Insomnia in hemodialysis patients: A multicenter study from morocco

Abstract

Previous studies have shown that insomnia is a common sleep disorder in patients with end-stage renal disease. This study aims to determine the prevalence and risk factors of insomnia in our chronic hemodialysis (HD) patients. This is a cross-sectional study conducted in three HD units in Morocco. To assess the prevalence of insomnia, we used a specific questionnaire. Patients complaining of difficulty in falling asleep and/or nocturnal awakenings occurring seven nights a week during the last month were included in the group "insomnia;" the other patients were used as controls. Clinical, biological, and dialysis data were recorded for each patient. Sleep disorders and their subjective causes were also identified. Eighty-nine percent of questioned patients admitted to having sleep disturbances of different degrees. Insomnia was significantly associated with female gender and time of dialysis. Age, body mass index, inter-dialytic weight gain, and blood pressure were similar between the two groups, as well as dialytic parameters and drug use. There was no significant difference in the values of plasma creatinine, urea, hemoglobin, parathyroid hormone, calcium, phosphorus, C-reactive protein, and albumin between the groups. Disorders most frequently encountered in patients with insomnia were waking up at night (90%), difficulty falling asleep (60%), and daytime sleepiness (60%). The restless legs syndrome was seen in half of these patients. The main reported causes of insomnia were anxiety and/or depression (70%) and bone pain (67%). Insomnia is common in HD patients and is frequently associated with other disorders of sleep. Female sex and duration on dialysis are the two risk factors found in our study. Insomnia does not appear related to any biochemical or dialysis parameters. Increased attention should be given to the management of dialysis patients regarding the diagnosis and management of insomnia and associated sleep disorders.

Higher Physical Activity Is Associated With Less Fatigue and Insomnia Among Patients on Hemodialysis

“…Our findings that hemodialysis patients are relatively sedentary 13 and that a large percentage experienced fatigue and insomnia7, 21, 22, 23 are in agreement with other studies. Although one might assume that fatigue and insomnia would be associated with physical activity based on inferences from the general population, dialysis patients have a much higher prevalence of depression, 5 inflammation, 24 and comorbid conditions 19 than the general population.…”

Association of Insomnia in Patients with Chronic Kidney Disease on Maintenance Hemodialysis

“…Diabetes and cardiovascular diseases are significant causes of insomnia, as reported by Manan et al [17], but we could not assess causality due to the cross-sectional nature of the study. A descriptive study published by Mark et al assessed sleep quality among patients with insomnia and reported three times more risk to sleep less than five hours per night and more than half had difficulty getting back to sleep or waking up too early in the morning or feeling tired and not getting ample amount of sleep [20]. In addition, he reported insomnia in 50%-80% of patients on hemodialysis; the current study observed a similar trend between insomnia and hemodialysis.…”

Lower urinary tract symptoms impair the quality of life in maintenance hemodialysis patients

“…Approximately 45% of MHD patients experience sleep disorders, and 90% of the reported disorders are nighttime waking [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20]. Sleep disorders have been linked to decreased survival, perceived decrease of health-related QOL, and poor adherence to hemodialysis [18][19][20]. The clinical characteristics of the LUTS and non-LUTS patients in this study were not significantly different and were in line with those reported in previous studies.…”

“…Approximately 45% of MHD patients experience sleep disorders, and 90% of the reported disorders are nighttime waking [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20]. Sleep disorders have been linked to decreased survival, perceived decrease of health-related QOL, and poor adherence to hemodialysis [18][19][20].…”

“…It is very important to evaluate LUTS as a cause of sleep disorder in MHD patients and to consider whether their sleep disorders might be improved by urological interventions. QOL improvement would be expected to directly improve both adherence to treatment and the survival of MHD patients [1][2][3][18][19][20]. MHD patients with perceived problems of daily living may experience feelings of depression, unstable behavior, or insomnia [1][2][3][18][19][20].…”