It is well known that dialysis patients have poor sleep quality, which seriously affects their quality of life. Some scholars believe that sleep quality is related to dialysis methods, comorbidities, and uremia toxins. So is this really the case?
The research team of the Faculty of Medicine of Ghent University in Belgium has made a special study on the above problems. The study aimed to confirm the quality of sleep in dialysis patients and whether they were associated with dialysis methods, comorbidities, and uremia toxins. Finally, they found that sleep quality was associated with dialysis methods, comorbidities, and uremia toxins.
Research design
The study was an observational study, supplemented by normal populations as a control group. The study included patients on peritoneal dialysis and daytime or nighttime central hemodialysis. Exclusion criteria were pregnancy, illness requiring acute intervention, and age less than 18 years. At the same time, healthy volunteers are recruited to match the age and gender of the patient.
Sleep quality is measured by instrument (Motion Watch) and consists of two questionnaires, namely objective sleep quality and subjective sleep quality.
In addition, patients receive a blood test on the day of using Motion Watch and compare them with the results of the test 1 month before the sleep test.
Research results
In this study, the observation group enrolled 10 patients on peritoneal dialysis, of which 3 were female. The average age was 66±17 years. Another 54 patients on hemodialysis were enrolled, of whom 42 were on daytime central dialysis (12 were females with an average age of 64±18 years) and 12 were on nighttime central dialysis (4 were females, with an average age of 55±13 years). A control group of 64 healthy volunteers was also included.
In terms of objective sleep quality, sleep time was lower (6:42±1:24 vs 7:09 ±0:46), less efficient (81±12% vs 89±4%), and more fragmented (44±20 vs 22±11) compared with the control group. In terms of subjective sleep quality, the PSQI score of dialysis patients (6.3±3.1 vs 4.6±2.9) and ISI score (7.7±4.9 vs 4.7±4.1) were higher than those of the control group, which meant that the subjective and objective sleep quality of dialysis patients was lower than that of healthy people. Adjusted for accepted thresholds, 59% and 81% of dialysis patients had sleep disturbances, compared with 13% and 34% in the healthy control group.
On the other hand, no matter what dialysis method is used in dialysis patients, such as peritoneal dialysis, daytime or nighttime central hemodialysis, the subjective and objective sleep quality is very close. Moreover, there was no difference in sleep efficiency and fragmentation index the night before dialysis and after dialysis. In addition, patients' comorbidity scores had less to do with sleep quality and less correlated.
Finally, the researchers also found that the toxic load of the uremia toxin was not related to objective sleep quality test results and davies stoke scores.
Overall, the quality of sleep in dialysis patients was worse than that of healthy control volunteers. The association of objective sleep quality with dialysis patterns, subjective scores, load on uremia toxins, or comorbidity scores was low. This means that some scholars' speculations about the factors affecting the sleep quality of dialysis patients may not be in line with objective facts.
bibliography:
1.ElootS, Holvoet E, Dequidt C. The complexity of sleep disorders in dialysispatients. Clin Kidney J. 2021 Jan 19;14(9):2029-2036.
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