Sleep Disorders in Hemodialyzed Patients – The Role of Comorbidities

Abstract

Background Sleep disorders are very frequent in hemodialyzed patients, but the relationship between these disorders and water withdrawal, urea removal and comorbidities has not been sufficiently clarified. Methods The study comprised a group of 88 patients in good nutritional condition, with target hemoglobin concentration, good control of blood pressure and optimal dry weight. After answering a questionnaire (SDQ) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) patients were assigned to one of 3 groups: those with no disturbances (no. 20), those with subclinical disorders (n. 35) and insomniacs (n. 33). Yearly fluid and urea withdrawal by dialysis and the Charlson Comorbity Index were measured. Results Sleep disorders were observed in 77.27% of the patients. There was no difference in body fluid and urea withdrawal between groups. In the group of patients with no sleeping disturbances, the Charlson Comorbidity Index was significantly lower (p<0.001) than in patients with subclinical disorders or insomnia and emerged as a strongly associated with sleep disturbances. The study also attributes a predictive role to age, dialytic age, dialysis shift, antihypertensive drugs. The data indicate that, in evaluating sleeping disorders in patients on maintenance hemodialysis, comorbidities should be assessed.

Insomnia severity in chronic kidney disease patients with various therapies

“…In our study, we also found that these habits did not contribute to the insomnia severity score. A few studies have suggested that number and severity of comorbidity in hemodialysis patients can be attributed with the increase in the prevalence of sleep disorders [2,4,30]. In our study, we found that ischemic hearth disease was an independent determinant of the insomnia severity score.…”

Factors Contributing to Sleep Disturbance and Hypnotic Drug Use in Hemodialysis Patients

“…Ge n e r a l J a p a n e s e P o p u l a t i o n cramps, dialysis shift, electrolyte or other imbalances in body fluids) and psychological factors (anxiety, depression), primary sleep disorders such as restless legs syndrome (RLS) and sleep-disordered breathing (SDB) are also potential contributors (4,5,7). RLS, the pathogenesis of which is not fully understood, is a distinct clinical entity with a prevalence estimated to be as high as 5-10% in the general population (8,9).…”

Sleep Disturbances Among Dialysis Patients

“…Sleep complaints seem to be more common in elderly patients on dialysis than in younger patients (Kutner et al, 2001;Walker et al, 1995). It has been reported that each decade of age increases the risk of insomnia (subclinical and clinical) by 239% and the risk of overt clinical insomnia by 51% (De Santo et al, 2005). The effect of gender on sleep quality is controversial.…”

“…It appears that, the longer the dialysis vintage, the higher the prevalence of sleep disturbances. In an Italian study, those patients on dialysis who presented sleep disturbances had a double dialysis vintage when compared to those on dialysis who did not have sleep problems (De Santo et al, 2005). When analyzing the timing of dialysis shifts, a higher rate of insomnia has been reported among patients on the morning dialysis shift.…”