Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 585 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

BRIEF COMMUNICATION Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 300-305
Sleep disorders in hemodialysis patients


1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt

Click here for correspondence address and email

Date of Web Publication9-Mar-2010
 

   Abstract 

The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni­versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques­tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa­tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno­graphy, is necessary to confirm our results. Interventional studies for management of sleep disor­ders in HD patients are warranted.

How to cite this article:
Sabry AA, Abo-Zenah H, Wafa E, Mahmoud K, El-Dahshan K, Hassan A, Abbas TM, Saleh ABM, Okasha K. Sleep disorders in hemodialysis patients. Saudi J Kidney Dis Transpl 2010;21:300-5

How to cite this URL:
Sabry AA, Abo-Zenah H, Wafa E, Mahmoud K, El-Dahshan K, Hassan A, Abbas TM, Saleh ABM, Okasha K. Sleep disorders in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Nov 17];21:300-5. Available from: http://www.sjkdt.org/text.asp?2010/21/2/300/60199

   Introduction Top


Sleep disorders affect the majority of chronic kidney disease (CKD) patients. [1] Some investi­gators hypothesized that end-stage renal disease (ESRD) directly influences the quality of sleep. [2] Interestingly, 80% of hemodialysis or perito­neal dialysis patients suffer from sleep abnor­malities, [3] and the prevalence is higher than that in the general population. The most frequently reported complaints are insomnia, restless leg syndrome (RLS), sleep-disordered breathing and excessive daytime sleepiness (EDS). [5]

The causal link between conventional dialy­sis and sleep dissatisfaction remains specula­tive, [6] while psychological causes such as an­xiety and depression, [7],[8] and physical disturban­ces such as hypertension, muscle cramps, and electrolytes or body fluids imbalances may sig­nificantly contribute to the sleep disorders. [5] In addition, primary sleep disorders such as rest­less legs syndrome (RLS) and sleep-disordered breathing (SDB) are potential contributors. [9]

Recently, Parker et al proposed different etio­logies for sleep problems in CKD and chronic HD patients. Functional and psychological fac­tors may play a more prominent role in the former group, while intrinsic sleep disruption may play a more significant role in the latter. [10] Furthermore; there is race influence on the self-reported sleep quality. [11]

We aimed in this study to evaluate the self­reported sleep quality in our hemodialysis po­pulation in order to estimate the prevalence of sleep disorders and determine the factors affec­ting them in this patient population.


   Patients and Methods Top


We studied 88 chronic HD patients in a cross­sectional design, who attended the 3 hemodia­lysis units of the Urology and Nephrology Cen­ter, Mansoura University, Egypt, over 4 months period. The patients were randomly selected for the study, and randomization was done ma­nually, without the use of a computer algo­rithm, to allocate every other patient on the patients' list. The inclusion criteria included a­dult patients > 18 years, who consented to par­ticipate in the study and were maintained on conventional hemodialysis (CHD) three times per week for at least 6 months. The patients were relatively young (mean age: 41.59 ± 16.3 years) with a male predominance (68.2%).

With the use of a questionnaire-based survey, we examined the prevalence of symptoms that reflect sleep disorders such as insomnia, RLS, OSAS, EDS, narcolepsy, and sleepwalking in our study patients. In order to determine the prevalence of sleep disturbances and the po­ssible effect of demographic or clinical data on sleep patterns, our questionnaire consisted of two parts. The first part was completed by the nephrologists at the dialysis unit and included: demographic data, some information about pa­tient's lifestyle such as smoking, general medi­cal history and pharmacological therapy. The questions concerned with sleep description were guided by the pulmonologist at the Sleep-Disor­dered Breathing Unit in our university hospital. The following questionnaires were used to de­sign our questionnaire:

  1. The score for insomnia was done accor­ding to the Ohayon method. [12] Those with insomnia but no daytime dysfunction were labeled as having level I, while insomnia and day-time dysfunction was labeled as level 2.
  2. The International Restless Legs Syndrome Study Group (IRLSSG) to evaluate RLS. [13]
  3. The Berlin Questionnaire to evaluate OSAS. [14]
  4. The Italian version of Epworth Sleepiness Scale (ESS) to evaluate EDS as suggested by Vignatelli et al in 2003. A score of > 9 was considered as the minimal criterion for the diagnosis of EDS. [15]
  5. The International Classification of Sleep Disorders (ICSD) to evaluate narcolepsy. [16]
  6. Hatoum's sleep questionnaire to evaluate sleep-walking. [17]
The study was approved by the Local Medi­cal Research and Ethics Committee. Informed consent was obtained from all the participants after being informed in detail of the purpose and methods of the study. The study was con­ducted according to the Good Clinical Practice (GCP) guidelines.


   Statistical Analysis Top


Analysis was performed using the Statistical Package for Social Science (SPSS) version 10. Data are expressed as mean ± standard devia­tion (SD) unless stated otherwise. ANOVA single factor, Student's t and Chi-squared tests were used as deemed appropriate. The relation of investigated sleep disorders with the other baseline characteristics was assessed by using spearman's correlation. Odds ratios were taken as approximation of relative risk and expressed with 95% CI for increased urinary albumin ex­cretion in the study population. P value :5 0.05 was considered statistically significant.


   Results Top


The mean duration of dialysis in our study patients was 54.48 months. Seventeen percent of our patients were smokers. A significant pro­portion of our cohort suffered from some psy­chiatric disorders such as anxiety (43.2%), dep­ression (27.2%) and social worry (30.7%). [Table 1] shows the dialysis-associated parameters for our patients. They were adequately dialyzed (Kt/V > 1.2), but hypoalbuminemic and anemic.

The prevalence of sleep disorders was 79.5% in our patients. The most common sleep ab­normality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%).

There was comparable parameters in patients without insomnia and those with level 1 and level 2 of insomnia except for sodium plasma levels (P= 0.022). However, RLS patients with low-risk (< 9) and high-risk (> 9) on Epworth questionnaire were not different regarding their electrolytes level as well as their markers of hemodialysis adequacy.

Insomnia correlated with the presence of ane­mia (r=0.31 and P= 0.003), anxiety (r=0.279 and P= 0.042), depression (r=0.298 and P= 0.24), and RLS (r=0.327 and P= 0.002). Also, RLS correlated with the presence of hypoalbu­minemia (r=0.41 and P= < 0.0001), anemia (r= 0.301 and P= 0.046), and hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5 and P= < 0.0001), snoring (r= 0.341 and P= 0.001), and social worry (r=0.27 and P= 0.011). We found no significant corre­lation between sleep disorders and gender, cause of renal failure (diabetics vs non diabetics), and smoking habits.

As shown in [Table 2], the risk factors for in­somnia among our study population were inade­quate dialysis, anemia, hypoalbuminemia and RLS. In addition, the risk factors for RLS in­cluded anemia, hypoalbuminemia, and hyper­phosphatemia [Table 3].


   Discussion Top


The results of our study show increased pre-valence of sleep disorders in the HD popula­tion. The sleep disorders are usually observed in the old age groups, [18],[19] while our patients' mean age was relatively young, which supports more the notion that uremia and its compli­cations are more likely the cause of sleep dis­orders observed in HD patients than aging.

The prevalence of sleep disorders observed in our patients was nearly similar to that reported elsewhere [20] with lesser, [21],[22] or higher [23] preva­lence of insomnia. Varied prevalence was also observed regarding RLS [24],[25] and sleep apnea. [26]

The country to country variability has been recently noted, [27] and could be explained at least in part by the suggested racial influence on self-reported sleep quality. [11]

Interestingly, we found no difference between diabetic and non-diabetic HD patients regar­ding the associated psychiatric disorders and the investigated sleep disorders, except more prevalent snoring among diabetics. Unruh and co-workers noted that sleep-disordered brea­thing (SDB) was more common in HD patients with DM. [28]

Anemia was indicative of the most frequently reported sleep abnormalities, insomnia and RLS. Such observation was reported by many inves­ tigators. [2],[21],[23]

Hypoalbuminemia was recently reported to be associated with lower sleep and even life quality. [29] in our study, we found that hypoal­buminemia increased the odds ratio for in­somnia and RLS.

Lower dialysis dose and hyperphosphatemia were highly correlated with sleep disorders in our study. Underdialysis was considered by Chen and colleagues [30] as a factor that increa­sed the likelihood of sleep disruption in hemo­dialysis patients, while Perl and associates [31] regarded the sleep abnormality as a marker of inadequate dialysis. Also, previous studies sho­wed that higher serum phosphate was associa­ted with a lower sleep quality in maintenance dialysis patients. [32]

RLS increased the odds for sleep disorders in our study patients. Such observation is in agreement with that in other populations. [22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33]

We did not detect any significant correlation between the noticed sleep disruption and age as many other did, [2],[20],[34] possibly because of the relatively young age of our study population. Also, female gender was not a contributing factor for the sleep abnormalities seen in this study as in others. [23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34] However, this study and many others [22],[23],[29] found a correlation of psy­chological factors such as depression, anxiety, and social worry with the sleep quality impair­ment in chronic HD patients.

We have not noticed any association between cigarette smoking and sleep disorders as many other have observed. [20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35] A simple explanation would be the small percentage (17%) of our study population who were smokers.

Finally, appropriate management of sleep dis­orders could improve cognitive functions [36] and quality of life. [27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37] Although sleep disorders are not improved by conventional modes of dialy­sis [38] nocturnal hemodialysis (NHD) has been suggested as a treatment option as it norma­lizes the higher heart rates and impaired vagal and augmented sympathetic hear rate modu­lation during sleep with better removal of ure­mic toxins. [39] Also it increases the pharyngeal cross-sectional area. [40] Furthermore, cool dialy­sate (35 degrees centigrade) during chronic HD was observed to improve nocturnal sleep. [41]

We conclude that Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assess­ment of sleep quality, preferably with polys­omnography, is necessary to confirm our re­sults. Interventional studies for management of sleep disorders in HD patients are warranted.

 
   References Top

1.De Santo RM, Bartiromo M, Cesare MC, Di Iorio BR. Sleeping disorders in early chronic kidney disease. Semin Nephrol 2006;26(1):64-7.  Back to cited text no. 1      
2.Iliescu EA, Coo H, McMurray MH, MeersCL, Quinn MM, Singer MA, Hopman WM. Qua­lity of sleep and health-related quality of life in hemodialysis patients. Nephrol Dial Transplant 2003;18(1):126-32.  Back to cited text no. 2      
3.Gul A, Aoun N, Trayner EM Jr. Why do pa­tients sleep on dialysis? Semin Dial 2006;19 (2):152-7.  Back to cited text no. 3      
4.Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial 2004;17 (2):109-14.  Back to cited text no. 4      
5.Parker KP. Sleep disturbances in dialysis pa­tients. Sleep Med Rev 2003;7(2):131-43.  Back to cited text no. 5      
6.Kraus MA, Hamburger RJ. Sleep apnea in renal failure. Adv Perit Dial 1997;13:88-92.  Back to cited text no. 6  [PUBMED]    
7.De Santo R, Lucidi F, Violani C, Diiorio BR. Sleep disorders in hemodialyzed patients: The role of co morbidities. Int J Artif Organs 2005; 28:557-65.  Back to cited text no. 7      
8.Weissman MM, Greenwald S, Nino-Murcia G, Dement WC. The morbidity of insomnia un­complicated by psychiatric disorders. Gen Hosp Psychiatry 1997;19:245-50.  Back to cited text no. 8      
9.Walker S, Fine A, Kryger MH. Sleep complaints are common in a dialysis unit. Am J Kidney Dis 1995;26:751-6.  Back to cited text no. 9  [PUBMED]    
10.Parker KP, Bliwise DL, Bailey JL, Rye DB. Polysomnographic measures of nocturnal sleep in patients on chronic, intermittent daytime haemodialysis vs those with chronic kidney disease. Nephrol Dial Transplant 2005;20(7): 1422-8.  Back to cited text no. 10      
11.Unruh M, Miskulin D, Yan G, et al. HEMO Study Group: Racial differences in health­related quality of life among hemodialysis patients. Kidney Int 2004;65:1482-91.  Back to cited text no. 11  [PUBMED]    
12.Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002;6:67-111.  Back to cited text no. 12      
13.Walters AS. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995;10(5):634-42.  Back to cited text no. 13      
14.Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP.Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131(7):485-91.  Back to cited text no. 14      
15.Vignatelli L, Plazzi G, Barbato A, et al. Italian version of the Epworth sleepiness scale: external validity. Neurol Sci 2003;23(6):295-300.  Back to cited text no. 15      
16.Diagnostic Classification Steering Committee of the American Sleep Disorders Association. The International Classification of Sleep Dis­orders: Diagnostic and Coding Manual. Ro­chester, MN: 1990.  Back to cited text no. 16      
17.Hatoum HT, Kania CM, Kong SX, Wong JM, Mendelson WB. Prevalence of insomnia: a survey of the enrollees at five managed care organizations. Am J Manage Care 1998;4:79­-86.  Back to cited text no. 17      
18.8 th Annual Report of the Egyptian Society of Nephrology for the year 2004).  Back to cited text no. 18      
19.Makhlouf MM, Ayoub AI, Abdel-Fattah MM. Insomnia symptoms and their correlates among the elderly in geriatric homes in Alexandria, Egypt. Sleep Breath 2007;11:187-94.  Back to cited text no. 19  [PUBMED]    
20.Merlino G, Piani A, Dolso P, et al. Sleep dis­orders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006;21(1):184-90.  Back to cited text no. 20      
21.Kusleikaite N, Bumblyte IA, Razukeviciene L, Sedlickaite D, Rinkunas K. Sleep disorders and quality of life in patients on hemodialysis. Medicina (Kaunas) 2005;41(Suppl1):69-74 Abstract.  Back to cited text no. 21      
22.Noda A, Nakai S, Soga T, et al. Factors contributing to sleep disturbance and hypnotic drug use in hemodialysis patients. Intern Med 2006;45(22):1273-8.  Back to cited text no. 22      
23.Pai MF, Hsu SP, Yang SY, Ho TI, Lai CF, Peng YS. Sleep disturbance in chronic hemo­dialysis patients: the impact of depression and anemia. Ren Fail 2007;29(6):673-7.  Back to cited text no. 23      
24.Gigli GL, Adorati M, Dolso P, et al. Restless legs syndrome in end-stage renal disease. Sleep Med 2004;5(3):309-15.  Back to cited text no. 24      
25.Rijsman RM, de Weerd AW, Stam CJ, Kerkhof GA, Rosman JB. Periodic limb movement disorder and restless legs syndrome in dialysis patients. Nephrology (Carlton) 2004;9(6):353­-61.  Back to cited text no. 25      
26.Jurado-Gamez B, Martin-Malo A, Alvarez­Lara MA, Mufoz L, Cosano A, Aljama P. Sleep disorders are underdiagnosed in patients on maintenance hemodialysis. Nephron Clin Pract 2007;105(1):c35-42.  Back to cited text no. 26      
27.Elder SJ, Pisoni RL, Akizawa T, et al. Sleep quality predicts quality of life and mortality risk in haemodialysis patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2008;23(3):998-1004.  Back to cited text no. 27      
28.Unruh ML, Sanders MH, Redline S, et al. Sleep apnea in patients on conventional thrice­weekly hemodialysis: Comparison with matched controls from the Sleep Heart Health Study. J Am Soc Nephrol 2006;17(12):3503-9.  Back to cited text no. 28      
29.Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M. Nutritional status and depre­ssion, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr 2007;17: 381-8.  Back to cited text no. 29  [PUBMED]    
30.Chen WC, Lim PS, Wu WC, et al. Sleep beha­vior disorders in a large cohort of Chinese (Taiwanese) patients maintained by long-term hemodialysis. Am J Kidney Dis 2006;48(2): 277-84.  Back to cited text no. 30      
31.Perl J, Unruh ML, Chan CT. Sleep disorders in end-stage renal disease: Markers of inadequate dialysis? Kidney Int 2006;70(10):1687-93.  Back to cited text no. 31      
32.Unruh M, Hartunian M, Chapman M, Jaber BL. Sleep quality and clinical correlates in patients on maintenance hemodialysis. Clin Nephrol 2003;59:280-8.  Back to cited text no. 32      
33.Mucsi I, Molnar MZ, Ambrus C, et al. Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant 2005;20:571-7.  Back to cited text no. 33  [PUBMED]    
34.Colbay M, Yuksel S, Fidan F, Acarturk G, Karaman O, Unlu M. Evaluation of the hemo­dialysis patient with Pittsburgh sleep quality index. Tuberk Toraks 2007;55(2):167-73 Abstract.  Back to cited text no. 34      
35.Unruh ML, Buysse DJ, Dew MA, et al. Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study: Sleep quality and its correlates in the first year of dialysis. Clin J Am Soc Nephrol 2006;1(4):802-10.  Back to cited text no. 35      
36.Kutner NG, Zhang R, Huang Y, Bliwise DL. Patient-reported sleep difficulty and cognitive function during the first year of dialysis. Int Urol Nephrol 2008;40(1):203-10.  Back to cited text no. 36      
37.Eryilmaz MM, Ozdemir C, Yurtman F, Cilli A, Karaman T. Quality of sleep and quality of life in renal transplantation patients. Transplant Proc 2005;37:2072-6.  Back to cited text no. 37  [PUBMED]    
38.Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Semin Dial 2004; 17(2):109-14.  Back to cited text no. 38      
39.Chan CT, Hanly P, Gabor J, Picton P, Pierratos A, Floras JS. Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep. Kidney Int 2004;65 (2):661-5.  Back to cited text no. 39      
40.Beecroft JM, Hoffstein V, Pierratos A, Chan CT, McFarlane P, Hanly PJ. Nocturnal haemo­dialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant 2008;23(2):673-9.  Back to cited text no. 40      
41.Parker KP, Bailey JL, Rye DB, Bliwise DL, Van Someren EJ. Lowering dialysate tempe­rature improves sleep and alters nocturnal skin temperature in patients on chronic hemodia­lysis. J Sleep Res 2007;16(1):42-50.  Back to cited text no. 41      

Top
Correspondence Address:
Alaa A Sabry
Assistant Professor of Nephrology, Mansoura Urology and Nephrology Center, Mansoura University
Egypt
Login to access the Email id


PMID: 20228517

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Restless legs syndrome in end-stage renal disease: A multicenter study in Taiwan
Lin, C.-H. and Wu, V.-C. and Li, W.-Y. and Sy, H.-N. and Wu, S.-L. and Chang, C.-C. and Chiu, P.-F. and Lion, H.-H. and Lin, C.-Y. and Chang, H.-W. and Lin, S.-Y. and Wu, K.-D. and Chen, Y.-M. and Wu, R.-M.
European Journal of Neurology. 2013; 20(7): 1025-1031
[Pubmed]
2 Diagnostic value of screening instruments for identifying obstructive sleep apnea in kidney failure
Nicholl, D.D.M. and Ahmed, S.B. and Loewen, A.H.S. and Hemmelgarn, B.R. and Sola, D.Y. and Beecroft, J.M. and Turin, T.C. and Hanly, P.J.
Journal of Clinical Sleep Medicine. 2013; 9(1): 31-38
[Pubmed]
3 Sleep problems before and after acute myocardial infarction: A comparative study [Akut miyokard İnfarktüsü öncesi İle sonrasi{dotless
Kara, B.
TAF Preventive Medicine Bulletin. 2012; 11(6): 687-694
[Pubmed]
4 Restless legs syndrome in patients on hemodialysis: Frequency, severity and risk factors [Sindrom nemirnih nogu kod pacijenata na hemodijalizi: Učestalost, težina i faktori rizika]
Sladojevic, N. and Knezevic, M. and Jovic, J. and Djordjevic, V.
Medicinski Casopis. 2012; 46(3): 138-144
[Pubmed]
5 Study of sleep disorders in resistant hypertensive patients on conventional hemodialysis
Ali Ibrahim, M. and Hosny Abdelsalam Ashmawy, M. and Asaad Abdo, T. and Alloush, H.
Life Science Journal. 2012; 9(4): 1887-1900
[Pubmed]
6 Total body Na+-depletion without hyponatraemia can trigger overtraining-like symptoms with sleeping disorders and increasing blood pressure: Explorative case and literature study
Blank, M.C. and Bedarf, J.R. and Russ, M. and Grosch-Ott, S. and Thiele, S. and Unger, J.K.
Medical Hypotheses. 2012; 79(6): 799-804
[Pubmed]
7 Restless legs syndrome in patients on maintenance hemodialysis and peritoneal dialysis
Emami Naini, A. and Masoumi, M. and Mortazavi, M. and Gholamrezaei, A. and Amra, B.
Journal of Research in Medical Sciences. 2012; 17(SUPPL.2): S264-S271
[Pubmed]
8 Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment
Yngman-Uhlin, P. and Fernström, A. and Börjeson, S. and Edéll-Gustafsson, U.
Journal of Clinical Nursing. 2012; 21(23-24): 3402-3417
[Pubmed]
9 Findings of multidimensional instruments for determining psychopathology in diabetic and non-diabetic hemodialysis patients
Çelik, G. and Annagür, B.B. and Yilmaz, M. and Kara, F.
International Journal of Clinical and Experimental Medicine. 2012; 5(4): 346-354
[Pubmed]
10 Is Nutritional Status Associated With Self-reported Sleep Quality in the HEMO Study Cohort?
Burrowes, J.D. and Russell, G.B. and Unruh, M. and Rocco, M.V.
Journal of Renal Nutrition. 2012; 22(5): 461-471
[Pubmed]
11 The prevalence of sleep disorder and associated factors in haemodialysis patients: An Iranian study
Normohamadi, B. and Jaafarpour, M. and Khani, A.
Journal of Clinical and Diagnostic Research. 2012; 6(6): 1007-1010
[Pubmed]
12 Risk factors for depressive symptoms in a large population on chronic hemodialysis
Araujo, S.M.H.A. and De Bruin, V.M.S. and De F. Daher, E. and Almeida, G.H. and Medeiros, C.A.M. and De Bruin, P.F.C.
International Urology and Nephrology. 2012; 44(4): 1229-1235
[Pubmed]
13 Insomnia in institutionalized older people in Cairo, Egypt: Prevalence and risk factors associated
Bakr, I.M. and Elaziz, K.M.A. and Ezz, N.F.A.E. and Fahim, H.I.
European Geriatric Medicine. 2012; 3(2): 92-96
[Pubmed]
14 Insomnia severity in chronic kidney disease patients with various therapies
Knezevic, M.Z. and Djordjevic, V.V. and Bivolarevic, I.C. and Jovic, J.J. and Djordjević, V.M.
Central European Journal of Medicine. 2012; 7(1): 112-117
[Pubmed]
15 Risk for sleep apnea syndrome and exc essive daily sleepiness in ch ronic hemodialysis patients [Rizik za sindrom apneje u spavanju i prekomjerna dnevna pospanost u bolesnika na kroničnoj hemodijalizi]
Zibar, L. and Krištić, A. and Krnjeta, D. and Dogaš, Z.
Acta Medica Croatica. 2011; 65(SUPP 3): 30-35
[Pubmed]
16 Depression, insomnia and sleep apnea in patients on maintenance hemodialysis
Rai, M. and Rustagi, T. and Rustagi, S. and Kohli, R.
Indian Journal of Nephrology. 2011; 21(4): 223-229
[Pubmed]
17 Epidemiology of sleep disorders in patients with chronic renal disease in Cairo, Egypt
Ibrahim, J.M. and Wegdan, O.M.
Journal of the Egyptian Public Health Association. 2011; 86(3-4): 68-72
[Pubmed]
18 Narcolepsy: The development of the unsolved sleep disorder
Zucker, S.
Journal of Clinical Sleep Medicine. 2011; 7(3): 15-17
[Pubmed]
19 Fragmented sleep: An unrevealed problem in peritoneal dialysis patients
Yngman-Uhlin, P. and Johansson, A. and Fernström, A. and Börjeson, S. and Edéll-Gustafsson, U.
Scandinavian Journal of Urology and Nephrology. 2011; 45(3): 206-215
[Pubmed]
20 Restless legs syndrome and quality of sleep in patients with chronic renal failure in predialysis stage
Deliyska, B. and Shivarov, H. and Vasilev, V. and Spasova, S. and Milanova, M. and Shurliev, V. and Lazarov, V. and Kaludina, I.
Nephrology, Dialysis and Transplantation. 2010; 16(2): 27-32
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Patients and Methods
    Statistical Analysis
    Results
    Discussion
    References
    Article Tables
 

 Article Access Statistics
    Viewed8514    
    Printed203    
    Emailed0    
    PDF Downloaded1770    
    Comments [Add]    
    Cited by others 20    

Recommend this journal