The complexity of sleep disorders in dialysis patients

Abstract

Background Dialysis patients experience a high burden of physical and emotional symptoms directly affecting their sleep and quality of life. In this study, objective and subjective measurements to quantify sleep were performed, compared with those of healthy controls, and associated with burden of comorbidity and uraemic toxicity. Methods A total of 64 dialysis patients were included—10 peritoneal dialysis, 42 in-centre daytime haemodialysis (HD) and 12 in-centre nocturnal HD patients—as well as one-to-one age- and gender-matched healthy controls. Assumed and actual sleep time, sleep efficiency and fragmentation index were measured by actigraphy for at least two consecutive nights. Patients and controls also completed Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. The patients’ blood was sampled to determine concentrations of a representative series of uraemic toxins and the Davies–Stoke comorbidity index was derived from medical records. Results Apart from the assumed sleep time, all objectively and subjectively measured sleep parameters were worse in the dialysis group compared with the healthy controls. No differences were seen in any of the measured sleep parameters among the different dialysis groups. None of the objectively measured sleep parameters were associated with ISI or PSQI scores in dialysis patients, while sleep times were related to the subjective scores in the healthy cohort. Objectively assessed sleep parameters were associated to neither the uraemic toxicity load nor the Davies–Stoke score. Conclusions Independent of the modality, dialysis patients have sleep quality much worse than age- and gender-matched healthy controls. The objectively measured sleep parameters could not be associated to the subjective score, uraemic toxicity or comorbidity score, highlighting the need for objective measurements of sleep and clinical guidelines to aid patient management.

Sleep Quality and Its Affecting Factors among Hemodialysis Patients: A Multicenter Cross-Sectional Study

“…This means that the quality of sleep can be affected by factors such as the presence of various comorbidities, as well as the length of time that HD patients were hospitalized. Comorbidities such as hypertension, diabetes, cardiovascular disease, and kidney-related problems are common among patients on maintenance HD and peritoneal dialysis and might have an indirect or direct effect on sleep quality [ 31 , 58 , 62 , 63 ]. Poor sleep quality is common among dialysis patients, and studies have shown that being on HD and having a mental condition are both risk factors [ 64 ].…”

“…Poor sleep quality is common among dialysis patients, and studies have shown that being on HD and having a mental condition are both risk factors [ 64 ]. Regardless of the type of dialysis used, patients have been found to have significantly poorer sleep quality compared to healthy controls of the same age and gender [ 63 ]. The sleep quality of HD patients was shown to be quite poor in a multicenter research study, with 66.4% of patients having a PSQI > 5 [ 62 ].…”

“…HD patients may experience poor sleep quality and sleep disruptions due to their prolonged hospitalization [ 13 , 17 , 66 ]. There is a significant weight of physical and mental symptoms experienced by HD patients which has a direct impact on their ability to sleep and their overall quality of life [ 63 ]. As shown in Lin et al’s [ 13 ] study, among patients undergoing maintenance HD, 61.78 percent reported experiencing some form of sleep disturbance.…”

Factors Associated With Insomnia in Patients Undergoing Hemodialysis

“…Insomnia is mostly affected by uraemic toxin accumulation, anemia, pain, and psychological problems [8]. It can be also caused by restless leg syndrome and itchy skin due to uremic pruritus [9], sleep apnoea [10], as well as by insufficient control of diabetes [11].…”

“Is It Removed During Dialysis?”—Cognitive Dysfunction in Advanced Kidney Failure—A Review Article

“…The prevalence is high, estimated at 44–95% of patients ( 89 ). Compared to age and sex matched healthy controls sleep quality is worse in those on dialysis ( 90 ). The underlying mechanisms for poor sleep are unclear.…”