Abstract: SA-PO783

Sleep Disorders in ESRD

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Kennedy, Claire, Beaumont Hospital, Dublin, Ireland
  • Kane, Thomas, Department of Respiratory and Sleep Medicine, Beaumont Hospital, Dublin 9, Dublin 9, Ireland
  • Conlon, Peter J., Beaumont Hospital, Dublin 9, Co Dublin, Ireland
Background

Sleep disturbance may be overlooked in patients with ESRD due to competing medical issues, as well as a perception that it is difficult to study and frustrating to manage. We aimed to study sleep quality in an ESRD cohort using subjective and objective tools, and to assess the impact of renal replacement therapy (RRT) modality change on sleep disturbance.

Methods

A detailed assessment of sleep quality was performed in an unselected cohort of dialysis patients using several validated subjective tools as well as unattended home polysomnography (PSG) and/or wrist actigraphy. Repeat assessment was performed in those that switched RRT modality.

Results

Baseline interviews were performed in 33 patients. The majority reported poor sleep quality (54.5%, n=18), troublesome restless legs syndrome (RLS; 54.5%; n=18) and reduced quality of life (QOL) most marked in the fatigue and general health perception domains. Screening for depression identified one patient with possible mild depression.

PSG (n=19) and actigraphy (n=14) confirmed high rates of sleep fragmentation and disordered sleep architecture across all dialysis modalities. PSG identified periodic limb movement (PLM) disorder in 42% (n=8) and sleep apnoea (apnea-hypopnea index >5) in 58% (n=11). Four patients were medicated for severe PLM with good effect; CPAP was initiated in one patient with severe obstructive sleep apnoea with marked clinical improvement.

There were six RRT modality changes. Three were transplanted with improved self-reported sleep quality, fatigue and RLS at 6 months; serial PSG (n=2) showed reduced sleep apnea and PLM, with increased sleep efficiency. Three switched from conventional to nocturnal home hemodialysis (NHHD); again this led to better self-reported sleep quality and fatigue scores. Repeat PSG (performed on and off NHHD at one and six months) demonstrated reduced PLM and increased sleep efficiency, with the improvement most marked on the on-dialysis nights.

Conclusion

This cohort of dialysis patients had poor sleep quality and reduced quality of life without features of depression. Simple therapeutic interventions, made on the basis of home PSG, made a big clinical difference. NHHD and transplantation improved sleep quality. Unattended home PSG and actigraphy were well tolerated, including by those on nocturnal dialysis.