Predictors of Sleep Quality in Hemodialysis Patients

Abstract

Purpose

Poor sleep quality (SQ) is common in hemodialysis (HD) patients. Factors associated with poor SQ are not well understood. The objectives of the present study were to determine the prevalence of poor SQ in HD patients in our region and to examine the association between SQ and health-related quality of life (HRQoL), depression, and certain clinical and laboratory parameters.

Methods

A total of 233 HD patients at 5 centers in the city center of Konya, Turkey were included in this study. Their demographic data and biochemical parameters were analyzed. All patients were instructed to complete Turkish versions of three questionnaires, namely, a modified post-sleep inventory (PSI), Beck Depression Inventory (BDI) and a Short Form of Medical Outcomes Study (SF-36).

Results

The mean age of the patients was 52.8±15.3 years and the male to female ratio was 1.33:1. The prevalence of poor sleepers, defined as those having a total sleep score (PSI-4 score) ≥ 4, was 60.9%. Compared with good sleepers, poor sleepers had higher BDI scores and as well as lower PCS and MCS domains of HRQoL. In addition, poor sleepers were older and more likely to be unemployed. There was a significant inverse correlation of PSI-4 score with PCS and MCS, and significant positive correlation of PSI-4 score with BDI and age (p<0.001). The significant independent predictors of PSI-4 score were BDI score, MCS score and employment status.

Conclusions

Depression, MCS score and employment status were the most important predictors of sleep quality in HD patients.

Keywords

Depression Hemodialysis HRQoL Sleep quality

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References

Elder

S.J.

, Pisoni

R.L.

, Akizawa

. Sleep quality predicts quality of life and mortality risk in haemodialysis patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplnt 2008; 23: 998–1004.

Pai

M.F.

, Hsu

S.P.

, Yang

S.Y.

. Sleep disturbance in chronic hemodialysis patients: The impact of depression and anemia. Ren Fail 2007; 29: 673–77.

Iliesqu

E.A.

, Coo

, McMurray

M.H.

. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 2003; 18: 126–32.

Sabbatini

, Minale

, Crispo

. Insomnia in maintenance hemodialysis patients. Nephrol Dial Transplant 2002; 17: 852–56.

Benz

R.L.

, Pressman

M.R.

, Hovick

E.T.

. A preliminary study of the effects of anemia with recombinant human erythropoietin therapy on sleep, sleep disorders, and daytime sleepiness in hemodialysis patients (the SLEEPO study). Am J Kidney Dis 1999; 34: 1089–95.

Veiga

, Gonçalves

, Gomes

, Santos

, Baptista

, Paiva

. Sleep disturbances in end-stage renal disease patients on hemodialysis. Dial Transplant 1997; 26: 380–84.

Craven

J.L.

, Rodin

G.M.

, Littlefield

. The Beck Depression Inventory as a screening device for major depression in renal dialysis patients. Int J Psychiatr Med 1988; 18: 365–74.

Kimmel

P.L.

, Peterson

R.A.

, Weihs

K.L.

. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int 2000; 57: 2093–98.

Kapci

E.G.

, Uslu

, Turkcapar

, Karaoglan

. Beck Depression Inventory II: evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depress Anxiety 2008; 25: E104–10.

10.

Ware

J.E.

Jr. , Kosinski

, Bayliss

M.S.

. Comparison of methods for scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care 1995; 33: AS264–79.

11.

Johansen

K.L.

, Painter

, Kent-Braun

J.A.

. Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int 2001; 59: 1121–27.

12.

De Vecchi

, Finazzi

, Padalino

. Sleep disorders in peritoneal and haemodialysis patients as assessed by a self-administered questionnaire. Int J Artif Organs 2000; 23: 237–42.

13.

Merlino

, Piani

, Dolso

. Sleep disorders in patints with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006; 21: 184–90.

14.

Güney

Ibrahim

, Biyik

Murat

, Yeksan

Mehdi

. Sleep Quality and Depression in Peritoneal Dialysis Patients. Ren Fail 2008; 30: 1017–22.

15.

Unruh

M.L.

, Buysse

D.J.

, Dew

M.A.

. Sleep quality and its correlates in the first year of dialysis. Clin J Am Soc Nephrol 2006; 1: 802–10.

16.

Hanly

P.J.

, Pierratos

. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001; 344: 102–7.

17.

Sabbatini

, Pisani

, Crispo

. Sleep quality in patients with chronic renal failure: a 3-year longitudinal study. Sleep Med 2008; 9: 240–6.

18.

Chou

F.F.

, Lee

C.H.

, Chen

J.B.

, Huang

S.C.

, Lee

C.T.

. Sleep disturbances before and after parathyroidectomy for secondary hyperparathyroidism. Surgery 2005; 137: 426–30.

19.

Esposito

M.G.

, Cesare

C.M.

, De Santo

R.M.

. Parathyroidectomy improves the quality of sleep in maintenance hemodialysis patients with severe hyperparathyroidism. J Nephrol 2008; 21(Suppl 13): S92–6.

20.

Chou

F.F.

, Ho

J.C.

, Huang

S.C.

, Sheen-Chen

S.M.

. A study on pruritus after parathyroidectomy for secondary hyperparathyroidism. J Am Coll Surg 2000; 190: 65–70.

21.

De Santo

R.M.

, Lucidi

, Violani

, Bertini

. Insomnia is associated with systolic hypertension in uremic patients on hemodialysis. Int J Artif Organs 2001; 24: 853–62.

22.

Chen

W-C

, Lim

P-S

, Wu

W-C

. Sleep behavior disorders in a large cohort of Chinese (Taiwanese) patients maintained by long-term hemodialysis. Am J Kidney Dis 2006; 48: 277–84.

23.

De Santo

R.M.

, Lucidi

, Violani

. Sleep disorders in hemodialyzed patients-the role of comorbidities. Int J Artif Organs 2005; 28: 557–65.

24.

Sabbatini

, Crispo

, Pisani

. Sleep quality in renal transplant patients: a never investigated problem. Nephrol Dial Transplant 2005; 20: 194–8.