Factors Contributing to Sleep Disturbance and Hypnotic Drug Use in Hemodialysis Patients
ABSTRACT Sleep disturbance and the use of hypnotic medications are common in patients on hemodialysis. Factors that contribute to sleep disturbance and the use of hypnotic medications in hemodialysis patients were investigated.
With the use of a questionnaire-based survey, we examined the prevalence of symptoms that reflect sleep disorders such as insomnia, restless legs syndrome (RLS), and snoring and use of hypnotic medications in 252 hemodialysis patients.
The overall prevalence of insomnia was 59.1%, with the prevalence of difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), and early morning awakening (EMA) being 47.6, 24.2, and 28.2%, respectively. Daytime sleepiness and habitual snoring were reported by 42.5 and 33.7%, respectively. The prevalence of routine use of hypnotic drugs was 25.8%. Both RLS and age were significantly associated with insomnia [odds ratio (OR), 3.75; p 0.001, OR, 1.03; p < 0.01]. RLS was a significant factor for DIS, DMS, and EMA (OR, 2.26; p < 0.05, OR, 3.44; p < 0.0005, OR, 4.25; p < 0.0005) and age was a significant factor for DMS and EMA (OR, 1.03; p = 0.053, OR, 1.05; p < 0.005). Both insomnia and snoring were associated with the use of hypnotic drugs (OR, 2.97; p < 0.001, 1.59; p=0.13).
Both RLS and sleep-disordered breathing may contribute to sleep disturbance in hemodialysis patients. RLS in particular may be an important factor in insomnia, which in turn is likely responsible for the high prevalence of hypnotic drug use in hemodialysis patients.
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- "Walker 8 3 1995 54 HD 83.3 Stepanski 9 3 1995 81 PD 73.0 De Vecchi 1 5 2000 171 HD, PD 56/49 De Santo et al. 11 6-9 2001-2008 294 HD 86.06 Sabbatini et al. 15 10 2002 694 HD 44.8 Iliescu et al. 16 11 2003 89 HD 71.0 de Barbieri 17 12 2004 112 HD 48.2 Mucsi 18 13 2004 78 HD 49.0 Kurella 19 14 2005 78 HD 34.0 Merlino et al. 20 15 2006 883 HD, PD 80.2 Chen et al. 21 16 2006 700 HD 66.0 Unruh et al. 22 17 2006 909 HD, PD 75.0 Noda 23 18 2006 252 HD 59.1 Bastos et al. 24 19 2007 100 HD 75.0 Hui 25 20 2007 201 PD 73.0 Yang 26 21 2007 190 PD 86.0 Güney et al. 27 22 2008 124 PD 53.5 Sabbagh et al. 28 23 2008 46 HD 76.0 Elder et al. 29 24 2008 6321 HD 49.0 Eryavuz 30 25 2008 104 HD, PD 88.5/78.0 Bornivelli 31 26 2008 45 HD 20 Pai 32 27 2008 164 HD 74.4 TABLE III.—Sleep disorders in 832 dialyzed patients in the study of Merlino et al. 16 Sleep disorder Prevalence Insomnia 69.1 Obstructive sleep apnoea syndrome 23.6 Restless leg syndrome 18.4 Nightmares 13.3 Excessive daytime sleepiness 11,8 Rapid eye movement behaviour 2.3 Sleepwalking 2.1 Possible narcolepsy 1.4 M I N E R V A M E D I C A C O P Y R I G H T ® DE SANTO SLEEP DISORDERS IN KIDNEY DISEASE "
Article: Sleep disorders in kidney disease[Show abstract] [Hide abstract]
ABSTRACT: Sleep disorders are common in patients with end stage renal disease receiving hemodialysis or peritoneal dialysis. However also a well functioning renal graft does not cure the poor sleep pattern which now emerges as a problem even in early chronic kidney disease (CKD). When patients are made aware for the first time of a disease such as CKD, which may brink to dialysis or at the best to a renal transplant patients begin to experience a disordered sleep. Sleeping disorders include insomnia (I), sleep apnoea (SAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), excessive daily sleeping (EDS), sleepwalking, nightmares, and narcolepsy. Disordered sleep did not meet the clinical and scientific interest it deserves, in addition and we do not have a well defined solution for sleeping complaints. However, awareness that a poor sleep is associated with poor quality of life and carries an increase in mortality risk has recently stimulated interest in the field. There are many putative causes for a disordered sleep in chronic kidney disease and in end-stage renal disease. For a unifying hypothesis demographic factors, lifestyles, disease related factors, psychological factors, treatment related factors, and social factor must be taken into consideration.Minerva urologica e nefrologica = The Italian journal of urology and nephrology 03/2010; 62(1):111-28. · 0.70 Impact Factor
Conference Paper: Digital sliding mode tuning control using a fuzzy mechanism[Show abstract] [Hide abstract]
ABSTRACT: In a sampled-data system, the sliding mode control output can change only at the sampling instants. The system state deviates from the sliding surface unavoidably. Discrete-time implementation of the switching type continuous-time sliding mode controller causes system chatterings. An idea of a non-switching type of discrete equivalent control is proposed for chattering elimination. In this paper, a fuzzy mechanism is introduced into the digital sliding mode control design. The proof and a numerical example show that the goal of the discrete-time sliding mode is attained successfully.Networking, Sensing and Control, 2004 IEEE International Conference on; 02/2004
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ABSTRACT: Objective: Restless legs syndrome (RLS) is known to be associated with chronic renal failure (CRF) patients on hemodialysis, however the prevalence of RLS in CRF patients on hemodialysis is variable due to different diagnostic criteria or dialysis technique. A few reports have indicated the association between RLS symptom and lower life quality in CRF patients on hemodialysis. This study aims to investigate the prevalence of RLS and its association with the quality of life in CRF patients of a single dialysis unit in Korea. Methods: A total of 83 Korean CRF patients on hemodialysis in the Korea University Hospital were examined. International Restless Legs Syndrome Study Group (IRLSSG) criteria and International Restless Legs Scale (IRLS) were used to determine the diagnosis and severity of RLS. Questionnaires including Athens Insomnia Scale (AIS), Epworth sleepiness scale (ESS), and Medical Outcome Study Form-36 (SF-36) were administered to all the patients for the assessment of sleep and quality of life. Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) were also measured for depression and status of mental illness by psychiatrist. Results: Of the 83 patients, 31 (37.3%) patients were found to have RLS and 43 (51.8%) patients met at least one of the RLS diagnostic criteria. The AIS (t=2.40, p=0.019), ESS (t=2.41, p=0.018), HDRS (t=3.85, p01/2007; 14(2).