Quality of sleep in patients undergoing hemodialysis

Sleeping problems are common in hemodialysis (HD) patients. The aim of this study was to determine sleep quality (SQ) in HD patients and to evaluate its relationship with patient's quality of life (QoL), sociodemographic and laboratory data.

Two hundred HD patients from the Hemodialysis Clinic, Bosnia and Herzegovina, were enrolled in the study. There were 122 men and 78 women with a mean age of 56.8 ± 14.3 (range 20-85) years and a mean HD duration of 62.6 ± 57.0 months. We used the Pittsburgh Sleep Quality Index (PSQI) and the Health Survey for Dialysis Patients (SF-36).

Seventy-three percent of patients showed a poor SQ response. The average sleep latency of patients was 48.2 min, and the average sleep duration was 4.9 h. Ninety-eight percent of patients experienced some sort of sleep disturbances on weekly basis. The most common sleep disturbances were insomnia (84.5%), day and night sleep reversal (39.0%), excessive daytime sleepiness (EDS) (34.0%), nightmares (25%) and restless legs syndrome (RLS) (20.5%). The most frequent causes of sleep disorders were snoring (47%), pain (35%), daytime napping (34%), breathing problems (30%) and pruritus (28%). Ninety-three percent of patients experienced daytime dysfunction and 46.5% of them were taking sleep medications. Younger patients, employed patients and patients in 3rd HD shift showed significantly better SQ compared to the others. Compared with good sleepers, poor sleepers were more frequently on conventional HD and had higher serum phosphate and PTH and significantly lower Hb.

The poor SQ in our HD population significantly correlated with their QoL.