Sleep Disorders in Hemodialysis Patients

A high prevalence of sleep disorders has been reported in patients with renal failure and is linked to cardiovascular complications in those patients. The exact etiology and pathogenesis of sleep disorders are not exactly known. Knowledge of the underlying factors helps to define better management for these complications. The study involved 30 patients with ESRD on regular hemodialysis (HD; group 1) and 20 normal control subjects (group 2). For both groups complete history taking and clinical examination, assessment of sleep disorders using the Pittsburgh Sleep Quality Index (PSQI), biochemical tests, efficiency of dialysis using KT/V in the patient group and plasma interleukin-6 level using ELISA technique were done. Poor sleep (PSQI>5) was found in 70% of the patient group vs. 15% of the control group with significant differences between group 1 and 2 regarding mean PSQI (p<0.001; 9.53±5.46, 3.7±2.53, respectively). The greatest sleep disorder in the patient group was sleep efficiency. The PSQI score is independently determined by KT/V (p=0.03), LDL (p=0.005), age (p=0.04), coffee consumption (p=0.03), Hb (p=0.024), and IL-6 levels (p=0.004). Independent predictors for poor sleep are age (p=0.001), serum albumin (p<0.001), KT/V (p=0.001), and IL-6 levels (p<0.001). Sleep disorders are very common in HD patients. Independent predictors for poor sleep are age, serum albumin, KT/V, and IL-6 levels. Sleep disorders are significantly associated with the efficiency of dialysis and IL-6 levels, which are related to inflammation. Sleep disorders may be a possible cause of the oxidative stress and inflammation in hemodialysis patients contributing to the development of complications.