Chronic insomnia in kidney transplant recipients.

Institute of Behavioral Sciences, First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
American Journal of Kidney Diseases (Impact Factor: 5.76). 04/2006; 47(4):655-65. DOI: 10.1053/j.ajkd.2005.12.035
Source: PubMed

ABSTRACT Recent studies confirmed that sleep disorders have a significant impact on various aspects of health in patients at different stages of chronic kidney disease. At the same time, there is an almost complete lack of information on the prevalence and correlates of insomnia in kidney transplant recipients.
In a cross-sectional study, the Athens Insomnia Scale was used to assess the prevalence of insomnia in a large sample of kidney transplant recipients compared with wait-listed dialysis patients and also a matched group obtained from a nationally representative sample of the Hungarian population.
The prevalence of insomnia was 15% in wait-listed patients, whereas it was only 8% in transplant recipients (P < 0.001), which, in turn, was not different from the prevalence of this sleep problem in the sample of the general population (8%). Prevalences of insomnia in the transplant group were 5%, 7%, and 14% for the groups with glomerular filtration rates (GFRs) greater than 60 mL/min (> 1.00 mL/s), 30 to 60 mL/min (0.50 to 1.00 mL/s), and less than 30 mL/min (< 0.5 mL/s), respectively (P < 0.01). However, estimated GFR was no longer associated significantly with insomnia in the transplant population after statistical adjustment for several covariates. In a multivariate model, insomnia was significantly and independently associated with treatment modality (transplantation versus wait listing), as well as the presence of depression, restless legs syndrome, and high risk for obstructive sleep apnea syndrome, and with self-reported comorbidity.
The prevalence of insomnia was substantially less in the transplant group than in wait-listed dialysis patients and similar to that observed in the general population. Because this condition potentially is treatable, attention should be directed to the appropriate diagnosis and management of insomnia in the kidney transplant recipient population.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Chronic renal failure prevalence is increasing worldwide. To correctly treat mood disorders in this population, it is imperative to make a correct differential diagnosis and to take into account all the complex interactions between psychosocial and biologic issues. Method: To review the literature concerning mood disorders in the dialyzed population. Results: The most prevalent psychiatric conditions found in this group are anxiety and depression. The clinical assessment of the former is complicated by its symptomatologic overlapping with cronic renal failure. This could explain why many studies show different prevalence rates, depending on the scale used, its way application and diagnostic approach. Conclusions: The management of patient in dialysis must include multidisciplinary teams whose psychotherapeutic strategies taking into account individual, family and the systemic interactions that are generated within the dialysis unit. Additionally, it is important to consider the vicious circle between depression, anxiety, cognitive impairment and cerebrovascular disease. The condition could be much more complex than initially thought, with permanent injury to small brain vessels that would explain, at least in part, the poor response to antidepressants in these patients.
    09/2009; 38(3):522-533.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background This study assessed the effect and feasibility of morning bright light therapy (BLT) on sleep, circadian rhythms, subjective feelings, depressive symptomatology and cognition in renal transplant recipients (RTx) diagnosed with sleep-wake disturbances (SWD).Methods This pilot randomized multicentre wait-list controlled trial included 30 home-dwelling RTx randomly assigned 1:1 to either 3 weeks of BLT or a wait-list control group. Morning BLT (10'000 lux) was individually scheduled for 30 min daily for 3 weeks. Wrist actimetry (measuring sleep and circadian rhythms), validated instruments (subjective feelings and cognition) and melatonin assay (circadian timing) were used. Data were analysed via a random-intercept regression model.ResultsOf 30 RTx recipients (aged 58±15, transplanted 15±6 years ago), 26 completed the study. While BLT had no significant effect on circadian and sleep measures, sleep timing improved significantly. The intervention group showed a significant get-up time phase advance from baseline to intervention (+24 min) [(standardized estimates (SE): -0.23 (-0.42;-0.03)] and a small (+14 min) but significant bedtime phase advance from intervention to follow-up (SE: -0.25 (-0.41;-0.09). Improvement in subjective feelings and depressive symptomatology were observed but were not statistically significant.Conclusion Bright light therapy showed preliminary indications of a beneficial effect in RTx with sleep-wake disturbances.This article is protected by copyright. All rights reserved.
    Transplant International 09/2014; 28(1). DOI:10.1111/tri.12443 · 3.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Poor sleep quality (SQ) and daytime sleepiness (DS) are common in renal transplant (RTx) recipients; however, related data are rare. This study describes the prevalence and frequency of self-reported sleep disturbances in RTx recipients. This cross-sectional study included 249 RTx recipients transplanted at three Swiss transplant centers. All had reported poor SQ and / or DS in a previous study. With the Survey of Sleep (SOS) self-report questionnaire, we screened for sleep and health habits, sleep history, main sleep problems and sleep-related disturbances. To determine a basis for preliminary sleep diagnoses according to the International Classification of Sleep Disorders (ICSD), 164 subjects were interviewed (48 in person, 116 via telephone and 85 refused). Descriptive statistics were used to analyze the data and to determine the frequencies and prevalences of specific sleep disorders. The sample had a mean age of 59.1 +/- 11.6 years (60.2% male); mean time since Tx was 11.1 +/- 7.0 years. The most frequent sleep problem was difficulty staying asleep (49.4%), followed by problems falling asleep (32.1%). The most prevalent sleep disturbance was the need to urinate (62.9%), and 27% reported reduced daytime functionality. Interview data showed that most suffered from the first ICSD category: insomnias. Though often disregarded in RTx recipients, sleep is an essential factor of wellbeing. Our findings show high prevalences and incidences of insomnias, with negative impacts on daytime functionality. This indicates a need for further research on the clinical consequences of sleep disturbances and the benefits of insomnia treatment in RTx recipients.
    BMC Nephrology 10/2013; 14(1):220. DOI:10.1186/1471-2369-14-220 · 1.52 Impact Factor
    This article is viewable in ResearchGate's enriched format