Poor sleep in organ transplant recipients: self‐reports and actigraphy

Abstract

Solid organ transplant recipients are at increased risk for poor sleep due to pharmacotherapy and co-morbidities, but sleep problems are often unrecognized and untreated. Study aims were to measure rates of occurrence, characteristics and correlates of poor sleep in recipients. The Pittsburgh Sleep Quality Index (PSQI) and sleep parameters measured by wrist actigraphy were obtained at baseline from 143 kidney, liver, heart, lung or pancreas transplant recipients enrolled in a psychosocial intervention trial to improve symptoms and quality of life. Rates of poor sleep were determined using accepted clinical cut-offs; 41% (58 of 143) were poor sleepers (PSQI >8) and 36% used sleep medications in the past month. 15% reported having obstructive sleep apnea and 4% reported restless legs syndrome. Based on actigraphy (n=73), 69% lacked sleep efficiency; 32% took greater than 30 minutes to fall asleep; 88% awakened during the night for more than 30 minutes; and 25% slept less than 6 hours per night. Obesity and use of psychotropics or sleep medications were independent risk factors for poor objectively-measured sleep. Poor sleep is an undertreated problem in transplantation. Screening for sleep problems and behavioral therapies with sleep hygiene instruction may benefit recipients.

Restless Legs Syndrome: An Unresolved Uremic Disorder after Renal Transplantation

“…In concordance with previous reports involving other solid grafts, we did not find an association between RLS and CNI or other immunosuppressive drugs, namely, steroids or m-TOR inhibitors [31, 32]. In addition to dopamine dysfunction, the pathogenesis of RLS has been linked with brain iron metabolism and plasma iron concentration [23]. Reduced iron levels seem to affect dopaminergic transmission, which in turn aggravates RLS.…”

“…Previous researchers have already noted a declining rate of RLS after transplantation, suggesting a benefit from the removal of “uremic influences” by the functional graft [8, 9, 11]. However, whether the frequency of RLS in renal transplant is above average and whether RLS contributes to the cardiovascular disease burden associated with renal disease are still controversial [5, 8, 9, 13, 23]. …”

Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

“…Of the 13 heart transplant recipients in this study, none was classified as having RLS. 60 The prevalence of selfreported RLS in this study was lower than other reports of RLS in transplant recipients, especially in kidney transplant recipients (2.6% in this study vs 4.8%). 61 In summary, the prevalence of PLMI in CHF ranges from 19% to 52%.…”

Psychologic Evaluation in Liver Transplantation: Assessment of Psychologic Profile of End-Stage Liver Disease Patients Before and After Transplant

“…44 Transplant recipients who acknowledge having fatigue also express lack of motivation and social interest, malaise, lethargy, and discomfort, which together affect daily function and quality of life. 22,45,46 Further studies could test how integration of complementary and alternative medicines such as yoga and mindfulness practices can lead to better outcomes for these patients.…”

“…17,18 Sleepiness and fatigue are also common events in patients with chronic liver disease, which can reduce their daily function and their health-related quality of life. [19][20][21][22][23] In addition, impaired neuropsychologic and cognitive functions, such as memory, have been common in liver disease patients and transplant recipients. [24][25][26][27][28] Such deficits may lead to nonadherence to medication and its debilitating consequences, including transplant rejection, infection, and even increased mortality.…”