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Lyons OD. Sleep disorders in chronic kidney disease. Nat Rev Nephrol 2024:10.1038/s41581-024-00848-8. [PMID: 38789686 DOI: 10.1038/s41581-024-00848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
Sleep disorders are highly prevalent in chronic kidney disease (CKD) but are often under-recognized. Restless legs syndrome, which is common in CKD owing to issues with dopamine metabolism and is exacerbated by iron deficiency and uraemia, can lead to poor sleep quality and increased daytime fatigue. Insomnia is also prevalent in CKD, particularly in patients requiring dialysis, with increased sleep latency and sleep fragmentation being reported. The cause of insomnia in CKD is multifactorial - poor sleep habits and frequent napping during dialysis, uraemia, medications and mood disorders have all been suggested as potential contributing factors. Sleep apnoea and CKD are also now recognized as having a bi-directional relationship. Sleep apnoea is a risk factor for accelerated progression of CKD, and fluid overload, which is associated with kidney failure, can lead to both obstructive and central sleep apnoea. The presence of obstructive sleep apnoea in CKD can exacerbate the already heightened cardiovascular morbidity and mortality in these patients, as well as leading to daytime fatigue and reduced quality of life. Increased awareness, timely diagnosis and appropriate therapeutic interventions are essential to reduce the negative impact of sleep disorders in patients with kidney disease.
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Affiliation(s)
- Owen D Lyons
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Women's College Hospital, Toronto, Canada.
- Women's College Research Institute, Toronto, Ontario, Canada.
- Sleep Research Laboratory, Toronto Rehabilitation Institute, KITE-UHN, Toronto, Ontario, Canada.
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Zhang C, Mu H, Yang YF, Zhang Y, Gou WJ. Effect of aromatherapy on quality of life in maintenance hemodialysis patients: a systematic review and meta-analysis. Ren Fail 2023; 45:2164202. [PMID: 36908215 PMCID: PMC10013488 DOI: 10.1080/0886022x.2022.2164202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Objective: Aromatherapy has been used for patients on maintenance hemodialysis (MHD), but the outcomes are still controversial. Thus, we conducted this study to systematically evaluate the effect of aromatherapy on the quality of life of patients on MHD.Methods: We searched the PubMed, Embays, Scopus, Web of Science, and CNKI databases for randomized controlled trials that evaluated the use of aromatherapy in dialysis patients and reported at least one outcome of interest.Results: Twenty-two relevant studies were included in the meta-analysis. The meta-analysis revealed that aromatherapy significantly increased subjective sleep quality (a lower score indicates better sleep quality) [standardized mean difference (SMD) = -1.52, 95% CI (-2.38, -0.67), p < 0.01] and reduced fatigue [SMD = -1.14, 95% CI (-1.95, -0.33), p = 0.01], anxiety [SMD = -1.38, 95% CI (-2.09, -0.67), p < 0.01], symptoms of restless legs syndrome [RLS; SMD = -1.71, 95% CI (-2.09, -1.33), p < 0.01], and arteriovenous fistula puncture pain [SMD= -1.56, 95% CI (-2.60, -0.52), p < 0.01].Conclusions: Aromatherapy may be used as a novel complementary and alternative therapy to improve sleep quality and reduce fatigue, anxiety, symptoms of RLS, and arteriovenous fistula puncture pain in patients on MHD.
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Affiliation(s)
- Cong Zhang
- Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou, PR China
| | - Hang Mu
- Department of Oncology, Jianli People's Hospital, Jianli, PR China
| | - Yong-Fang Yang
- Department of Nursing, Jianli People's Hospital, Jianli, PR China
| | - Yong Zhang
- Department of Nephrology, Jianli People's Hospital, Jianli, PR China
| | - Wen-Jun Gou
- Department of Nephrology, The First Affiliated Hospital of Yangtze University, Jingzhou, PR China
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Beerappa H, Gt K, Chandrababu R. The Effects of Inhalational Lavender Essential Oil Aromatherapy on Sleep Quality in Hemodialysis Patients: A Before-and-After-Intervention Trial. Holist Nurs Pract 2023; 37:356-362. [PMID: 35703289 DOI: 10.1097/hnp.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the most essential physical prerequisites for human survival is sleep. Patients undergoing hemodialysis often experience a lack of sleep, and it is one of the decisive variables in dialysis patients' quality of life. The objective of this study was to assess the effects of inhaling lavender essential oil on sleep quality in hemodialysis patients. A total of 30 patients were enrolled in the before-and-after intervention trial, which took place in a tertiary care hospital's dialysis unit. The study participants were selected using the purposive sampling technique and they received lavender oil inhalation therapy. The sleep quality was measured using the Pittsburgh Sleep Quality Index. The mean age of the participants was 55.11 (SD = 8.45) years. The mean posttherapy Pittsburgh Global Sleep Quality Index score was 8.8 ± 1.89 compared with the pretherapy score of 14.73 ± 1.53. Patients undergoing hemodialysis experienced a substantial improvement in sleep quality ( P < .05). Aromatherapy using lavender oil is effective in enhancing sleep quality in hemodialysis patients.
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Affiliation(s)
- Harish Beerappa
- Cauvery College of Nursing, Cauvery Group of Institutions, Mysore, Karnataka, India (Mr Beerappa and Ms Kavana); and Department of Medical Surgical Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (Dr Ramesh)
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Safarpour Y, Vaziri ND, Jabbari B. Restless Legs Syndrome in Chronic Kidney Disease- a Systematic Review. Tremor Other Hyperkinet Mov (N Y) 2023; 13:10. [PMID: 37008995 PMCID: PMC10064886 DOI: 10.5334/tohm.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives The objective of this review is to provide updated information on the epidemiology, correlating factors and treatment of chronic kidney disease associated restless legs syndrome (CKD-A-RLS) in both adult and pediatric population. Materials and Methods We have reviewed the Medline search and Google Scholar search up to May 2022, using key words restless legs syndrome, chronic kidney disease and hemodialysis and kidney transplant. The reviewed articles were studied for epidemiology, correlating factors, as well as pharmacologic and non-pharmacologic treatment options. Results Our search revealed 175 articles, 111 were clinical trials or cross- sectional studies and 64 were review articles. All 111 articles were retrieved and studied in detail. Of these, 105 focused on adults and 6 on children. A majority of studies on dialysis patients reported a prevalence between 15-30%, which is notably higher than prevalence of RLS in general population (5-10%). The correlation between presence of CKD-A-RLS with age, gender, abnormalities of hemogram, iron, ferritin, serum lipids, electrolytes and parathyroid hormones were also reviewed. The results were inconsistent and controversial. Limited studies have reported on the treatment of CKD-A-RLS. Non-pharmacological treatment focused on the effect(s) of exercise, acupuncture, massage with different oils and infra-red light whereas, pharmacologic treatment options include the effects of dopaminergic drugs, Alpha2-Delta ligands (gabapentin and pregabalin), vitamins E and C, and intravenous iron infusion. Conclusion This updated review showed that RLS is two to three times more common in patients with CKD compared to the general population. More patients with CKD-A-RLS demonstrated increased mortality, increased incidence of cardiovascular accident, depression, insomnia and impaired quality of life than those with CKD without RLS. Dopaminergic drugs such as levodopa, ropinirole, pramipexole and rotigotine as well as calcium channel blockers (gabapentin and pregabalin) are helpful for treatment of RLS. High quality studies with these agents are currently underway and hopefully confirm the efficacy and practicality of using these drugs in CKD-A-RLS. Some studies have shown that aerobic exercise and massage with lavender oil can improve symptoms of CKD-A- RLS suggesting that these measures can be useful as adjunct therapy.
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Qu SS, Zhang Y, Ren JN, Yang SZ, Li X, Fan G, Pan SY. Effect of different ways of ingesting orange essential oil on blood immune index and intestinal microflora in mice. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2023; 103:380-388. [PMID: 35894931 DOI: 10.1002/jsfa.12152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/04/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Studies have found that the addition of plant essential oils to feed had a positive effect on intestinal microflora and immunity in mice. However, the effect of different ways of ingestion of orange essential oil on mice has seldom been reported. In the present study, we investigated the effects of ingestion of orange essential oil by gavage, sniffing and feeding on intestinal microflora and immunity in mice. RESULTS The results obtained showed that a low concentration of essential oil feeding significantly increased the spleen index of mice (P < 0.05). The effect of different ways of ingestion on the thymus index, immunoglobulin G and immunoglobulin M of mice was not significant (P > 0.05). High and medium concentrations of essential oil feeding increased the level of interleukin-2 in mice (P < 0.05). H+ K+ -ATPase activity was significantly increased in mice fed with gavage and different concentrations of essential oil feed compared to the control group (P < 0.05). The analysis of the results of the microflora in the cecum and colon of mice indicated that the medium concentration of essential oil feeding group and the sniffing group significantly changed the structure of the flora and increased the diversity of the intestinal microflora. All three essential oil ingestion methods increased the abundance of Bacteroidetes and Lactobacillus in the intestine of mice. CONCLUSION Compared with gavage and feeding, sniffing had a significant effect on immunoglobulins in mice. All the three ingestion methods could affect the intestinal microflora of mice and increase the abundance of Lactobacillus. © 2022 Society of Chemical Industry.
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Affiliation(s)
- Sha-Sha Qu
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Yan Zhang
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Jing-Nan Ren
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Shu-Zhen Yang
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Xiao Li
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Gang Fan
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Si-Yi Pan
- Key Laboratory of Environment Correlative Dietology, Ministry of Education, College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
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Luo J, Jiang W. A critical review on clinical evidence of the efficacy of lavender in sleep disorders. Phytother Res 2022; 36:2342-2351. [PMID: 35412693 DOI: 10.1002/ptr.7448] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022]
Abstract
Sleep disorders are one of the most prevalent psychiatric diseases. Insomnia is the most common sleep disorder amongst the general population. It is also one of the most frequent complaints in primary healthcare centers. Lavender is called "the broom of the brain" in different oriental traditional medicines. It is one of the most used plants for patients with sleep disorders. This study reviews what is currently known about the use of lavender for sleep disorders in patients with different diseases, from cancers and end-stage renal disease to neurological-psychiatric diseases (e.g., depression, dementia, and autism), respiratory, cardiac, and metabolic diseases. Additionally, its most used administration route is the inhalation of its essential oil (i.e., aromatherapy) alone or in combination by massage. Some limitations of the reviewed literature were discussed briefly. Overall, this critical review provides promising evidence of the lavender efficacy for sleep disorders in a wide variety of populations and diseases. However, further clinical studies with robust design and longer durations of intervention are necessary for more evidence-based judgment on its effect on sleep problems and to investigate its mechanism of action.
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Affiliation(s)
- Jing Luo
- Medical Examination Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wubian Jiang
- Department of Outpatient Management Service, Renmin Hospital of Wuhan University, Wuhan, China
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Xia M, He Q, Ying G, Fei X, Zhou W, He X. Clinical Efficacy and Safety of Massage for the Treatment of Restless Leg Syndrome in Hemodialysis Patients: A Meta-Analysis of 5 Randomized Controlled Trials. Front Psychiatry 2022; 13:843263. [PMID: 35479488 PMCID: PMC9035587 DOI: 10.3389/fpsyt.2022.843263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
AIM We conducted this meta-analysis to evaluate the clinical efficacy and safety of massage for the treatment of hemodialysis patients with restless leg syndrome (RLS). METHODS A comprehensive literature search was performed using the PubMed database, EMBASE database (via OVID), and the Cochrane Library in order to identify eligible randomized controlled trials (RCTs) published before August 31, 2021. After extracted essential data and assessed risk of bias of each eligible study, we calculated the pooled estimate of RLS score and safety after treatment. Statistical analysis was performed by using Review Manager 5.3. RESULTS Five studies involving 369 hemodialysis patients with RLS were analyzed. The RLS score after treatment [mean difference (MD), -12.01; 95% confidence interval (CI), -14.91 to -9.11] and mean difference of RLS score at the beginning and end of treatment [mean difference (MD), -11.94; 95% confidence interval (CI), -15.45 to -8.43] in a massage group was significantly better than that in route care group. Subgroup analysis suggested that massage with lavender oil also significantly reduced the RLS score after treatment (MD, -14.22; 95% CI, -17.81 to -10.63) and mean difference of RLS score at the beginning and end of treatment (MD, -14.87; 95% CI, -18.29 to -11.45) compared with route care. Meanwhile, massage regime significantly relieved RLS severity compared with route care but did not increase adverse events. CONCLUSION Massage may be a preferred treatment modality for hemodialysis patients with RLS because it effectively reduces RLS symptoms, relieves RLS severity, and does not increase the risk of adverse events. However, future study with a larger sample size is warranted due to the fact that only limited number of eligible studies with small sample size are enrolled.
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Affiliation(s)
- Min Xia
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Qien He
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Guanghui Ying
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Xiapei Fei
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Wenjing Zhou
- Department of Nephrology, Beilun People's Hospital, Ningbo, China
| | - Xuelin He
- Department of Nephrology, Beilun People's Hospital, Ningbo, China.,Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of China, Hangzhou, China
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Döner A, Taşcı S. Effect of massage therapy with lavender oil on severity of restless legs syndrome and quality of life in hemodialysis patients. J Nurs Scholarsh 2021; 54:304-314. [PMID: 34779137 DOI: 10.1111/jnu.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This study assessed the effects of massage therapy using 5% lavender oil on the severity of restless legs syndrome (RLS) and the quality of life (QoL) of patients on hemodialysis (HD). DESIGN AND METHODS This is a randomized placebo-controlled study with a pretest-posttest design. This study was conducted from January 30, 2019, to May 6, 2019, at HD centers in Turkey, and it includes 58 participants-31 study patients and 27 controls. Data were collected using patient identification form, RLS severity rating scale, Kidney Disease Quality of Life Scale (KDQOLTM -36) and patient follow-up charts. As per the massage therapy protocol, the patients in the study and control groups received massage therapy with lavender oil and baby oil, respectively. FINDINGS RLS severity significantly decreased in all follow-up weeks in the study group and in the first, second, and third follow-up weeks in the control group. There were significant differences between the groups in terms of KDQOLTM -36 subscales and total scores at the initial and final follow-ups. CONCLUSION In HD patients, massage with lavender oil lessened the severity of RLS and improved the QoL. Accordingly, this therapy can be recommended to HD patients. CLINICAL RELEVANCE Massage therapy during HD sessions is easy, inexpensive, and patient-friendly with no side effects. It is known to reduce symptoms and enable the patients to easily perform daily activities of living. Massage therapy with lavender oil is effective and can be easily applied to patients with RLS by nurses. TRIAL REGISTRATION This study was registered under the Clinical Trials protocol registration system (NCT04630470) upon completion.
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Affiliation(s)
- Ayser Döner
- Department of Internal Nursing, Erciyes University Faculty of Health Science, Kayseri, Turkey
| | - Sultan Taşcı
- Department of Internal Nursing, Erciyes University Faculty of Health Science, Kayseri, Turkey
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Chen JJ, Lee TH, Tu YK, Kuo G, Yang HY, Yen CL, Fan PC, Chang CH. Pharmacological and Nonpharmacological Treatments for Restless Legs Syndrome in End Stage Kidney Disease: A Systematic Review and Component Network Meta-Analysis. Nephrol Dial Transplant 2021; 37:1982-1992. [PMID: 34612498 PMCID: PMC9494057 DOI: 10.1093/ndt/gfab290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Restless legs syndrome (RLS) is common among patients with end stage kidney disease (ESKD) and is associated with poor outcomes. Several recently published studies had focused on pharmacological and nonpharmacological treatments of RLS, but an updated meta-analysis has not been conducted. METHODS The study population was adult ESKD patients on dialysis with RLS. Randomized controlled trials were selected. The primary outcome was reduction in RLS severity. The secondary outcomes were improvement in sleep quality and treatment-related adverse events. Frequentist standard network meta-analysis and additive component network meta-analysis was performed. The evidence certainty was assessed using Confidence in NMA (CINeMA) framework. RESULTS A total of 24 RCTs with 1,252 participants were enrolled and 14 interventions were compared. Cool dialysate produced the largest RLS severity score reduction (MD: 16.82, 95% CI: 10.635-23.02) and high level of confidence. Other potential non-pharmacologic interventions including intradialytic stretching exercise (MD: 12.00, 95% CI: 7.04-16.97) and aromatherapy massage (MD: 10.91, 95% CI: 6.96-14.85) but all with limited confidence of evidence. Among the pharmacological interventions, gabapentin was the most effective (MD: 8.95, 95% CI: 1.95-15.85), which also improved sleep quality (SMD: 2.00, 95% CI: 0.47-3.53). No statically significant adverse events were detected. CONCLUSIONS The NMA supports that cool dialysate is appropriate to apply to treat patients with ESKD and RLS. Gabapentin is most effective pharmacologic intervention which also might improve sleep quality. Further parallel RCTs with sufficient sample sizes are required to evaluate these potential interventions and long-term effects.
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Affiliation(s)
- Jia-Jin Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tao Han Lee
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - George Kuo
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Huang-Yu Yang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chieh-Li Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
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