Circadian sleep–wake rhythm disturbances in end-stage renal disease

Abstract

End-stage renal disease (ESRD) is an increasing health problem worldwide. Given the increasing prevalence of this disease, the high cost of hemodialysis treatment and the burden of hemodialysis on a patient's life, more research on improving the clinical outcomes and the quality of life of hemodialysis-treated patients is warranted. Sleep disturbances are much more prevalent in the dialysis population than in the general population. Several studies investigating the effect and importance of sleep problems on quality of life in dialysis patients revealed that sleep disturbances have a major influence on the vitality and general health of these patients. Sleep disturbances in this patient group are caused both by the pathology of the renal disease and by the dialysis treatment itself. This Review focuses on circadian sleep-wake rhythm disturbances in individuals with ESRD. The possible external and internal influences on sleep-wake rhythmicity in patients with ESRD, such as the effect of dialysis, medications, melatonin and biochemical parameters, are presented. In addition, possible approaches for strengthening the synchronization of the circadian sleep-wake rhythm, such as nocturnal hemodialysis, exogenous melatonin, dialyzate temperature, exogenous erythropoietin, use of bright light and exercise during dialysis treatment, are explored. Further research in this area is warranted, and a greater awareness of sleep problems is needed to improve the quality of life of patients with ESRD.

Perfil do sono de pacientes idosos submetidos à hemodiálise

“…18 Aspectos ligados à atividade laboral e social (restritas nesses indivíduos submetidos à hemodiá-lise), fatores genéticos, psicológicos e hábitos de vida podem interferir no sono. 19,20 Entretanto, outros fatores pouco avaliados nos estudos podem estar também relacionados aos TS nesses pacientes, como a anemia, os níveis de ureia e toxinas urêmicas no sangue, doenças cardiovasculares, hipertensão arterial, diabetes melito, idade avançada, tempo em hemodiálise, abuso de álcool e tabaco, depressão, e outros. 4 Neste estudo, depressão figura como elemento clínico que se mostrou associado ao perfil de sono dos pacientes em regime dialítico; portanto, é um aspecto clínico a ser investigado em estudos subsequentes sobre a mesma temática.…”

“…Uma causa plausível e já referida em alguns estudos consiste na influência dos parâmetros bioquímicos, como níveis de hemoglobina, ureia e fósforo. 19 Na prática clínica, observase que níveis elevados de fósforo podem favorecer a dor óssea, o prurido e, consequentemente, um sono fragmentado. Este estudo não identificou relação desses parâmetros com a qualidade do sono.…”

Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial

“…The study had no data safety or monitoring board because melatonin was considered safe. 28,29 We reported all serious adverse events to the Medical Ethics Committee and had a protocol to break the randomization code in case of a suspected unex pected serious adverse reaction. This trial was registered with the Netherlands Trial Registry (NTR1576) and was funded by an unrestricted grant (no.…”

Η Επίδραση Της Άσκησης Στην Ευρωστία Ασθενών Με Χρόνια Νεφρική Ανεπάρκεια Που Πάσχουν Από Το Σύνδρομο Των Ανήσυχων Ποδιών

“…Γενικά στοιχεία για το Σύνδρομο Ανήσυχων Ποδιών (ΣΑΠ) [33][34][35][36] Φαινότυποι του ΣΑΠ ………………………………………………………………………………. 36…”

“…Η παθολογία της νεφρικής νόσου όπως επίσης και η θεραπεία υποκατάστασης της νεφρικής λειτουργίας μέσω της αιμοκάθαρσης ίσως να συνδέονται με την αυξημένη εμφάνιση διαταραχών του ύπνου στον συγκεκριμένο πληθυσμό (35,36).…”