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Tao LL, Zeng CH, Mei WJ, Zou YL. Sleep quality in middle-aged and elderly hemodialysis patients: Impact of a structured nursing intervention program. World J Clin Cases 2024; 12:5713-5719. [DOI: 10.12998/wjcc.v12.i25.5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being. This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middle-aged and elderly hemodialysis patients.
AIM To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.
METHODS This cross-sectional study was conducted in a tertiary hospital, the First Affiliated Hospital of Nanchang University, in 2023. This study included 105 middle-aged and elderly hemodialysis patients aged ≥ 45 years who underwent maintenance hemodialysis for at least 3 mo, utilizing the Pittsburgh Sleep Quality Index (PSQI) to identify poor sleepers. Those identified underwent a 12-wk nursing intervention program focusing on education, relaxation techniques, and counseling. Post-intervention, sleep quality was reassessed using the PSQI.
RESULTS The study found that 68.6% of hemodialysis patients were poor sleepers. Following the 12-wk nursing intervention program, there was a significant decrease in the mean global PSQI score from 8.9 ± 3.2 to 5.1 ± 2.7 (P < 0.001), indicating improved sleep quality. This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.
CONCLUSION The structured nursing intervention program focusing on sleep hygiene education, relaxation techniques, and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients. The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population. These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.
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Affiliation(s)
- Ling-Ling Tao
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Cai-Hua Zeng
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wen-Juan Mei
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yan-Li Zou
- Blood Purification Room, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Markowska M, Niemczyk S, Romejko K. Melatonin Treatment in Kidney Diseases. Cells 2023; 12:cells12060838. [PMID: 36980179 PMCID: PMC10047594 DOI: 10.3390/cells12060838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Melatonin is a neurohormone that is mainly secreted by the pineal gland. It coordinates the work of the superior biological clock and consequently affects many processes in the human body. Disorders of the waking and sleeping period result in nervous system imbalance and generate metabolic and endocrine derangements. The purpose of this review is to provide information regarding the potential benefits of melatonin use, particularly in kidney diseases. The impact on the cardiovascular system, diabetes, and homeostasis causes melatonin to be indirectly connected to kidney function and quality of life in people with chronic kidney disease. Moreover, there are numerous reports showing that melatonin plays a role as an antioxidant, free radical scavenger, and cytoprotective agent. This means that the supplementation of melatonin can be helpful in almost every type of kidney injury because inflammation, apoptosis, and oxidative stress occur, regardless of the mechanism. The administration of melatonin has a renoprotective effect and inhibits the progression of complications connected to renal failure. It is very important that exogenous melatonin supplementation is well tolerated and that the number of side effects caused by this type of treatment is low.
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Mohamed NA, Mohamed YA, Eraslan A, Kose S. The impact of perceived social support on sleep quality in a sample of patients undergoing hemodialysis in Somalia. Front Psychiatry 2023; 14:1108749. [PMID: 36950258 PMCID: PMC10025465 DOI: 10.3389/fpsyt.2023.1108749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
Objective The main objective of the present study is to examine the relationship between perceived social support and the quality of sleep and to determine the predictors of sleep quality in a sample of patients undergoing hemodialysis (HD) in Somalia. Methods A sample of 200 patients with end-stage renal disease (ESRD) who were undergoing hemodialysis treatment approximately two to three times a week were included. All participants were administered a sociodemographic data form, the Multidimensional Scale of Perceived Social Support (MSPSS), the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI). Patients undergoing HD for less than 3 months prior to the study date were excluded. Results Of the patients undergoing hemodialysis, 200 patients aged between 18 and 68 years (mean = 52.29; SD = 14.13) gave consent and participated in the study. Sixty-three subjects (31.5%) reported poor sleep quality, defined as having a total PSQI score > 5. Forty-one subjects (20.5%) reported clinically significant (moderate-to-severe) insomnia. The majority of our patients undergoing HD reported remarkably high family support, but low friends and significant other support. Poor sleep quality significantly correlated with perceived friends' support and perceived total social support. While perceived family support significantly correlated with both family income and the duration of chronic kidney disease (CKD), perceived friends' support significantly correlated with age and family income. Hierarchical regression analyses showed that perceived family support and friends' support were significant predictors of poor sleep quality. Perceived friends' support was a significant predictor of insomnia severity. Perceived family support was a significant predictor of subjective sleep quality and sleep duration. Perceived friends' support was a significant predictor of subjective sleep quality, sleep duration, sleep latency, sleep disturbance, and daytime dysfunction. Family income was a significant predictor of sleep duration. Age and gender were significant predictors of sleep efficiency. The duration of CKD and duration of HD were significant predictors of sleep disturbance. Conclusion This present study has highlighted the value of family as a principal support system in Somalian culture. Understanding the impact of perceived social support on the quality of sleep in patients undergoing HD will help healthcare providers and social services to focus on and improve the social support systems of the patients as an integral part of their treatment.
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Affiliation(s)
- Nur Adam Mohamed
- Department of Psychiatry and Behavioral Sciences, Mogadishu Somalia Turkey Recep Tayyip Erdogan Research and Training Hospital, Mogadishu, Somalia
- *Correspondence: Nur Adam Mohamed,
| | - Yusuf Abdirisak Mohamed
- Department of Psychiatry and Behavioral Sciences, Mogadishu Somalia Turkey Recep Tayyip Erdogan Research and Training Hospital, Mogadishu, Somalia
| | - Asir Eraslan
- Department of Urology, Mogadishu Somalia Turkey Recep Tayyip Erdogan Research and Training Hospital, Mogadishu, Somalia
| | - Samet Kose
- Department of Psychiatry and Behavioral Sciences, Mogadishu Somalia Turkey Recep Tayyip Erdogan Research and Training Hospital, Mogadishu, Somalia
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Agarwal R, Burton J, Gallieni M, Kalantar-Zadeh K, Mayer G, Pollock C, Szepietowski JC. Alleviating symptoms in patients undergoing long-term hemodialysis: a focus on chronic kidney disease-associated pruritus. Clin Kidney J 2022; 16:30-40. [PMID: 36726430 PMCID: PMC9871858 DOI: 10.1093/ckj/sfac187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Since the breakthrough of kidney replacement therapy, increases in life expectancy for patients with end-stage kidney disease have been limited. However, patients have become increasingly vocal that, although mortality and life expectancy matter to them, the quality of their life, and particularly the relief of symptoms associated with their treatment, are in many cases more important. The majority of dialysis-associated symptoms and adverse effects do not currently have any approved treatments in this patient population, with the few treatments that are available used off-label, frequently without proven efficacy, yet still potentially adding further adverse effects to patients' current symptom burden. This article will illustrate how understanding the pathophysiology of a single, particularly burdensome symptom of dialysis (chronic kidney disease-associated pruritus) resulted in the design, development and regulatory approval of a treatment for that symptom. The pathway described here can be applied to other symptoms associated with dialysis, meaning that if we cannot add years to patients' lives, we can at least add life to their remaining years.
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Affiliation(s)
| | - James Burton
- Department of Cardiovascular Sciences, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università Di Milano, Milano, Italy
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, CA, USA
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Carol Pollock
- Renal Research Laboratory, Kolling Institute, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
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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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Do Brief Mindfulness Interventions (BMI) and Health Enhancement Programs (HEP) Improve Sleep in Patients in Hemodialysis with Depression and Anxiety? Healthcare (Basel) 2021; 9:healthcare9111410. [PMID: 34828457 PMCID: PMC8621877 DOI: 10.3390/healthcare9111410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/22/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Objective: to determine if a brief mindfulness intervention (BMI) and a health education program (HEP) could improve measures of insomnia in patients undergoing hemodialysis. (2) Methods: this was a planned secondary analysis of a randomized controlled trial of BMI vs. HEP for hemodialysis patients with depression and/or anxiety symptoms. The primary outcome for the analysis was the Athens Insomnia Scale (AIS). The secondary outcome was consolidation of daily inactivity (ConDI), an actigraphy measure that describes sleep continuity and is based on a sleep detection algorithm validated by polysomnography. We also explored whether changes in AIS and ConDI were associated with changes in depression, anxiety, and quality of life scores over 8-week follow-up. (3) Results: BMI and HEP groups did not differ significantly from one another. Exposure to BMI or HEP improved sleep quality (baseline AIS 9.9 (±5.0) vs. 8-week follow-up 6.4 (±3.9), (V = 155.5, p = 0.015)), but not ConDI. Improvements in AIS were associated with lower depression scores (Rho = 0.57, p = 0.01) and higher quality-of-life scores (Rho = 0.46, p = 0.04). (4) Conclusions: mindfulness and HEP may be helpful interventions to improve self-reported sleep quality in patients undergoing hemodialysis. Decreases in insomnia scores were associated with decreased depression symptoms and increased quality of life scores.
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Rao SR, Vallath N, Siddini V, Jamale T, Bajpai D, Sancheti NN, Rangaswamy D. Symptom Management among Patients with Chronic Kidney Disease. Indian J Palliat Care 2021; 27:S14-S29. [PMID: 34188374 PMCID: PMC8191745 DOI: 10.4103/ijpc.ijpc_69_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
Abstract
Patients with chronic kidney disease (CKD) experience high symptom burden, both physical and psychological, that is underrecognized and undertreated. The high symptom burden significantly impacts the quality of life for patients and their families. This review enumerates the various physical and psychological symptoms that patients with CKD often experience and guides in the management of these symptoms. This review follows the recommended international guidelines and has been tailored to suit the Indian context.
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Affiliation(s)
- Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
- APHN Palliative Care Consultant for Lien Collaborative for Palliative Care, Asia Pacific Hospice Palliative Care Network, Singapore
- Honorary Tutor, School of Medicine, Cardiff University, UK
| | - Nandini Vallath
- Clinical consultant, BARC Hospital, Mumbai, India
- Division of Palliative Care and Medical Humanities, KEM Hospital, Mumbai, India
- Palliative Care Lead, National Cancer Grid-India
| | | | - Tukaram Jamale
- Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai,India
| | - Divya Bajpai
- Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai,India
| | - Nitish Nitin Sancheti
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | - Dharshan Rangaswamy
- Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Rosdiana I, Cahyati Y. The effect of the progressive muscle relaxation combined withs lavender aromatherapy on insomnia of hemodialysis patients. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
disorder in hemodialysis patients, which will cause a decrease in quality of life. Aromatherapy combined with progressive muscle relaxation are expected to increase the effects of relaxation on the patient so that the patient's sleep quality can improve optimally.Objective: The study aimed to investigate the effect of the progressive muscle relaxation combined with lavender aromatherapy on insomnia among patients undergoing hemodialysis. Material and Methods: The design of this study included a quasi-experiment with a pretest-posttest control group approach. The sample selection was performed using a consecutive sampling technique and involved 50 respondents, divided into two equal control and study group. Patients in study group recommended to do progressive muscle relaxation at least four times per week for three weeks and were told to drop two – three drops lavender aromatherapy on a pillow 30 minutes before bedtime at least 4 nights per week for three weeks. The control group recommended to do muscle relaxation and daily routine care at least four times per week for three weeks. Results: The results showed that both study and control groups were equal in terms of demographics, and scores of insomnia at the baseline. There no significant difference between the mean insomnia scores of two group before intervention, while the difference was statistically significant after the intervention. The mean insomnia scores were lower in study group than in the control group.Conclusion: Progressive muscle relaxation and lavender aromatherapy were effective in decreasing insomnia scores among patients undergoing hemodialysis.
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Affiliation(s)
- Ida Rosdiana
- Departamento de Enfermería. Poltekkes Kemenkes Tasikmalaya. Java Occidental. Indonesia
| | - Yanti Cahyati
- Departamento de Enfermería. Poltekkes Kemenkes Tasikmalaya. Java Occidental. Indonesia
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Muz G, Erdoğan Yüce G, Yıldırım C, Dağdelen M. The effect of sleep hygiene training applied to hemodialysis patients on sleep quality and quality of life: randomized controlled trial. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-020-00293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Xu S, Zou D, Tang R, Li S, Chen W, Wen L, Liu Y, Liu Y, Zhong X. Levels of trace blood elements associated with severe sleep disturbance in maintenance hemodialysis patients. Sleep Breath 2021; 25:2007-2013. [PMID: 33666836 DOI: 10.1007/s11325-021-02336-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Sleep disturbance is frequently observed in patients on maintenance hemodialysis (MHD), and this population usually presents imbalances in trace elements. We investigated the association between blood trace element levels and sleep quality in patients on MHD. METHODS This cross-sectional and single-center study was performed in September 2019. Patients regularly undergoing hemodialysis for > 3 months at our center were recruited, and demographic, clinical, and laboratory parameters were recorded. The Pittsburgh Sleep Quality Index (PSQI) was applied to define sleep disturbance. Blood trace element (zinc, manganese, copper, selenium, and lead) levels were measured using an inductively coupled plasma mass spectrometer. RESULTS In total, 121 patients on MHD (male/female = 68:53) were enrolled in the study (mean age 63.7 ± 13.9 years, median dialysis vintage 38.0 [20.0, 60.0] months). According to PSQI, 56 (46%) patients experienced severe sleep disturbance. These patients were characterized by older age, higher serum parathyroid hormone levels, and lower blood selenium levels (all P < 0.05). No significant differences in blood zinc, manganese, copper, and lead levels were observed between groups. Univariate binary logistic regression showed that lower blood selenium levels were associated with severe sleep disturbance (odds ratio = 0.976, 95% confidence interval: 0.954-0.999, P = 0.038). Multivariate analyses also confirmed the results after adjusting for confounding factors. CONCLUSION Our study indicated an association between lower blood selenium levels and the occurrence of severe sleep disturbances in patients on MHD. However, a prospective study with a larger sample size and assessing the importance of selenium supplementation are needed to confirm the results.
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Affiliation(s)
- Shilin Xu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - De'e Zou
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Ruiying Tang
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Shuting Li
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Wenxuan Chen
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Luona Wen
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.,Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou, China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
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Asghar MS, Ahsan MN, Jawed R, Rasheed U, Ali Naqvi SA, Hassan M, Yaseen R, Mallick N, Zehra M, Saleem M. A Comparative Study on the Use of Alprazolam and Melatonin for Sleep Disturbances in Hemodialysis Patients. Cureus 2020; 12:e11754. [PMID: 33403184 PMCID: PMC7773292 DOI: 10.7759/cureus.11754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Sleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning. Irrespective of the adverse effects reported, benzodiazepines are widely utilized among patients with sleep disorders in end-stage renal disease. Melatonin is a newer agent being studied for use in hemodialysis patients for improvement of sleep quality. The aim of our observational study is to witness the effectiveness of both benzodiazepine and exogenous melatonin as a treatment of sleep disorders in patients undergoing hemodialysis. Materials and methods We conducted a comparative, observational study in ESRD patients who are on hemodialysis. These patients were selected from attendees of the hemodialysis unit, nephrology department of a tertiary care hospital, including those who were on regular hemodialysis, thrice-weekly in frequency for at least once per year, and taking regular sleep medications for at least three months with frequently reported drug dosages of alprazolam 0.5 mg once daily or melatonin 3 mg once daily (before bedtime). The subjective sleep assessment was done by utilizing four scales, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Results A total of 117 hemodialysis-dependent patients met the inclusion criteria, among whom 79 patients were using alprazolam while 38 were using melatonin for their disturbed sleep. The mean age of the study participants was 49.12 ± 12.75, comprising 72 males (61.53%) and 45 females (38.46%). The duration of the diagnosis of chronic kidney disease (CKD), duration of onset of hemodialysis, and estimated glomerular filtration rate (eGFR) was comparable in both groups. Both groups had similar laboratory markers except for higher hemoglobin in the melatonin group (p=0.028) and high parathyroid hormone (PTH) levels in the alprazolam group (p=0.001). PSQI scores were 8.76 ± 3.09 in the alprazolam group and 7.32 ± 2.65 in the melatonin group (p=0.015). In the sub-scores, there were no differences in sleep latency (p=0.481) and daytime dysfunction (p=0.662) while sleep efficiency (p=0.167) and subjective sleep quality (p=0.132) were not statistically significant. The significant differences were lower scores of sleep duration (p=0.040) and sleep disturbance (p=0.003) in the melatonin group. The ESS scores revealed no significant difference in either group (p=0.074). With respect to the ISI and SSS, higher scores were obtained in the alprazolam group. Overall, 89 study participants had reported poor sleep quality, out of which 81% were using alprazolam, and 65% were using melatonin (p=0.071). A total of 50 study participants exhibited excessive daytime sleepiness with 45% of them were using alprazolam and 36% were using melatonin. About 54% of the alprazolam using hemodialysis patients had moderate insomnia while 50% of the melatonin using patients had sub-threshold insomnia (p=0.062). Conclusion As melatonin use has shown better sleep quality and less insomnia severity as compared to alprazolam use in our study, it is postulated that the sleep-wake cycle should be commonly targeted by pharmacological therapy in ESRD.
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Affiliation(s)
| | | | - Rumael Jawed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | | | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Rabail Yaseen
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Najia Mallick
- Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Mahrukh Zehra
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Park HY, Lee H, Jhee JH, Park KM, Choi EC, An SK, Namkoong K, Lee E, Park JT. Changes in resting-state brain connectivity following computerized cognitive behavioral therapy for insomnia in dialysis patients: A pilot study. Gen Hosp Psychiatry 2020; 66:24-29. [PMID: 32615333 DOI: 10.1016/j.genhosppsych.2020.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Insomnia is prevalent among dialysis patients and affects their mortality. Although cognitive behavioral therapy for insomnia (CBTi) is recommended, attending regular face-to-face CBTi sessions is a major challenge for patients. We evaluated the effectiveness of a self-directed computerized CBTi (cCBTi) in dialysis patients, and investigated changes in resting-state brain connectivity and inflammatory cytokines following cCBTi. METHOD Thirty-five patients undergoing maintenance hemodialysis or peritoneal dialysis who had insomnia were screened for participation in the study, with 17 participants included in the final analyses. A self-directed cCBTi protocol accessed via tablet computer during dialysis or at home was developed and applied. Information about sleep, anxiety, depression, laboratory data, and resting-state functional magnetic resonance imaging data was obtained 3-5 days before and after cCBTi. RESULTS cCBTi improved sleep quality, and this was correlated with increased resting-state brain connectivity between the default-mode network and the premotor/dorsolateral prefrontal cortex. The decrement of interleukin-1β levels were correlated with improved sleep quality and increased brain connectivity after cCBTi. CONCLUSION Our pilot study findings suggest that cCBTi is effective for dialysis patients with insomnia, and the therapeutic effects of cCBTi are related to changes in brain functional connectivity and inflammatory cytokines.
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Affiliation(s)
- Hye Yoon Park
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeongrae Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mee Park
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Eun Chae Choi
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyoon An
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee Namkoong
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jung Tak Park
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Wang X, Gu J, Liu J, Hong H. Clinical evidence for acupressure with the improvement of sleep disorders in hemodialysis patients: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 39:101151. [DOI: 10.1016/j.ctcp.2020.101151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
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Hassinger AB, Bletnisky N, Dudekula R, El-Solh AA. Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert Opin Pharmacother 2020; 21:1035-1043. [PMID: 32202451 DOI: 10.1080/14656566.2020.1743265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations. AREAS COVERED The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients' characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative 'Z-drug' hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia. EXPERT OPINION A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.
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Affiliation(s)
- Amanda B Hassinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Nikolas Bletnisky
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Rizwan Dudekula
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Ali A El-Solh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA.,Department of Epidemiology and Environmental Health, Research and Development, School of Public Health, University at Buffalo , Buffalo, NY, USA
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Gu YH, Yang XH, Pan LH, Zhan XL, Guo LL, Jin HM. Additional hemoperfusion is associated with improved overall survival and self-reported sleep disturbance in patients on hemodialysis. Int J Artif Organs 2019; 42:347-353. [PMID: 30917741 DOI: 10.1177/0391398819837546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Patients with maintenance hemodialysis have experienced long-standing sleep disturbance. In this study, we attempted to explore whether long-term hemoperfusion could improve sleep and increase the overall survival in hemodialysis patients. Methods: A total of 158 patients, who underwent routine hemodialysis, were assessed in this study. These patients were computer-matched into two groups, with one group including 80 patients with absolute hemodialysis and the other consisting of 78 cases with hemodialysis in combination with hemoperfusion. Hemoperfusion was performed 1–2 times biweekly, with each session lasting 2 h. Self-reported sleep disturbance was evaluated before and after the observational time (2-year period); sleep quality was measured using the Pittsburgh Sleep Quality Index. Findings: Using multivariate regression analyses, we found sleep duration was associated with age, diabetes, low income, pruritus, hyperphosphatemia, hypercalcemia, high parathyroid hormone, and hemoglobin ( P < 0.001). The overall survival rate of the hemodialysis in combination with hemoperfusion group was significantly higher than that of the absolute hemodialysis group ( P < 0.05) after adjusting for sex, age, and diabetes. A 2-year hemoperfusion therapy was associated with improved sleep disturbance and sleep efficiency; this was accompanied by an increase in nocturnal melatonin levels. Furthermore, there was a significant difference in the first hospitalization between the hemodialysis and hemodialysis in combination with hemoperfusion groups ( P < 0.01). Discussion: Our results indicated that hemoperfusion in combination with hemodialysis is associated with an increase in the overall survival and improved sleep disorders in hemodialysis patients.
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Affiliation(s)
- Yan Hong Gu
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiu Hong Yang
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Hua Pan
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiao Li Zhan
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Li Guo
- Hemodialysis Center, Bao Shan Branch of No.1 People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Min Jin
- Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
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The Effect of Lavender Oil Application via Inhalation Pathway on Hemodialysis Patients' Anxiety Level and Sleep Quality. Holist Nurs Pract 2018; 32:324-335. [PMID: 30320657 DOI: 10.1097/hnp.0000000000000292] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep and anxiety problems occur in hemodialysis (HD) patients due to physical symptoms, lifestyle changes, and psychosocial changes. To remove these sleep and anxiety problems, lavender oil inhalation is one of the nonpharmacological treatment options with less adverse effects than pharmacological methods. The purpose of this study was to determine the effect of lavender oil application via inhalation pathway on HD patients' anxiety level and sleep quality. The study was conducted with 34 HD patients who have been on HD treatment at 2 dialysis centers. The patients of the intervention group (n = 17) were told to drip 2 drops into the box and to place it 15 to 20 cm away from the pillow, 30 minutes before going to bed for 1 week. Control group (n = 17) received no intervention. Data were collected with questionnaire form, Visual Analog Scale, and Hamilton Anxiety Assessment Scale with a face-to-face interview. Subjective sleep quality of the intervention group was higher than that of control group, mean Visual Analog Scale daytime sleepiness score declined (P < .05), and mean score of sleep duration increased (P < .001) in the intervention group. However, the differences of mean score of time for falling asleep between the 2 groups were not different. The mean score of total and subdimensions of Hamilton Anxiety Assessment Scale of intervention group and control group was significantly different (P < .001). These study results provide new promising information about the effect of lavender inhalation on sleep problems and anxiety and these have made significant contributions to nursing, especially for dialysis nurses.
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Abstract
Kidney disorders have been associated with a variety of sleep-related disorders. Therefore, researchers are placing greater emphasis on finding the role of chronic kidney disease (CKD) in the development of obstructive sleep apnea and restless legs syndrome. Unfortunately, the presence of other sleep-related disorders with CKDs and non-CKDs has not been investigated with the same clinical rigor. Recent studies have revealed that myriad of sleep disorders are associated with CKDs. Furthermore, there are a few non-CKD-related disorders that are associated with sleep disorders. In this narrative review, we provide a balanced view of the spectrum of sleep disorders (as identified in International Classification of Sleep disorders-3) related to different types of renal disorders prominently including but not exclusively limited to CKD.
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Affiliation(s)
- Gaurav Nigam
- Division of Sleep Medicine, Clay County Hospital, Flora, IL
| | - Macario Camacho
- Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Honolulu, HI
| | - Edward T Chang
- Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Honolulu, HI
| | - Muhammad Riaz
- Division of Sleep Medicine, Astria Health Center, Grandview, WA, USA
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Abstract
Poor sleep and sleep-related breathing disorders are common in patients with end-stage renal disease (ESRD) but are often unrecognized and undertreated. Sleep disorders are known negative prognostic factors for morbidity and mortality. The most frequent sleep disorders seen in patients with ESRD are conditioned insomnia, excessive daytime sleepiness, obstructive or central sleep apnea (SA), as well as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Several uremic and nonuremic factors are thought to participate in the pathogenesis of sleep disorders in patients with ESRD. The therapy of sleeping disorders includes nonpharmacological and pharmacological measures that can improve the functionality and quality of life in patients with ESRD.
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Affiliation(s)
- G.C. Kosmadakis
- “John Walls” Renal Unit, Leicester General Hospital, Leicester - UK
| | - J.F. Medcalf
- “John Walls” Renal Unit, Leicester General Hospital, Leicester - UK
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Effect of intradialytic exercise on daily physical activity and sleep quality in maintenance hemodialysis patients. Int Urol Nephrol 2018; 50:745-754. [DOI: 10.1007/s11255-018-1796-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
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Pengo M, Ioratti D, Bisogni V, Ravarotto V, Rossi B, Bonfante L, Simioni F, Nalesso F, Maiolino G, Calò L. In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders. Kidney Blood Press Res 2017; 42:804-815. [DOI: 10.1159/000484357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/14/2017] [Indexed: 11/19/2022] Open
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Sleep Parameters in Short Daily versus Conventional Dialysis: An Actigraphic Study. Int J Nephrol 2017; 2017:2473217. [PMID: 28912971 PMCID: PMC5585576 DOI: 10.1155/2017/2473217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/17/2017] [Indexed: 01/17/2023] Open
Abstract
Previous studies have observed worse sleep quality in patients undergoing conventional dialysis as compared to daily dialysis. Our aim was to compare the sleep parameters of patients undergoing daily or conventional dialysis using an objective measure (actigraphy). This cross-sectional study was performed in three dialysis centers, including a convenience sample (nonprobability sampling) of 73 patients (36 patients on daily hemodialysis and 37 patients on conventional hemodialysis). The following parameters were evaluated: nocturnal total sleep time (NTST), expressed in minutes; wake time after sleep onset (WASO), expressed in minutes; number of nighttime awakenings; daytime total sleep time (DTST), expressed in minutes; number of daytime naps; and nighttime percentage of sleep (% sleep). The Mini-Mental State Examination and the Beck Depression Inventory were also administered. The mean age was 53.4 ± 17.0 years. After adjustment of confounding factors using multiple linear regression analysis, no difference in actigraphy parameters was detected between the groups: NTST (p = 0.468), WASO (p = 0.88), % sleep (p = 0.754), awakenings (p = 0.648), naps (p = 0.414), and DTST (p = 0.805). Different from previous studies employing qualitative analysis, the present assessment did not observe an influence of hemodialysis modality on objective sleep parameters in chronic renal patients.
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Orasan OH, Saplontai AP, Cozma A, Racasan S, Kacso IM, Rusu CC, Moldovan D, Tirinescu D, Potra A, Patiu IM, Orasan RA. Insomnia, muscular cramps and pruritus have low intensity in hemodialysis patients with good dialysis efficiency, low inflammation and arteriovenous fistula. Int Urol Nephrol 2017; 49:1673-1679. [PMID: 28534129 DOI: 10.1007/s11255-017-1624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Insomnia, muscular cramps, pruritus and postdialysis recovery time (RT) are quality-of-life parameters that affect hemodialysis (HD) patients physically and mentally. METHODS We included 171 end-stage renal disease patients: 115 on high-flux HD and 56 on online hemodiafiltration (HDF). Patients were asked "How long does it take you to recover from a dialysis session?" and they evaluated intensity (absent, mild, medium and severe) of insomnia, muscular cramps and pruritus in the past 4 weeks. We sought associations of RT, insomnia, muscular cramps and pruritus with themselves and age, dialysis vintage, sex, body mass index, hemoglobin, albumin, C-reactive protein (CRP), Daugirdas single-pool Kt/V (Kt/V), ultrafiltration volume, blood processed volume and vascular access type. RESULTS Insomnia absence correlated with muscular cramps absence (p = 0.01), arteriovenous fistula (AVF) presence (p = 0.02) and lower CRP (p = 0.003). Muscular cramps absence associated pruritus absence (p = 0.007) and AVF (p = 0.001). Absent pruritus patients were younger (p = 0.04), had higher Kt/V (p = 0.01) and more AVF (p = 0.02). Men insomnia was more severe in HD than HDF and albumin related (p = 0.007), while CRP was lower in absent pruritus. Women insomnia associated with muscular cramps (p = 0.04) and vascular access (p = 0.03), as was pruritus (p = 0.03). RT had no relations with any parameter. CONCLUSIONS HD patients with AVF have less insomnia, muscular cramps and pruritus. Insomnia is associated with muscular cramps and inflammation. Pruritus is worse in older patients, is diminished with increased dialysis efficiency and is associated with higher CRP in men. There is no difference between HD and HDF patients, except more severe insomnia for HD in men.
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Affiliation(s)
- Olga Hilda Orasan
- 4th Medical Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Aniela Pop Saplontai
- 5th Medical Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Angela Cozma
- 4th Medical Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | | | - Ina Maria Kacso
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Crina Claudia Rusu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Diana Moldovan
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Dacian Tirinescu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Alina Potra
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Sasaki S, Yoshioka E, Saijo Y, Bannai A, Kita T, Tamakoshi A, Kishi R. A prospective cohort study of insomnia and chronic kidney disease in Japanese workers. Sleep Breath 2017; 22:257-265. [DOI: 10.1007/s11325-017-1508-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 01/04/2023]
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Sleep Quality in Patients Undergoing Long-term Hemodialysis Using the Pittsburgh Sleep Quality Index. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.44278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Maung S, Sara AE, Cohen D, Chapman C, Saggi S, Cukor D. Sleep disturbance and depressive affect in patients treated with haemodialysis. J Ren Care 2016; 43:60-66. [PMID: 28000424 DOI: 10.1111/jorc.12188] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleep disorders and depression are prevalent conditions in patients with end-stage kidney disease. These co-morbidities have significant overlap and compounded morbidity and mortality burden. This overlap presents challenges to optimal clinical assessment and treatment. The goal of this study was to assess the prevalence of sleep disturbance in patients on maintenance haemodialysis, and to assess the impact of depressive affect. OBJECTIVES This was a single-site, single group, cross-sectional study of 69 English-speaking patients undergoing maintenance haemodialysis. Self-reported assessments included those of sleep quality (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory), daytime sleepiness (Epworth's Sleepiness Scale), a dialysis-specific sleep questionnaire, and standard laboratory values. No objective sleep information was collected. METHOD All participants were well dialysed, and represented all four daily shifts. Fifty-eight per cent reported clinically significant sleep difficulty, with elevated yet sub-threshold daytime sleepiness. Mean depressive affect was also elevated, yet sub-diagnostic and was positively correlated with increased age. RESULTS Participants scoring above the diagnostic threshold for depression had significantly more disturbed sleep quality, more daytime sleepiness and had more problems sleeping due to restless leg syndrome than people with minimal depressive affect. CONCLUSION Poor sleep quality is prevalent in patients on maintenance haemodialysis, and is associated with increased daytime sleepiness. Depression further compounds this relationship, and is significantly associated with increased daytime sleepiness and restless leg syndrome.
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Affiliation(s)
- Stephanie Maung
- College of Medicine, Downstate Medical Center Brooklyn, New York, USA
| | - Ammar El Sara
- Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA
| | - Danielle Cohen
- Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA.,City University of New York Queens College, Queens, New York, USA
| | - Cherylle Chapman
- Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA
| | - Subodh Saggi
- Medicine, Renal Division, Downstate Medical Center Brooklyn, New York, USA
| | - Daniel Cukor
- Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA
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Maung SC, El Sara A, Chapman C, Cohen D, Cukor D. Sleep disorders and chronic kidney disease. World J Nephrol 2016; 5:224-232. [PMID: 27152260 PMCID: PMC4848147 DOI: 10.5527/wjn.v5.i3.224] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/26/2015] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.
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Analyses of melatonin, cytokines, and sleep in chronic renal failure. Sleep Breath 2015; 20:339-44. [PMID: 26271951 DOI: 10.1007/s11325-015-1240-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/14/2015] [Accepted: 08/04/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Inflammation and oxidative stress are involved in the process of chronic renal failure (CRF). CRF patients show indication of sleep disturbances, and the melatonin rhythm, which modulates sleep, is abnormal in these patients; however, it is still unclear whether inflammation could be related to the blockage of melatonin production and sleep disturbances in this population. The aim of this study was to characterize and correlate sleep, the melatonin rhythm, and the levels of the inflammatory cytokines tumor necrosis factor (TNF) and interleukin (IL)-6 in patients with CRF and controls. METHODS Sleep was evaluated by the "Sleep Quality Index Pittsburgh" (PSQI) questionnaire, and melatonin and cytokine contents in saliva and blood samples, respectively, were analyzed by ELISA. RESULTS The CRF group scored higher on the global PSQI, which indicates a lower sleep quality and a higher prevalence of sleep disorders, than the control group. The CRF individuals also showed lower melatonin content than the control groups, both during the day and at night, and lacked rhythmicity in melatonin production. The CRF group also showed higher contents of TNF and IL-6 than the control group and a negative correlation between TNF and melatonin content. CONCLUSION These results suggest that the sleep disorders observed in the CRF group were probably related to the low production of melatonin observed in this population. The high level of TNF, as previously demonstrated in other pathologies, is probably involved in this blockage of melatonin production in CRF.
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Zou C, Yang L, Wu Y, Su G, Chen S, Guo X, Wu X, Liu X, Lin Q. Auricular acupressure on specific points for hemodialysis patients with insomnia: a pilot randomized controlled trial. PLoS One 2015; 10:e0122724. [PMID: 25874938 PMCID: PMC4398355 DOI: 10.1371/journal.pone.0122724] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/11/2015] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess the feasibility and acceptability of a randomized controlled trial compared auricular acupressure (AA) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis (MHD) patients with insomnia. METHODS Sixty three (63) eligible subjects were randomly assigned into either AA group received AA on specific acupoints (n=32), or sham AA (SAA) group received AA on points irrelevant to insomnia treatment (n=31) for eight weeks. All participants were followed up for 12 weeks after treatments. The primary outcome was clinical response at eight weeks after randomization, defined as a reduction of Pittsburgh Sleep Quality Index (PSQI) global score by 3 points and more. RESULTS Fifty-eight (58) participants completed the trial and five dropped out. Twenty participants in AA group (62.5%) and ten in SAA group (32.3%) responded to the eight-week interventions (χ2 = 5.77, P = 0.02). PSQI global score declined 3.75 ± 4.36 (95%CI -5.32, -2.18) and 2.26 ± 3.89 (95%CI -3.68, -0.83) in AA group and SAA group respectively. Three participants died during the follow-up period. No evidence supported their deaths were related to the AA intervention. No other adverse event was observed. CONCLUSION Feasibility and logistics of patient recruitment, randomization procedure, blinding approach, interventions application and outcome assessment had been tested in this pilot trial. The preliminary data appeared to show a favorable result on AA treatment. A full-scale trial is warranted. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-TRC-12002272.
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Affiliation(s)
- Chuan Zou
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong province, P.R. China
| | - Lihong Yang
- Evidence-based Medicine and Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital/Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, Guangdong province, P.R. China
| | - Yuchi Wu
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong province, P.R. China
| | - Guobin Su
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong province, P.R. China
| | - Shuhui Chen
- Evidence-based Medicine and Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital/Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, Guangdong province, P.R. China
| | - Xinfeng Guo
- Evidence-based Medicine and Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital/Clinical College, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences), Guangzhou, Guangdong province, P.R. China
| | - Xiuqing Wu
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong province, P.R. China
| | - Xusheng Liu
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong province, P.R. China
| | - Qizhan Lin
- Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong province, P.R. China
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El-Aatty HA, El-Aziz AA, Aora M, El-Helbawy R, El-Refaey R. Sleep disordered breathing in patients with chronic kidney diseases: How far the problem? EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yang B, Xu J, Xue Q, Wei T, Xu J, Ye C, Mei C, Mao Z. Non-pharmacological interventions for improving sleep quality in patients on dialysis: systematic review and meta-analysis. Sleep Med Rev 2014; 23:68-82. [PMID: 25645131 DOI: 10.1016/j.smrv.2014.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/02/2014] [Accepted: 11/13/2014] [Indexed: 12/19/2022]
Abstract
We conducted a meta-analysis to summarise and quantify the effects of non-pharmacological interventions on sleep quality improvement in uraemic patients on dialysis. We defined the primary outcome as the change of sleep quality before and after interventions (evaluated by polysomonography or subjective questionnaires such as Pittsburgh sleep quality index, PSQI). The change of fatigue scales, inflammatory cytokines and adverse events were analysed as secondary outcomes. Twelve eligible randomised controlled trials and one prospective cohort study were identified. All three identified non-pharmacological interventions could result in a greater PSQI score reduction compared to controls: 1) cognitive-behavioural therapy (CBT) versus sleep hygiene education (standardised mean difference (SMD) 0.85, 95% CI 0.37-1.34); 2) physical training versus no training (SMD 3.36, 95% CI 2.16-4.57) and 3) Acupressure (including other acupoints massages) versus control (SMD 1.77, 95% CI 0.80-2.73). In terms of subscores, we found that CBT may shorten sleep latency, alleviate sleep disturbance and reduce the use of sleep medications. The finding of the cohort study suggested that intradialytic aerobic exercise training improved sleep quality in haemodialysis patients with restless leg syndrome. In conclusion, in dialysis-dependent patients, CBT could shorten sleep latency, alleviate sleep disturbance and reduce the use of sleep medications. Acupressure (including other acupoints massages) and exercise training are promising interventions but the results in these subgroups should be interpreted cautiously due to the concern of methodological quality and potential confounding factors.
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Affiliation(s)
- Bo Yang
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiaruo Xu
- No. 5 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China
| | - Qiang Xue
- No. 5 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China
| | - Tingting Wei
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jing Xu
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Chaoyang Ye
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Changlin Mei
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Zhiguo Mao
- Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Bliwise DL, Zhang RH, Kutner NG. Medications associated with restless legs syndrome: a case-control study in the US Renal Data System (USRDS). Sleep Med 2014; 15:1241-5. [PMID: 25156752 PMCID: PMC4172448 DOI: 10.1016/j.sleep.2014.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/28/2014] [Accepted: 05/29/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine the association between the usage of four classes of "at-risk" medications (antidepressants, neuroleptics, antihistamines, and antiemetics with dopamine blockade) and restless legs syndrome (RLS) in dialysis patients within the United States Renal Data System (USRDS). METHODS This was a case-control design within a national (United States) patient registry of all patients with end-stage renal disease (ESRD) in the USRDS anytime during the period of 1 October 2006 to 31 December 2010, inclusive. A total of 16,165 ESRD patients (3234 cases; 12,931 age-, sex-, and race-matched controls) were studied. RESULTS All four classes of "at-risk" medications see widespread use among patients in the USRDS. All were associated with increased odds of an RLS diagnosis (range of odds ratios, 1.47-2.28; all p < 0.0001) during the period of observation. Results were unchanged when controlling for time on hemodialysis. Usage of more than one class of medication increased the odds for having RLS. CONCLUSIONS ESRD patients often receive medication intended for relief of conditions associated with their disease, such as depression and psychological issues, pruritus, and gastroparesis; however, such medications may increase the risk of RLS. Given the high prevalence of RLS in ESRD patients, these medications should only be used when their benefits clearly outweigh the risk of development of the troubling and distressing symptoms of RLS.
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Affiliation(s)
- Donald L Bliwise
- United States Renal Data System Rehabilitation/Quality of Life Special Studies Center and Department of Neurology, Emory University, Atlanta, GA, USA.
| | - Rebecca H Zhang
- United States Renal Data System Rehabilitation/Quality of Life Special Studies Center and Department of Neurology, Emory University, Atlanta, GA, USA
| | - Nancy G Kutner
- United States Renal Data System Rehabilitation/Quality of Life Special Studies Center and Department of Neurology, Emory University, Atlanta, GA, USA
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Thompson S. People receiving dialysis in the morning have better subjective sleep quality than those who receive dialysis at other times. Evid Based Nurs 2014; 17:108. [PMID: 24415764 DOI: 10.1136/eb-2013-101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Einollahi B, Izadianmehr N. Restless leg syndrome: a neglected diagnosis. Nephrourol Mon 2014; 6:e22009. [PMID: 25695039 PMCID: PMC4318015 DOI: 10.5812/numonthly.22009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 01/04/2023] Open
Abstract
Context: Restless legs syndrome (RLS) is an irresistible urge to move legs that usually occur during inactivity and at night. This neurologic condition is associated with increased risk of nocturnal hypertension as well as cardiovascular events and affects patient’s sleep, which leads to anxiety, depression, and decreases quality of life. Presence of RLS in patients on hemodialysis is associated with higher mortality rate. Most of the times, patients have indescribable symptoms. The aim of this review was to provide physicians with information to be aware and turn their attention to the patient’s symptoms, which are the most important clue to diagnosis of RLS. Evidence Acquisition: For data extraction, we reviewed PubMed, Scopus, Google scholar, the Cochrane collaboration, and Up to Date databases with the keywords of restless legs syndrome, sleep disorders, and end-stage renal disease (ESRD). The most recent review articles, clinical trials, and cross-sectional studies with large sample sizes that had used International RLS Study Group criteria (IRLSSG) and had focused on demographic characteristics and renal function were included. This situation has described in primary and secondary forms. The former usually occurs in younger patients and seems to have genetic tendencies and the latter is due to the iron deficiency state, pregnancy, and ESRD. Results: Two major theories are developed regarding the pathophysiology of RLS. The first one concerns central nervous system dopamine imbalance and the second one concerns intracellular iron dysregulation. The most common used pharmacologic agents in treatment of RLS are dopamine agonists. Other used therapeutic agents include levodopa, Alpha-2-delta calcium channel ligands, opioids, anticonvulsants, benzodiazepines, clonidine, iron therapy in low levels of serum ferritin, and nonpharmacologic therapies. Conclusions: The most important factor in diagnosis is physician’s attention and clinical experience with this condition and using IRLSSG.
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Affiliation(s)
- Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Neda Izadianmehr
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Neda Izadianmehr, Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125856547, Fax: +98-2188600062, E-mail:
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Parvan K, Lakdizaji S, Roshangar F, Mostofi M. Quality of sleep and its relationship to quality of life in hemodialysis patients. J Caring Sci 2013; 2:295-304. [PMID: 25276738 DOI: 10.5681/jcs.2013.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients' quality of life (QOL). This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients. METHODS By using a descriptive and correlational design, this study was conducted on 245 hemodialysis patients in 2012. Patients were selected by convenience sampling from the hemodialysis ward of four training hospitals of Tabriz and Maragheh. Quality of sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), and the quality of life for patients was measured by the Kidney Disease Quality Of Life questionnaire (KDQOL-SF). RESULTS 83.3% of hemodialysis patients had poor quality of sleep. Poor quality of life was significantly associated with poor quality of sleep. There was a significant negative correlation between global PSQI and important aspects of quality of life including physical health, symptoms and problems, the impact of kidney disease on daily life, burden of kidney disease, mental health, social support, and sexual function. CONCLUSION The low quality of sleep in hemodialysis patients has an effect on the deterioration of their quality of life. Therefore, training, counseling, and advocacy programs should be developed to improve the patients' quality of sleep and quality of life, especially those with lower education level and income, and older people.
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Affiliation(s)
- Kobra Parvan
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sima Lakdizaji
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariborz Roshangar
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahtab Mostofi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Yngman-Uhlin P, Fernström A, Börjeson S, Edéll-Gustafsson U. Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment. J Clin Nurs 2013; 21:3402-17. [PMID: 23145513 DOI: 10.1111/j.1365-2702.2012.04282.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to evaluate effects of a non-pharmacological intervention on sleep, activity and fatigue in patients receiving peritoneal dialysis by the use of both actigraphy registration and self-assessed questionnaires. BACKGROUND Insomnia is estimated to affect up to 60% of haemo- and peritoneal dialysis patients. It is associated with two common uremic symptoms, pruritus and restless legs syndrome. To our knowledge, no interventions have been evaluated by actigraphy. DESIGN A prospective multiple baseline single-case experimental design. METHODS Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study from January 2009 to February 2011. Two interventions were separately implemented. First, a pressure-relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires. RESULTS A total of 315 sleep-wake cycles from nine individuals were evaluated. Three patients improved clinically significantly in five or more of the nine outcomes, i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index, number of steps, metabolic equivalent unit, sleep efficiency and fatigue. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements. CONCLUSIONS This study illuminates the need for regular assessment of sleep and tiredness. It also demonstrates how a non-pharmacological treatment and self-management can be applied with renal supportive care to improve sleep quality. RELEVANCE TO CLINICAL PRACTICE This study is a clinical example of a non-pharmacological intervention with supportive care and self-management. This model can improve health and reduce the pharmacological burden because hypnotics can be replaced by sleep hygiene self-care activities.
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Affiliation(s)
- Pia Yngman-Uhlin
- Division of Nursing Science, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Wang MY, Chan SF, Chang LI, Chen TH, Tsai PS. Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: A cross-sectional observational study. Int J Nurs Stud 2013; 50:1468-73. [DOI: 10.1016/j.ijnurstu.2013.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 02/09/2013] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
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Aperis G, Prakash P, Paliouras C, Papakonstantinou N, Alivanis P. The role of melatonin in patients with chronic kidney disease undergoing haemodialysis. J Ren Care 2012; 38:86-92. [PMID: 22494522 DOI: 10.1111/j.1755-6686.2012.00267.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with chronic kidney disease including those undergoing haemodialysis have deranged sleep-wake pattern. In large part this is due to an abnormal circadian cycle of melatonin, a hormone secreted by the pineal gland in the evening and induces sleep. Subjects undergoing automated peritoneal dialysis or nocturnal haemodialysis have better sleep profile compared to those on daytime dialysis. Studies have shown that exogenous melatonin improves sleep-wake cycle in daytime haemodialysis patients. However, large randomised controlled trials are needed in order to establish its role in this patient population.
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Affiliation(s)
- Georgios Aperis
- Nephrology Department, General Hospital of Rhodes, Agioi Apostoloi, Rhodes, Greece.
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Chan SF, Chen TH, Liao YM, Chou KR, Tsai PS. Development and preliminary validation of the Chinese version of the Sleep-Associated Monitoring Index. Int J Nurs Stud 2012; 49:54-64. [PMID: 21813125 DOI: 10.1016/j.ijnurstu.2011.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/27/2011] [Accepted: 07/09/2011] [Indexed: 11/27/2022]
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Araujo SMHA, Bruin VMS, Daher EF, Medeiros CAM, Almeida GH, Bruin PFC. Quality of sleep and day-time sleepiness in chronic hemodialysis: a study of 400 patients. ACTA ACUST UNITED AC 2011; 45:359-64. [PMID: 21702725 DOI: 10.3109/00365599.2011.584694] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Impaired sleep has potential health consequences in chronic hemodialysis patients. To date, this issue has not been examined in studies involving a large number of subjects. This study aimed to identify factors associated with poor sleep quality and excessive day-time sleepiness (EDS) in dialysis patients. MATERIAL AND METHODS This cross-sectional observational study involved 400 patients (59% male) from three hemodialysis centers (SD-HEMOFOR). Quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI), EDS by the Epworth Sleepiness Scale (ESS), risk of obstructive sleep apnea (OSA) by the Berlin questionnaire and comorbidity severity by the Charlson Comorbidity Index (CCI). RESULTS Poor sleep quality (PSQI >5) was found in 227 individuals (57%) and was associated with older age (p = 0.001), diabetes (p = 0.03), heart failure (p < 0.005), hypoalbuminemia (p = 0.01), low transferrin saturation (TSAT) (p = 0.009), higher CCI score (p = 0.01) and depression (p < 0.005). Independent factors were older age, heart failure, low TSAT and depressive symptoms. Day-time somnolence was present in 108 patients (27%) and was independently associated with stroke [odds ratio (OR) = 2.84, CI 1.03-7.76), lower hemoglobin concentration (OR = 2.45, CI 0.95-3.03) and high risk of OSA (OR = 1.65, CI 1.03-2.63). High risk of OSA (n = 120; 30%), was associated with hypertension (p < 0.001), overweight/obesity (p = 0.001), older age (p = 0.003) and symptoms of depression (p = 0.01). CONCLUSIONS Poor sleep quality and EDS were prevalent on chronic hemodialysis. Heart failure, low TSAT and depressive symptoms were independently associated with poor sleep quality. Stroke, anemia and high risk of OSA were independently associated with EDS. These results provide new insight into possible treatment strategies.
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Affiliation(s)
- Sônia M H A Araujo
- Department of Medicine, School of Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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Unruh M, Kurella Tamura M, Larive B, Rastogi A, James S, Schiller B, Gassman J, Chan C, Lockridge R, Kliger A. Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study. Am J Nephrol 2011; 33:398-406. [PMID: 21474924 DOI: 10.1159/000326343] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/22/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients. METHODS Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality. RESULTS The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001). CONCLUSION These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.
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Affiliation(s)
- Mark Unruh
- University of Pittsburgh, Presbyterian Hospital C1111, Pittsburgh, PA 15213, USA.
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Quality of sleep in patients undergoing hemodialysis. Int Urol Nephrol 2010; 44:557-67. [DOI: 10.1007/s11255-010-9881-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
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Szeifert L, Hamvas S, Adorjáni G, Novák M. [Mood disorders in patients with chronic kidney disease. Diagnosis, screening and treatment of depression]. Orv Hetil 2009; 150:1723-30. [PMID: 19723601 DOI: 10.1556/oh.2009.28698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Depression is a common co-morbid condition in patients suffering from a variety of chronic medical conditions. In spite of this, mental health of patients with chronic kidney disease is understudied. Accurate estimation of the prevalence of depressive disorders in this population is difficult due to the different definitions and assessment techniques and the overlap of depressive symptomatology with symptoms of uremia. Several potential pathways link depression and chronic kidney disease. The association between the two conditions is probably bidirectional. Consequently, treatment of mood disorders could impact medical outcome. Very little has been published about the therapeutic options for depression in patients with chronic kidney disease. Available data, however, suggest that several antidepressant medications and psychotherapeutic methods are likely to be safe and effective also in this population. In this review, which is the second of a series of reviews on this topic, we provide an overview of the literature concerning the diagnosis, screening and therapy of depressive disorders in patients with chronic kidney disease.
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Affiliation(s)
- Lilla Szeifert
- Semmelweis Egyetem, Altalános Orvostudományi Kar Magatartástudományi Intézet Budapest
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Koch BCP, Nagtegaal JE, Hagen EC, Wee PMT, Kerkhof GA. Different melatonin rhythms and sleep-wake rhythms in patients on peritoneal dialysis, daytime hemodialysis and nocturnal hemodialysis. Sleep Med 2009; 11:242-6. [PMID: 19596605 DOI: 10.1016/j.sleep.2009.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 04/07/2009] [Accepted: 04/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little comparative data on sleep-wake rhythms in different dialysis groups exist. The aim of this study was to investigate sleep-wake parameters measured with actigraphy and sleep questionnaires as well as melatonin rhythms in automated peritoneal dialysis, conventional daytime hemodialysis and nocturnal hemodialysis patients. METHODS Conventional daytime dialysis (n=20), nocturnal hemodialysis (n=13) and automated peritoneal dialysis patients (n=6) were included in the study. Melatonin in saliva was sampled at 5 time points (21:00, 23:00, 1:00, 7:00 and 9:00 h). Furthermore, actigraphy measurements and sleep questionnaires were performed. All parameters were tested by Kruskall-Wallis test (followed by post hoc Dunn test) to find significant differences (p<0.05). RESULTS Although most sleep parameters were impaired in all three groups, conventional daytime dialysis patients had the worst sleep. In nocturnal hemodialysis patients a normal nocturnal melatonin rise was found. In daytime hemodialysis and automated peritoneal dialysis patients this rise was absent. CONCLUSIONS The study showed impaired sleep parameters in all dialysis patient groups. As automated peritoneal dialysis is also performed during night time, the same effect on normalized melatonin was anticipated as was found in nocturnal hemodialysis. Melatonin seems to play a subordinate role in the sleep-wake rhythm of automated peritoneal dialysis patients.
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Affiliation(s)
- Birgit C P Koch
- Department of Clinical Pharmacy, Meander Medical Center, ES Amersfoort, The Netherlands.
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Koch BCP, Nagtegaal JE, Hagen EC, van der Westerlaken MML, Boringa JBS, Kerkhof GA, Ter Wee PM. The effects of melatonin on sleep-wake rhythm of daytime haemodialysis patients: a randomized, placebo-controlled, cross-over study (EMSCAP study). Br J Clin Pharmacol 2008; 67:68-75. [PMID: 19076157 DOI: 10.1111/j.1365-2125.2008.03320.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIM The aim of this study was to investigate the effects of exogenous melatonin on sleep-wake rhythm in haemodialysis patients. METHODS The study design is a randomized, double-blind, placebo-controlled, cross-over study of 3 x 6 weeks melatonin 3 mg at 22.00 h every night. Haemodialysis patients were asked to fill out a sleep questionnaire and to wear an actometer to record their sleep problems objectively. Furthermore, melatonin concentrations in saliva were sampled the night after daytime haemodialysis and the consecutive night. Actometers, the sleep questionnaire and melatonin concentrations were repeated during the study. RESULTS In total, 20 patients (six female, median age 71 years) completed the investigation. On nights after daytime dialysis, objective sleep onset latency decreased significantly from a median of 44.5 (placebo) to a median of 15.5 min with melatonin (P < 0.01). Sleep efficiency increased from 67.3 to 73.1% with melatonin (P < 0.05). Actual sleep time increased from 376 min (placebo) to 388 min with melatonin (P < 0.01), and sleep fragmentation decreased from 4.5 to 3.1 (P < 0.01). Furthermore, subjective sleep parameters improved also. Patients reported less time needed to fall asleep (P < 0.05) and fewer wake periods (P < 0.05) on the nights with and without daytime dialysis and an increase in sleep time on the night of daytime dialysis (P < 0.05). Furthermore, the nocturnal melatonin rise was recovered. CONCLUSION Treatment with melatonin resulted in an improvement of subjective and objective sleep parameters, as well as a recovered nocturnal melatonin rhythm.
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Affiliation(s)
- Birgit C P Koch
- Department of Clinical Pharmacy, Meander MC, Amersfoot, The Netherlands.
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Kutner NG. Promoting functioning and well-being in older CKD patients: review of recent evidence. Int Urol Nephrol 2008; 40:1151-8. [DOI: 10.1007/s11255-008-9469-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
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Chen HY, Chiang CK, Wang HH, Hung KY, Lee YJ, Peng YS, Wu KD, Tsai TJ. Cognitive-behavioral therapy for sleep disturbance in patients undergoing peritoneal dialysis: a pilot randomized controlled trial. Am J Kidney Dis 2008; 52:314-23. [PMID: 18511165 DOI: 10.1053/j.ajkd.2008.03.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 03/10/2008] [Indexed: 01/11/2023]
Abstract
BACKGROUND Greater than 50% of dialysis patients experience sleep disturbances. Cognitive-behavioral therapy (CBT) is effective for treating chronic insomnia, but its effectiveness has never been reported in peritoneal dialysis (PD) patients and its association with cytokines is unknown. We investigated the effectiveness of CBT in PD patients by assessing changes in sleep quality and inflammatory cytokines. STUDY DESIGN Randomized control study with parallel-group design. SETTING & PARTICIPANTS 24 PD patients with insomnia in a tertiary medical center without active medical and psychiatric illness were enrolled. INTERVENTION The intervention group (N = 13) received CBT from a psychiatrist for 4 weeks and sleep hygiene education, whereas the control group (N = 11) received only sleep hygiene education. OUTCOMES & MEASUREMENTS Primary outcomes were changes in the Pittsburgh Sleep Quality Index and Fatigue Severity Scale scores, and secondary outcomes were changes in serum interleukin 6 (IL-6), IL-1beta, IL-18, and tumor necrosis factor alpha levels during the 4-week trial. RESULTS Median percentages of change in global Pittsburgh Sleep Quality Index scores were -14.3 (interquartile range, -35.7 to - 6.3) and -1.7 (interquartile range, -7.6 to 7.8) in the intervention and control groups, respectively (P = 0.3). Median percentages of change in global Fatigue Severity Scale scores were -12.1 (interquartile range, -59.8 to -1.5) and -10.5 (interquartile range, -14.3 to 30.4) in the intervention and control groups, respectively (P = 0.04). Serum IL-1beta level decreased in the intervention group, but increased in the control group (P = 0.04). There were no significant differences in changes in other cytokines. LIMITATIONS This study had a small number of participants and short observation period, and some participants concurrently used hypnotics. CONCLUSIONS CBT may be effective for improving the quality of sleep and decreasing fatigue and inflammatory cytokine levels. CBT can be an effective nonpharmacological therapy for PD patients with sleep disturbances.
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Affiliation(s)
- Hung-Yuan Chen
- Department of Internal Medicine, Division of Nephrology, Far Eastern Memorial Hospital, Taipei, Taiwan
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Sabbatini M, Pisani A, Crispo A, Ragosta A, Gallo R, Pota A, Serio V, Tripepi G, Cianciaruso B. Sleep quality in patients with chronic renal failure: A 3-year longitudinal study. Sleep Med 2008; 9:240-6. [PMID: 17644473 DOI: 10.1016/j.sleep.2007.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 04/06/2007] [Accepted: 04/06/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite the high prevalence of sleep disorders in patients with kidney disease, no relationship has been demonstrated between sleep quality and the degree of renal function in cross-sectional studies. A prospective trial was, therefore, started in patients with chronic renal failure (CRF) to evaluate whether a link exists between the modifications of these parameters observed during a three-year follow-up period. METHODS Sleep quality was determined by the Pittsburgh Sleep Quality Index (PSQI) at baseline and after two and three years (Time 0, 2 and 3, respectively) in 78 patients with various degrees of CRF in association with the main clinical and biochemical variables. RESULTS The baseline PSQI averaged 6.2+/-3.8 (range: 0-21, with higher values indicating worse sleep quality) and was significantly increased at both Time 2 and 3 (8.8+/-3.7 and 10.2+/-3.5, respectively, P<0.0001 vs baseline), whereas creatinine clearance progressively decreased (45+/-24 vs 41+/-26 and 32+/-20ml/min, at time 0, 2 and 3, respectively, P<0.0001), although an independent association with PSQI could not be demonstrated after adjustment for confounding factors (P=0.90, mixed linear model). CONCLUSIONS Our data suggest that the progression of renal disease is accompanied by a progressive worsening of sleep quality; age is strongly related to both phenomena. PSQI represents an easy tool to use to detect sleep disorders and to more effectively evaluate renal patients; the prevention of sleep disorders by early and appropriate treatments could beneficially influence the course of the disease.
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