vitamin D Levels and Sleep Disturbance in Hemodialysis Patients. Nutrients 2017; 9:nu9020139. [PMID: 28216568 PMCID: PMC5331570 DOI: 10.3390/nu9020139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/17/2017] [Accepted: 02/07/2017] [Indexed: 01/25/2023] Open
Abstract
Sleep disturbance is a frequent and serious complication of hemodialysis (HD). Low serum vitamin D levels have been associated with sleep quality in non-HD subjects. Our aim was to examine the possible association between serum vitamin D levels and the presence of sleep disturbance in HD patients. We recruited 141 HD patients at the HD center of the First Affiliated Hospital of Jiaxing University during 2014–2015. Serum levels of 25-hydroxyvitamin D (25(OH)D) were determined by the competitive protein-binding assay. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Demographic, clinical and laboratory data were recorded. Meanwhile, 117 healthy control subjects were also recruited and underwent measurement of 25(OH)D. Eighty-eight patients (62.4%) had sleep disturbance (PSQI scores ≥ 5). Patients with sleep disturbance showed lower levels of 25(OH)D as compared to those without sleep disturbance (85.6 ± 37.4 vs. 39.1 ± 29.1 nmol/L, p < 0.001). In multivariate analyses, serum levels of 25(OH)D (≤48.0 nmol/L) were independently associated with sleep disturbance in HD patients (OR 9.897, 95% CI 3.356–29.187, p < 0.001) after adjustment for possible variables. Our study demonstrates that low serum levels of vitamin D are independently associated with sleep disturbance in HD patients, but the finding needs to be confirmed in future experimental and clinical studies.
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Affiliation(s)
- Bin Han
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Fu-Xiang Zhu
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Chao Shi
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Heng-Lan Wu
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Xiao-Hong Gu
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
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24
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Brekke FB, Waldum-Grevbo B, von der Lippe N, Os I. The effect of renal transplantation on quality of sleep in former dialysis patients. Transpl Int 2016; 30:49-56. [PMID: 27696543 DOI: 10.1111/tri.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/29/2016] [Accepted: 09/26/2016] [Indexed: 01/08/2023]
Abstract
Data on sleep quality in renal transplanted (RTX) patients are scarce, and longitudinal studies are lacking. The purpose of this study was to assess the prevalence of sleep complaints in RTX patients and identify variables associated with improvement in sleep quality. In a longitudinal study, 301 dialysis patients were followed for up to 5.5 years, during which time 142 were transplanted. Out of the transplanted patients, a total of 110 were eligible for inclusion. Sleep quality and depression were assessed with the validated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), and data were collected during dialysis and after RTX. Based on PSQI scores, 59% were characterized as poor sleepers after RTX compared to 75% when in dialysis (P = 0.016). A total of 46% experienced a clinical relevant improvement in overall sleep quality, while 21% experienced a clinical relevant deterioration. In multivariable analyses, clinical meaningful change in sleep quality was not associated with either depressive symptoms assessed with BDI or other clinical variables. Sleep quality improved after RTX in nearly half of the patients, but poor sleep quality was prevalent in RTX patients. Therefore, sleep quality should routinely be assessed in RTX patients.
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Affiliation(s)
- Fredrik B Brekke
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Nanna von der Lippe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Os
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
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25
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Ogna A, Forni Ogna V, Haba Rubio J, Tobback N, Andries D, Preisig M, Tafti M, Vollenweider P, Waeber G, Marques-Vidal P, Heinzer R. Sleep Characteristics in Early Stages of Chronic Kidney Disease in the HypnoLaus Cohort. Sleep 2016; 39:945-53. [PMID: 26715230 PMCID: PMC4791628 DOI: 10.5665/sleep.5660] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/14/2015] [Indexed: 02/04/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the association between early stages of chronic kidney disease (CKD) and sleep disordered breathing (SDB), restless legs syndrome (RLS), and subjective and objective sleep quality (SQ). METHODS Cross-sectional analysis of a general population-based cohort (HypnoLaus). 1,760 adults (862 men, 898 women; age 59.3 (± 11.4) y) underwent complete polysomnography at home. RESULTS 8.2% of participants had mild CKD (stage 1-2, estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m(2) with albuminuria) and 7.8% moderate CKD (stage 3, eGFR 30-60 mL/min/1.73 m(2)). 37.3% of our sample had moderate-to-severe SDB (apnea-hypopnea index [AHI] ≥ 15/h) and 15.3% had severe SDB (AHI ≥ 30/h). SDB prevalence was positively associated with CKD stages and negatively with eGFR. In multivariate analysis, age, male sex, and body mass index were independently associated with SDB (all P < 0.001), but kidney function was not. The prevalence of RLS was 17.5%, without difference between CKD stages. Periodic leg movements index (PLMI) was independently associated with CKD stages. Subjective and objective SQ decreased and the use of sleep medication was more frequent with declining kidney function. Older age, female sex, and the severity of SDB were the strongest predictors of poor SQ in multivariate regression analysis but CKD stage was also independently associated with reduced objective SQ. CONCLUSIONS Patients with early stages of CKD have impaired SQ, use more hypnotic drugs, and have an increased prevalence of SDB and PLM. After controlling for confounders, objective SQ and PLMI were still independently associated with declining kidney function.
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Affiliation(s)
- Adam Ogna
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Valentina Forni Ogna
- Service of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - José Haba Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Dana Andries
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Mehdi Tafti
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Center for Integrative Genomics, Lausanne University, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Gerard Waeber
- Department of Internal Medicine, Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Internal Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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26
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Liebman S, Li NC, Lacson E. Change in quality of life and one-year mortality risk in maintenance dialysis patients. Qual Life Res 2016; 25:2295-306. [PMID: 26941217 DOI: 10.1007/s11136-016-1257-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Quality of life (QOL) is an important metric of high-quality dialysis care. QOL is commonly measured by the Short Form 36 Questionnaire (SF-36), which provides two summary scores: a mental component score (MCS) and a physical component score (PCS). Poor QOL is associated with mortality in dialysis patients. Small studies show that changes in QOL also predicts mortality. We investigated whether changes in QOL over time are associated with mortality in a large cohort of maintenance hemodialysis patients. METHODS This retrospective study was conducted in 1017 outpatient dialysis facilities. Over 10,000 hemodialysis patients completed two SF-36 surveys. We compared 1-year morality rates in those whose MCS or PCS increased or decreased ±5 vs. those whose did not. RESULTS For those who completed two surveys, mean score for PCS was unchanged, whereas MCS increased slightly (48.6 vs. 48.9, p = 0.05). Individual patients, however, showed marked variation. On the second survey, more than half of patients demonstrated a ± 5 point change in the PCS and/or MCS. After multivariate adjustment, a ≥ 5 decrease in MCS was associated with an increase in mortality (HR = 1.33, 95 % CI 1.18, 1.50). CONCLUSIONS Clinicians should be aware that many patients experience a significant change in both the MCS and PCS on dialysis. A MCS decrease of ≥5 was associated with increased mortality. More study is needed to determine whether this is a causal relationship. Physicians should evaluate root causes and seek to mitigate declines in QOL whenever possible.
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Affiliation(s)
- Scott Liebman
- University of Rochester Medical Center, 601 Elmwood Ave, Box 675, Rochester, NY, 14642, USA.
| | - Nien-Chen Li
- Fresenius Medical Care North America, Waltham, MA, USA
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28
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Aribas A, Kayrak M, Tekinalp M, Akilli H, Alibasic H, Yildirim S, Gunduz M, Taner A, Unlu A. The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus. Korean J Intern Med 2015; 30:316-24. [PMID: 25995662 PMCID: PMC4438286 DOI: 10.3904/kjim.2015.30.3.316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/23/2014] [Accepted: 11/14/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/AIMS Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. METHODS The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. RESULTS The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. CONCLUSIONS Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.
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Affiliation(s)
- Alpay Aribas
- Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kayrak
- Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Tekinalp
- Cardiology Clinic, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Hakan Akilli
- Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey
| | | | - Serkan Yildirim
- Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Gunduz
- Department of Cardiology, Ercis Government Hospital, Van, Turkey
| | - Alpaslan Taner
- Department of Biochemistry, Dr Faruk Sükan Maternity and Children's Hospital, Konya, Turkey
| | - Ali Unlu
- Department of Biochemistry, Selcuk University School of Medicine, Konya, Turkey
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29
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Einollahi B, Motalebi M, Rostami Z, Nemati E, Salesi M. Sleep quality among Iranian hemodialysis patients: a multicenter study. Nephrourol Mon 2014; 7:e23849. [PMID: 25738125 PMCID: PMC4330687 DOI: 10.5812/numonthly.23849] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/12/2014] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Motalebi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohsen Motalebi, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181262073, Fax: +98-2181262073, E-mail:
| | - Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Eghlim Nemati
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Salesi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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