Subjective Assessment of Sleep Quality and Excessive Daytime Sleepiness in Conventional Hemodialysis Population: A Single-Center Experience

Abstract

Sleep disturbances are common in patients with end-stage kidney disease on hemodialysis (hemodialysis population: HDP). Higher rates of primary sleep disorders, demographic characteristics, metabolic abnormalities, and the efficacy of treatment place HDP at higher risk. The pattern observed is delayed onset of sleep, frequent awakening episodes, insomnia, sleep apnoea, excessive daytime sleepiness, restless leg syndrome, abnormal limb movements, pain in limbs, confusion, and nightmares. Two commonly used subjective assessment scores are the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness. Objective: Subjective assessment of sleep using PSQI and ESS scores in HDP and correlation with clinical and demographic characteristics. Patients and Methods: A cross-sectional descriptive study of 148 patients with ESKD undergoing in-center hemodialysis. From June 2021 to October 2021 in Madurai medical college, Madurai, India. Subjective assessment with PSQI and ESS scores was done to identify sleep quality and daytime sleepiness, respectively. Results: The median PSQI score was 6 (IQ:4-10), and as much as 68.24% scored >5 on the PSQI (poor sleepers). The median ESS score of the study participants was 4 (Iq range 3-7), and 19.59% had a total ESS score of more than 10 (excessive daytime sleepiness). The mean age of the participants was 44±14.5. Age more than 60, lower body mass index, unemployment, higher dialysis vintage of more than 2 years, lower hemoglobin, high calcium-phosphorus product are statistically significant for both PSQI and ESS scores. Conclusion:The prevalence of poor sleep quality and excessive daytime sleepiness is high in HDP. Subjective assessment scores (PSQI and ESS) on the bedside are valuable tools in identifying sleep quality and EDS where objective assessment methods are not feasible and will help in the short time identification and management of sleep disturbances.

The Interplay of Anxiety, Depression, Sleep Quality, and Socioeconomic Factors in Somali Hemodialysis Patients

“…Different tools capture different aspects of sleep disturbances, leading to variations in reported rates. Consistent with previous research [18,23], our study found no significant gender-based differences in sleep quality among HD patients, indicating consistent experiences of poor sleep quality between male and female patients. These findings align with prior studies exploring gender differences in sleep patterns among individuals with chronic illnesses.…”

“…It assesses the severity of difficulties with sleep onset, maintenance, early morning awakening, sleep dissatisfaction, interference with daytime functioning, noticeability of sleep problems by others, and distress caused by lack of sleep over the past month using a 5-point Likert scale (0 = no difficulty, 4 = very severe problem). The total score ranges from 0 to 28 and categories of insomnia are as follows: no insomnia (0-7), sub-threshold insomnia (8)(9)(10)(11)(12)(13)(14), moderate insomnia (15)(16)(17)(18)(19)(20)(21), and severe insomnia (22)(23)(24)(25)(26)(27)(28). The ISI is available in three forms: patient, clinician, and significant other.…”

“…Moreover, patients with kidney failure undergoing regular HD frequently encounter sleep disorders [15,16]. The prevalence of sleep disturbances among these individuals has been reported to range from 40% to 80%, significantly surpassing rates observed in the general population [17,18]. Kidney failure patients may experience various sleep disorders, including restless leg syndrome (RLS), obstructive sleep apnea (OSA), central disorders of hypersomnolence, insomnia, sleep-related breathing disorders, excessive daytime sleepiness, sleep-wake disorders, nightmares, narcolepsy, night-time waking, sleepwalking, and parasomnias [19,20].…”

Systematic Review of Prevalence of Sleep Problems in India: A Wake- up Call for Promotion of Sleep Health

“…Data also exists about its prevalence in general population. Methods employed ranged from questionnaires 5,6,8–10,12–14,16,18–21,24,25,29–32,34,38–40,42,44,47,48,51,52,55,56,59,60,63,64,67,70–75,80,82,84,87,88,90–97,99–104 , home testing to overnight sleep studies 34,49,51,52,55,58–66,68,69,98,99 . In some studies, screening using questionnaires was done followed by polysomnography 10,26,48,51,52,59,64,99 .…”

“…Excessive daytime sleepiness (EDS) remained a symptom which was found in many studies and analysis for EDS was done. Studies reporting insomnia or insomnia like features , OSA 13,22,26,27, , RLS 10,15,19,25,28,[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] and excessive daytime sleepiness 11,17,40,59,60,67,72,80,88,[91][92][93][94][95][96][97][98][99][100][101][102][103][104] were analysed. The details of which are tabulated in Table 1.…”