Sleep Disturbance in Chronic Hemodialysis Patients: The Impact of Depression and Anemia

Pai, Mei‐Fen; Hsu, Shih‐Ping; Yang, Shan-Yi; Ho, Tai-I; Lai, Chun-Fu; Peng, Yu‐Sen

doi:10.1080/08860220701459642

Cited by 106 publications

(96 citation statements)

References 20 publications

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“…These results were in agreement with many observations reported by the other investigators. 7,13,14 As regard to phosphate level and sleep disorders there was positive correlation between phosphate level and brief arousal index and PLM in all the groups (r ¼ 0.367, p ¼ 0.0004 and r ¼ 0.384, p ¼ 0.0002), respectively, While negative correlation was found between phosphate level and sleep efficiency in all groups (r ¼ À0.4131, p50.0001 and r ¼ À0.3987, p50.0001), respectively. On the other hand, sleep disorders were also reported in many cases with chronic illness such as liver cirrhosis and heart failure.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of sleep disorders among ESRD patients

Ezzat

Mohab

2015

Renal Failure

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Sleep disorders are common among the patients undergoing dialysis in end stage renal disease (ESRD). Although variable, their prevalence has been reported to be higher when compared to the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). The aim of this study was to assess the prevalence of sleep disorders in end stage renal disease patients on regular hemodialysis (group I with 30 patients) and CKD patients (group II with 30 patients) in comparison to 30 normal population (control group). In addition to laboratory investigations which included creatinine clearance using Cockroft and Gault formula, hemoglobin level (Hb), blood urea, serum creatinine, serum albumin, serum calcium and phosphorus and lipid profile, all subjects underwent one night of laboratory-based polysomnography (PSG) consisting of a standard montage of electroencephalography (EEG) (C3/A1 and O2/C3 or O1/C4), monopolar left and right electrooculography (EOG) referenced to the opposite mastoid, surface mentalis electromyography (EMG), respiratory airflow (measured by thermistor) and effort (piezoelectric sensors), electrocardiography (ECG), anterior tibialis EMG and pulse oximetry. For hemodialysis subjects, this study was performed on a night immediately following hemodialysis treatment. The results showed that patients on hemodialysis have sleep disorders, and that sleep disorders are common in group I and II than control group. The percentage of sleep disorders in hemodialysis patients were as follows: insomnia (69%), followed by obstructive sleep apnea syndrome OSAS (24%), RLS and periodic limb movement PLM (18%), nightmares (13%), EDS (12%), sleepwalking (2%), possible rapid eye movement behavior disorders RED (2%), possible narcolepsy (1.4%). While the percentage of sleep disorders in CKD patients were as follows: insomnia (54%), followed by RLS (19%), PLM (12%), OSAS (16%), nightmares (15%), EDS (15%), sleepwalking (4%), possible RBD (3%), possible narcolepsy (1%). There was inverse correlation between sleep disorders and Hb, albumin and creatinine clearance; also there was positive correlation between sleep disorder and phosphorus. We concluded that the sleep disorders are common in CKD patients either on conservative management or on regular hemodialysis. Treatment of anemia, hyperphosphatemia and hypoalbuminemia may improve sleep disorders among those patients.

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Section: Discussionmentioning

confidence: 99%

Prevalence of sleep disorders among ESRD patients

Ezzat

Mohab

2015

Renal Failure

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“…29 The Chinese version of the PSQI has been used for the study of sleep quality in Taiwan's HD patients. 7,8 The AIS was used to assess sleep complaints and to identify possible cases of clinically significant insomnia. The AIS consists of eight items.…”

Section: Measurement Of Sleep Qualitymentioning

confidence: 99%

“…[2][3][4][5][6] Taiwan-based studies showed a high prevalence of insomnia (66.6%) and poor sleep quality (74.4%) in ESRD patients. 7,8 Many conditions may cause sleep disturbances in these patients, including constraints in life, metabolic abnormalities, dietary restrictions, dyspnea, fatigue, nocturnal cramps, advanced age, hypocapnia accompanied by metabolic acidosis, neuropathic pain, and emotional problems. 9 Sleep disorders appear to be part of the ESRD and manifest as sleep-disordered breathing/ sleep apnea, 10,11 excessive daytime sleepiness (EDS), 12,13 periodic limb movement disorder (PLMD), and restless legs syndrome (RLS).…”

Section: Introductionmentioning

confidence: 99%

The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Wei

Chung

et al. 2011

Renal Failure

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Introduction: Sleep disturbances and cardiovascular autonomic dysfunction are major complications of hemodialysis (HD). The goal of this study is to identify clinical, heart rate variability (HRV) or laboratory parameters that are independently associated with subjective sleep quality. Patient and methods: Forty-six stable HD patients filled out sleep questionnaires -Pittsburgh sleep quality index (PSQI), Athens insomnia scale (AIS), and Epworth sleepiness scale (ESS). In addition, they received analyses of 5-minute HRV twice, in lying posture before and after HD. We also recruited 50 healthy subjects who received 5-min HRV. Results: The patients with end-stage renal disease have a high rate of poor sleep quality according to PSQI, AIS, and ESS. The activities of total power (0-0.5 Hz), high-frequency power (HF, 0.15-0.40 Hz), low-frequency power (0.04-0.15 Hz), and very-low-frequency power (0.003-0.04 Hz) in HD patients are obviously lower than that in the healthy people. The poor sleepers (PSQI > 5) show lower heart rate, higher HF and variance before HD, but did not show a significant difference after HD. There is no significant difference between HRV and global score of AIS, but the insomnia group (AIS > 5) has higher BMI. These patients with sleepiness (ESS > 9) only reveal lower hemoglobin, although the global score of ESS reveals no significant relationship with HRV. Conclusion: HD patients have a high rate of poor sleep quality and autonomic dysfunction. Greater attention for the evaluation of sleep quality is needed for the better care of HD patients.

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“…Insomnia correlated with the presence of depression, anxiety, anemia, primary sleep disorders such as restless legs syndrome, metabolic [23,25] and immunology distress [26]. It is questionable how dialysis therapy influences, directly or indirectly (through the co-morbidites state), the onset of insomnia in these patients.…”

Section: Discussionmentioning

confidence: 99%

Insomnia severity in chronic kidney disease patients with various therapies

Knežević

Djordjević²,

Bivolarevic

et al. 2011

Open Medicine

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AbstractThe prevalence of insomnia is greater in end-stage renal disease. The aim of our study was to determine the frequency of insomnia and subclinical insomnia in patients with various dialysis therapy and kidney transplant recipients, in order to assess the severity of insomnia and examine whether there is a difference in severity among groups. In cross-sectional study, we evaluated 120 patients with terminal renal failure. Based on therapy, patients were divided into four groups: hemodiafiltration, standard bicarbonate dialysis, peritoneal dialysis and kidney transplant recipients. The severity of insomnia was evaluated through the use of the Insomnia Severity Index (ISI). Most patients who reported any kind of insomnia problems with ISI were on conventional dialysis (80%), followed by hemodiafiltration (76.7%) and peritoneal dialysis (63.3%). Transplant recipients had least difficulties with insomnia (46.7%). Insomnia Severity Index showed that insomnia in end-stage renal patients is not very severe. Most of the patients had “no clinically significant insomnia”. Our findings indicate that patients on hemodiafiltration and transplant recipients have a significantly lower score on Insomnia Severity Index. Patients with end-stage renal disease have high frequency insomnia problems. However, our study shows that insomnia in these patients is not severe. Insomnia is the most frequent and severest in patients on standard bicarbonate dialysis.

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Sleep Disturbance in Chronic Hemodialysis Patients: The Impact of Depression and Anemia

Cited by 106 publications

References 20 publications

Prevalence of sleep disorders among ESRD patients

Prevalence of sleep disorders among ESRD patients

The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Insomnia severity in chronic kidney disease patients with various therapies

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