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Wen ZY, Zhang Y, Feng MH, Wu YC, Fu CW, Deng K, Lin QZ, Liu B. Identification of discriminative neuroimaging markers for patients on hemodialysis with insomnia: a fractional amplitude of low frequency fluctuation-based machine learning analysis. BMC Psychiatry 2023; 23:9. [PMID: 36600230 PMCID: PMC9811801 DOI: 10.1186/s12888-022-04490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Insomnia is one of the common problems encountered in the hemodialysis (HD) population, but the mechanisms remain unclear. we aimed to (1) detect the spontaneous brain activity pattern in HD patients with insomnia (HDWI) by using fractional fractional amplitude of low frequency fluctuation (fALFF) method and (2) further identify brain regions showing altered fALFF as neural markers to discriminate HDWI patients from those on hemodialysis but without insomnia (HDWoI) and healthy controls (HCs). METHOD We compared fALFF differences among HDWI subjects (28), HDWoI subjects (28) and HCs (28), and extracted altered fALFF features for the subsequent discriminative analysis. Then, we constructed a support vector machine (SVM) classifier to identify distinct neuroimaging markers for HDWI. RESULTS Compared with HCs, both HDWI and HDWoI patients exhibited significantly decreased fALFF in the bilateral calcarine (CAL), right middle occipital gyrus (MOG), left precentral gyrus (PreCG), bilateral postcentral gyrus (PoCG) and bilateral temporal middle gyrus (TMG), whereas increased fALFF in the bilateral cerebellum and right insula. Conversely, increased fALFF in the bilateral CAL/right MOG and decreased fALFF in the right cerebellum was observed in HDWI patients when compared with HDWoI patients. Moreover, the SVM classification achieved a good performance [accuracy = 82.14%, area under the curve (AUC) = 0.8202], and the consensus brain regions with the highest contributions to classification were located in the right MOG and right cerebellum. CONCLUSION Our result highlights that HDWI patients had abnormal neural activities in the right MOG and right cerebellum, which might be potential neural markers for distinguishing HDWI patients from non-insomniacs, providing further support for the pathological mechanism of HDWI.
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Affiliation(s)
- Ze-Ying Wen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Radiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Meng-Han Feng
- R&D Support Group, Xin-Huangpu Joint Innovation Institute of Chinese Medicine in Guangdong Province, Guangzhou, 510700, China
| | - Yu-Chi Wu
- Hemodialysis Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Cheng-Wei Fu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Kan Deng
- Philips Healthcare, Guangzhou, 510120, China
| | - Qi-Zhan Lin
- Hemodialysis Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
| | - Bo Liu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Hashem RES, Abdo TA, Sarhan II, Mansour AM. Sleep pattern in a group of patients undergoing hemodialysis compared to control. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-021-00168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients with chronic kidney disease progress regularly every year to end-stage renal disease and have to undergo dialysis. Sleep disturbances have been reported to be frequent among patients receiving dialysis and contributing to the increase of their mortality and morbidity. The present research aimed to study the sleep pattern in hemodialysis patients and the risk factors associated. This cross-sectional case-control study included 40 subjects divided into 2 groups: 20 cases recruited from Ain Shams University Hospital’s dialysis unit and 20 in the control group with normal Pittsburgh Sleep Quality Index score matched for age and sex. Both groups were subjected to overnight polysomnography, and the cases group was assessed by the Pittsburgh Sleep Quality Index to determine their sleep quality.
Results
Nearly all polysomnographic parameters were significantly abnormal in the cases group except for sleep onset latency (P > 0.05), showing obstructive sleep apnea and periodic limb movement (P value 0.001). Based on their Pittsburgh Sleep Quality Index score, 30% were classified as good sleepers and 70% as bad sleepers. On comparing both groups, a significant difference was found. Poor sleepers had more worse sleep efficiency (62.9%), spent longer time during their sleep in stage 1 (26.6%) with shorter REM onset latency (113.5 ± 99.5), and had a longer duration of illness with lower serum creatinine level compared to good sleepers.
Conclusions
The prevalence of obstructive sleep apnea and periodic limb movement in hemodialysis patients is high; patients with longer time on dialysis are at more risk of sleep disorders, whereas hemoglobin levels, BUN, and other demographic factors do not seem to play a role in sleep disorder. Hence, patients on hemodialysis need to be screened for sleep disorders so as to improve their mortality and morbidity.
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Bang YY, Park H. Effect of Auricular Acupressure on Sleep and Pruritus in Patients Undergoing Hemodialysis. ACTA ACUST UNITED AC 2020. [DOI: 10.7739/jkafn.2020.27.2.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: The aim of this study was to evaluate the effects of auricular acupressure on sleep quality and pruritus in patients undergoing hemodialysis and to propose an effective and evidence-based nursing intervention.Methods: This was a single-blind, nonequivalent, group comparison study with 42 participants. The experimental period was a total of 8 weeks, and five different acupressure sites were applied in each group. Dependent variables were measured before the intervention, at the 4th week of the intervention, and at the 8th week of the intervention.Results: There were significant differences in the Pittsburgh sleep quality index, total sleep time, sleep efficiency, sleep onset latency, light sleep, deep sleep, number of awakenings, serum melatonin levels, subjective pruritus and skin hydration. No significant difference was found in skin pH between the two groups. Conclusion: Auricular acupressure was found to be an effective nursing intervention to improve sleep quality and to reduce pruritus in patients undergoing hemodialysis.
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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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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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Akizawa T, Koiwa F. Clinical Expectation of Online Hemodiafiltration: A Japanese Perspective. Blood Purif 2015; 40 Suppl 1:12-6. [DOI: 10.1159/000437405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many pieces of evidence of online hemodiafiltration (HDF) have been reported, and the clinical advantage of postdilution online HDF with sufficient substitution is now established. After the approval of online HDF in 2012, the number of online HDF patients has been dramatically increasing in Japan and reached 10% of the total dialysis population at the end of 2013. One of the marked characteristics of Japanese online HDF is a widespread use of predilution treatment and, in 2013, 90.8% of online HDFs were carried out with the predilution mode. The main reason for the wide use of predilution online HDF results from the low blood flow rate in Japan, by which it is difficult to substitute a sufficient volume during the limited treatment time. Other reasons to choose the predilution mode include the reduction of albumin loss and the suppression of membrane fouling during treatment. Contrary to postdilution treatment, adequate clinical evidence has not been reported for predilution online HDF to provide a better outcome of the patients. A further clinical trial is expected to elucidate the clinical advantages over conventional hemodialysis for predilution online HDF.
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El Harraqui R, Abda N, Bentata Y, Haddiya I. [Evaluation and analysis of insomnia in chronic hemodialysis]. Pan Afr Med J 2014; 19:221. [PMID: 25838849 PMCID: PMC4374896 DOI: 10.11604/pamj.2014.19.221.4444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/19/2014] [Indexed: 11/16/2022] Open
Abstract
L'insomnie est aussi fréquente chez les hémodialysés chroniques qu'elle est négligée par le personnel soignant, davantage attelé à gérer les complications qui accompagnent l'insuffisance rénale chronique terminale et la dialyse chronique. Notre travail a eu pour but de déterminer la prévalence de l'insomnie et les facteurs qui lui sont associés, afin de pouvoir, dans un temps futur, lui dédier une stratégie de prise en charge adaptée. Il s'agit d'une étude transversale incluant 93 hémodialysés chroniques, dont nous avons étudié les données sociodémographiques, biologique, dialytiques; nous avons également collecté les caractéristiques de l'insomnie, et enfin mis en exergue les facteurs associés à sa survenue. L'insomnie a été définie par un score total supérieur ou égal à 15 au questionnaire de l'I.S.I (Insomnia Severity Index). Ainsi, la prévalence de l'insomnie est de 67,7% (n=63); l’âge moyen est de 55,6±12,7 (22-82) ans, le sexe ratio de 24 Hommes/39 Femmes, la durée moyenne en hémodialyse de 94,6 ± 58,2 (6-252) mois. 45 des patients insomniaques sont dialysés deux fois par semaine. Cette insomnie concernait le début de la nuit dans 52,3% des cas, le milieu de la nuit dans 55,5% des cas, et le petit matin dans 19,04% des cas. Les troubles associés à cette insomnie ont été: la somnolence diurne dans 79,3% des cas (n=50), le syndrome de la jambe sans repos dans 17,4% des cas (n=11), et les cauchemars dans 30,1% des cas (n=19). Une prise régulière d'hypnogènes a été notée chez 20 patients (31,7%). En analyse univariée, les facteurs associés à la survenue de l'insomnie sont l’âge avancé des patients, le sexe féminin, l'ancienneté en hémodialyse, la fréquence de deux séances de dialyse par semaine, le taux d'urée en prédialyse, le score de Charlson, la présence d'une douleur chronique (depuis plus de trois mois), la dépression et enfin l'hypertension artérielle. En analyse multivariée, on retient l’âge avancé des patients, le sexe féminin, l'ancienneté en dialyse et la fréquence de deux séances de dialyse par semaine. En conclusion, les troubles du sommeil et en particulier l'insomnie chez les hémodialysés chroniques sont fréquents et multifactoriels. Une attention particulière doit leur être accordée, incluant une collaboration régulière et étroite entre néphrologues et psychologues, psychiatres et spécialistes du sommeil.
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Affiliation(s)
- Ryme El Harraqui
- Service de Néphrologie-Hémodialyse, Centre Hospitalier Al Farabi, Oujda-Maroc
| | - Naima Abda
- Laboratoire de Biostatistiques, Faculté de Médecine et de Pharmacie, Université Mohamed Ier, Oujda-Maroc
| | - Yassamine Bentata
- Service de Néphrologie-Hémodialyse, Centre Hospitalier Al Farabi, Oujda-Maroc
| | - Intissar Haddiya
- Service de Néphrologie-Hémodialyse, Centre Hospitalier Al Farabi, Oujda-Maroc
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