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Kidney Week

Abstract: TH-PO280

A Cross-Sectional Study of Insomnia in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Braden, Gregory Lee, Kidney Care & Transplant Services of New England, Springfield, Massachusetts, United States
  • Landry, Daniel L., Kidney Care & Transplant Services of New England, Springfield, Massachusetts, United States
  • Hinckley, Ann, Kidney Care & Transplant Services of New England, Springfield, Massachusetts, United States
  • Mulhern, Jeffrey, Kidney Care & Transplant Services of New England, Springfield, Massachusetts, United States
Background

The most frequent complaint in chronic hemodialysis(CHD) patients(pts) is insomnia yet little research has identified all of the causes of this disorder in CHD pts.(Flythe, CJASN,14:150, 2018)

Methods

We conducted a review of sleep patterns in 103 CHD pts on the first & second shifts in our 2 largest dialysis units using these tools: the National Sleep Foundation Survey, the Sleep Diary, Insomnia Severity Index(>8 abnl), Stop-Bang-8 for sleep apnea(SA, 5-8 high risk), Epsworth Sleepineess Scale, Restless Leg(RL) Survey & the International RL Severity Score(>8 abnl).

Results

25 CHD pts (24%) including 4 with SA had normal sleep patterns averaging 8.1 hours of sleep/nite & <1 awakening from the Sleep Diary & scores of < 7 on the Insomnia Severity Index, 0-3 on Epsworth & 3 or < on Stop Bang-8. Insomnia occurred in 78 CHD pts(76%). Mean duration of sleep ws 3.9 hrs with 2.5 awakenings from the Sleep Diary, p<.001 vs normal CHD pts. The National Sleep Foundation Survey & Epsworth Scale were inconsisitent in identifying these pts. There were no differences in age, duration of dialysis, sex, or causes for ESRD between groups. 24 CHD pts had known SA & in all 24 the STOP Bang-8 was 4 or >, mean 6.2 which is a high risk score for SA. 13 other CHD pts had a Stop Bang-8 of 4 or > & have been sent to sleep medicine. RL occurred in 19 CHD pts with a mean severity score of 25. 14/19 RL pts had iron deficiency vs 22/78(28%) of all other CHD pts with insomnia(p<.01) The levels of serum iron & saturation did not correlate with the RL Severity Score. They are receiving iv iron therapy & will be re-scored. 5 CHD pts had both SA and RL. 13 CHD pts had newly reported causes for insomina : painful neuropathy 9, cramps 2, pruritus, 1 & arthrits 1. Only 13 CHD pts had primary insomnia. Cognitive behavioral therapy(CBT) has started for these pts.

Conclusion

Insomnia occurs in up to up to 75% of CHD pts from diverse causes.The most useful tools to identify insomnia are the Sleep Diary, Insomnia Severity Index & the Stop Bang-8 which correctly identifed all 24 SA CHD pts. RL in CHD pts was associated with iron deficiency. We found 4 new insomnia causes in CHD pts including painful neuropathy, cramps, pruritis & arthritis. Algorithms to treat each cause of insomnia have been developed especailly for safe sedatives for primary insomnia if CBT fails.

Funding

  • Clinical Revenue Support