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

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 1280 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 22  |  Issue : 5  |  Page : 922-930
A comparison of sleep disturbances and sleep apnea in patients on hemodialysis and chronic peritoneal dialysis


Department of Medicine, Sleep Disorders Centre, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Click here for correspondence address and email

Date of Web Publication6-Sep-2011
 

   Abstract 

Studies have shown that sleep disorders are common among dialysis patients; however, few studies have compared the prevalence of different sleep disorders in patients on peritoneal dialysis (PD) and hemodialysis (HD). We used questionnaires to assess the prevalence of common sleep disorders in dialysis patients. We compared the prevalence of sleep apnea (SA) risk, restless legs syndrome (RLS), insomnia, and excessive daytime sleepiness (EDS), as well as sleep quality, in both groups. Of the 227 patients who were enrolled in the study, the total number of patients on HD was 188 (82%), while the total number of patients on PD was 39 (18%). There were no significant differences between the two groups regarding age, neck size, or duration on dialysis (all P >0.05). The estimated overall prevalence of SA was significantly higher in PD patients in comparison with HD patients (92% and 67%, respectively; P <0.05). The prevalence of insomnia was similar in both groups. The prevalence of RLS was significantly greater in PD than in HD patients (69% and 46%, respectively; P <0.05). In addition, EDS was significantly higher in PD than in HD patients (77% and 37%, respectively; P <0.05). Our study shows that sleep disorders are common in dialysis patients; however, SA, EDS, and RLS were more common in PD patients than in HD pa-tients. Poor sleep quality and insomnia were comparable in both groups.

How to cite this article:
Al-Jahdali H. A comparison of sleep disturbances and sleep apnea in patients on hemodialysis and chronic peritoneal dialysis. Saudi J Kidney Dis Transpl 2011;22:922-30

How to cite this URL:
Al-Jahdali H. A comparison of sleep disturbances and sleep apnea in patients on hemodialysis and chronic peritoneal dialysis. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2021 Dec 6];22:922-30. Available from: https://www.sjkdt.org/text.asp?2011/22/5/922/84321

   Introduction Top


End-stage renal disease (ESRD) is a significant problem in Saudi Arabia. The prevalence of ESRD was 139 per one million people in 1986. [1] The number of patients who receive hemodialysis (HD) therapy in the Kingdom of Saudi Arabia has increased by approximately 10-15-fold since 1983, and the estimated annual increase in the number of patients who suffer from this condition in Saudi Arabia is about 8.6%. [2],[3]

The prevalence of sleep disorders among renal failure patients on dialysis is quite high. [4],[5],[6] Unfortunately, little attention has been paid to the impact of sleep disorders in patients with chronic renal failure who are on dialysis. [7],[8],[9],[10],[11] The constellation of sleep disorders includes sleep apnea (SA), restless legs syndrome/periodic legs movements (RLS/PLM), insomnia, and excessive daytime sleepiness (EDS). [5],[12],[13] The prevalence of SA in ESRD and dialysis patients has been reported to be more than 50%, [14] which is much higher than that in the general population (2- 4%). [15],[16],[17],[18] SA among peritoneal dialysis (PD) patients has been reported to be between 55 and 67%. [19],[20],[21],[22] Wadhwa et al compared 15 PD patients with 15 HD patients and found that the incidence and severity of SA is similar in both groups. [22]

Insomnia is a common sleep problem, and its prevalence in the general population ranges from 4 to 64%; [23],[24] however, the prevalence is substantially greater in dialysis patients, which is reported to be between 45 and 59%. [25],[26],[27] Furthermore, insomnia in uremic patients has more significant daytime consequences in comparison with that in the general population. [14],[28] EDS is the most common complaint in dialysis patients (66.7%). [8],[10] Other commonly reported sleep disorders in patients with chronic renal failure include a delayed sleep onset (46%), frequent awakening (35%), and RLS (33.3%). [8] Studies have also shown that disordered sleep symptoms are more common in the elderly than in young patients and in men than in women. [8],[29] Hypocalcemia and anemia have been associated with an increased incidence of sleep complaints; however, no such association has been found with blood urea, creatinine, or dialysis adequacy rate. [7],[8],[30] RLS is a common condition that may affect as many as 15% of the general adult population. [31] The prevalence of RLS is much greater in the dialysis than in the general population with the reported prevalence among uremic patients ranging from 20 to 57.4%. [21],[32],[33],[34]

Multiple conditions may cause sleep disorders in patients with chronic renal failure and dialysis patients, including metabolic abnormalities, which underlie several different medical problems, such as diabetes or neuropathy, uremia, psychiatric disorders, and anemia. [4],[11],[13],[17],[35],[36] Poor sleep quality is also common in dialysis patients [25] and directly influences quality of life. [26] Eryavuz et al have observed that both HD and PD patients exhibit similar rates of poor sleep quality. [37]

A few limited studies have compared the prevalence of sleep disorders among HD versus PD patients. In this study, we compared the risk factors and prevalence of insomnia, RLS, EDS, and the estimated risk of obstructive SA in both groups. We will also present a summary of the prevalence of SA according to previously published data.


   Methods Top


This observational cross-sectional study was conducted at The King Abdulaziz Medical City, King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah over the period from May to September, 2007. This study was approved by the research and ethics committees at KAMC-KFNGH, Riyadh. All stable patients who were undergoing routine dialysis at each center were enrolled into this study. We excluded confused, demented patients and those who declined participation. Data collection was carried out during a personal professional interview via a structured questionnaire. These questionnaires were adopted from standard international questionnaires and are routinely used at our sleep disorders center. All the questionnaires were translated from English into Arabic and translated again from Arabic into English by a professional medical translator. Moreover, these questionnaires were also reviewed by two sleep specialists for accuracy and clarity in the Arabic translation. Finally, these questionnaires were pre-tested on 30 patients and modified for any ambiguity.

The collected data included common demographic characteristics such as age, gender, education level, marital status, employment, and personal habits (coffee drinking and smoking). Data regarding past medical history, medication, the underlying cause of chronic renal failure, the duration on dialysis, and the dialysis shift were also collected.

In the Epworth Sleeping Scale (ESS) that was used to measure daytime sleepiness, a score of greater than ten indicated increased sleepiness. [38] The Berlin questionnaires were used to assess the risk of SA. The Berlin questionnaire was developed in 1996 and its validity and accuracy in primary care settings has been previously shown. [39] The Berlin questionnaire has been found to have a high accuracy in the identification of patients who have a high risk of SA. Based on the Berlin questionnaire scoring, patients were classified as having either a low or high risk of developing SA. The pre-test probability of being at high risk for SA was previously found to predict a respiratory disturbance index (RDI) of greater than five with a sensitivity of 86%, specificity of 77%, positive predictive value of 89%, and likelihood ratio of sleep apnea of 3.79. [39] The Pittsburgh Sleep Quality Index (PSQI), the details of which have previously been published, is also used to assess sleep quality, wherein a score of five or more indicates poor sleep quality. [40] We also used the ICSD-2 definition for insomnia: difficulty in falling asleep, waking up too early, or frequent awakening with difficulty in falling asleep once again, in addition to secondary daytime impairments that relate to night time sleep difficulties. [41] The diagnosis of RLS is clinical, and its definition has been clarified and standardized by internationally recognized diagnostic criteria that have been published by the International Restless Legs Syndrome Study Group (IRLSSG). [42] We compared patients on PD with those on HD concerning the prevalence of insomnia, RLS, EDS, and risk for sleep apnea. We also compared demographic characteristics, underlying medical problems, medications, and biochemistry in both groups in relation to different sleep disorders. The dialysis adequacy was assessed by KT/V and was considered adequate if the KT/V was ≥1.2 for HD and ≥1.7 for PD.

Data were summarized as mean and standard deviation or as a number and percent, as deemed appropriate. To assess the possible influence of demographics such as age, gender, weight, and other variables, on the prevalence of SA and EDS, we used an unpaired "t" test and the Mann-Whitney U-test for non-parametric data, as appropriate. A multivariate logistic regression analysis was used to assess the risk of EDS (using an ESS significant daytime sleepiness >10) and the risk for sleep apnea (using the Berlin Questionnaire, wherein a high risk was defined as a score of greater than one and a low risk as a score of zero) while controlling for other sleep disorders, such as RLS, and the PSQI (a score greater than five indicates poor sleep quality). A P-value of less than 0.05 was considered to be statistically significant. Data management and analyses were carried out using the Statistical Package for Social Sciences (SPSS), version 13.


   Results Top


A total of 227 patients were recruited for this study. The mean age of these patients was 55.7 ΁ 17.2 years, including 105 females (46.3%) and 122 males (53.7%). The mean duration a patient was on dialysis was 40.4 ΁ 37.8 months. The mean body mass index was 26.7 ΁ 6.4. Diabetes mellitus (DM) was the most common cause of renal failure in this patient group (52%). The majority of patients (80%) had a less than high school education level, and 50.7% were employed. The majority of the patients were non-smokers (77%), and daily coffee intake was reported in 75.8% of the patients. The most commonly used medications in this patient group included erythropoietin and iron supplements (96.5%), vitamins (91.6%), anti-hypertensive medications (84%), and antidepressants (8.8%). Other patient characteristics are summarized in [Table 1]. The total number of patients on HD was 188 (82%), while the total number of patients on PD was 39 (18%). There were no significant differences between the two groups regarding age, neck size, or duration on dialysis (all P >0.05%). The rate of obesity was significantly greater in the PD group (38%) in comparison with the HD group (22%) (P < 0.05). The prevalence of diabetes was almost equally distributed among the PD (56%) and HD patients (52%); however, the prevalence of hypertension was significantly higher in PD patients (95%) in comparison with HD patients (81%) (P <0.05). The efficacy of PD, as measured by KT/V, was available in only 29 of 39 PD patients (74%) in comparison with 172 of 188 (91%) HD patients. The dialysis adequacy was greater in HD patients than in PD patients (90% versus 76%, respectively), although this was not statistically significant (CI: 0.91-7.95). The rate of coffee consumption was greater in PD (92%) than in HD patients (72%) (P < 0.05); there was no difference in smoking habits between the two groups. There was no differrence in the medications that were used by the two groups, except that HD patients used more iron supplements and erythropoietin. In addition, there were no significant biochemical differences between the two groups, except for lower potassium and higher phosphorus levels in PD patients in comparison with HD patients, as shown in [Table 2]. As shown in [Table 3], both groups exhibited significantly poor sleep qualities, as measured by the PSQI scores of five or more, and the prevalence of poor sleep quality was 100% and 98% for PD and HD patients, respectively. The estimated overall prevalence of high risk of SA was significantly higher in PD patients in comparison with HD patients (92% and 67%, respectively; P <0.05). The prevalence of insomnia was similar in both groups, as shown in [Table 3]. The prevalence of RLS was significantly greater in PD than in HD patients (69% and 46%, respectively; P <0.05). In addition, EDS was significantly more common in PD than in HD patients (77% and 37%, respectively; P <0.05). There was no significant difference in the prevalence of snoring between the two groups. [Table 4] compares the estimated prevalence of SA in our study with that reported in previous studies.
Table 1: Demographic and other characteristic data of the study patients.

Click here to view
Table 2: Demographic and other characteristic differences between peritoneal dialysis and hemodialysis patients.

Click here to view
Table 3: Prevalence of sleep disorders in peritoneal and hemodialysis patients.

Click here to view
Table 4: Reported prevalence of sleep apnea in peritoneal dialysis patients in previous studies and in the current study.

Click here to view



   Discussion Top


This study demonstrates that patients on PD have more sleep disorders. Many investigations have reported on the prevalence of sleep disorders in dialysis patients; however, most of these studies concern either HD or PD patients. Studies that compare the prevalence of common sleep disorders in both groups are very limited. In fact, only two small studies have compared these two groups, wherein both observed a similar prevalence of SA in both PD and HD patients. The first study, which was conducted by Wadhwa et al, [22] studied 30 patients and reported SA in nine of 15 PD patients and in eight of 15 HD patients. Another study by Hallett et al, [43] which investigated a total of 21 patients, observed that eight of 11 PD and seven of 10 HD patients had SA. Our study is the largest study that compares not only the prevalence of SA but also other sleep disorders in both groups. There were no significant differences between these two groups with regard to age, gender distribution, neck size, and the duration on dialysis. The prevalence of DM as the underlying medical problem that caused renal failure was similar in both groups; however, hypertension as the cause of renal failure was greater in the PD group. In addition, the sleep adequacy was greater in HD patients in comparison with PD patients, which may contribute to the higher prevalence of sleep disorders in PD patients. We know from previous studies that sleep disorders may be a marker of inadequate dialysis. [13],[30] Patients on PD have lower potassium and higher phosphorus, which may contribute to more symptoms of RLS in this group when compared with the HD group. Other factors that are known to cause or exaggerate symptoms of RLS, such as low iron or ferritin levels, were similar in both groups. In this study, the overall prevalence of RLS in PD patients is higher in comparison with HD patients, which is similar to that reported by other workers. [21],[44] In addition, the prevalence of insomnia was similar in PD patients in comparison with HD patients, which is also consistent with other published studies. [21],[44]

The major weakness of our study is that we used questionnaires rather than objective measurements, such as the PSG. In this study, we did not devise our own instrument to assess sleep disorders. Although we did use questionnaires that have been validated in the general population, their validity has not been demonstrated in the ESRD population. We do not believe that there was any component in the questionnaires that may have made them inapplicable to our patients. In addition, this survey was conducted by a professional interviewer, and, as explained in the methods section, these questionnaires were translated from English to Arabic and back to English by professional translators, verified by sleep specialists, and initially tested in a pilot study for clarity. Furthermore, the questionnaires were then used in sleep lab questionnaires and in two other published stu-dies. [45],[46] When we compared the prevalence rate of SA in our patients with those of other studies [Table 4], our patients were found to have a greater risk of SA. The explanation for this phenomenon is unclear; however, dialysis adequacy has been known to cause more sleep disorders in dialysis patients. [13] The efficacy of PD was available for 74% of the patients in comparison with 91% of the HD patients. Dialysis adequacy was greater in HD patients than in PD patients (90% versus 75%), and PD patients were more obese than HD patients. These differences between the two groups may explain why there was a greater risk of sleep disorders in the PD patients. Other possibilities include the removal of sleep-promoting material from the peritoneal dialysate as well as the presence of uremia, anemia, chronic metabolic acidosis, hypo-capnia, or other metabolic abnormalities. This has been supported by the decrease in the incidence of sleep disorders in kidney transplant patients. [47],[48],[49] Other studies have shown that upper airway edema in dialysis patients may increase the risk of SA. [50] Patients on dialysis possibly have increased total body water content and upper airway edema, which places them at a higher risk of developing SA. Sleep quality, as measured by the PSG I, was very poor in almost all our patients, and greater than 99% of both PD and HD patients reported poor sleep quality. Eryavuz et al used the same measurement and reported poor sleep quality in 78% of the PD patients and 88.5% of the HD patients. [51] However, in our study, we did not assess patients for psychiatric disorders so as to examine what effect this may have on insomnia and sleep quality.

Our study confirms that sleep disorders are common in dialysis patients. Furthermore, it is one of only a few studies that compare PD with HD using a reasonably large number of investigated patients. In addition, this study confirms that SA, daytime sleepiness, and RLS were more common in PD patients than in HD patients. The rate of poor sleep quality and insomnia was similar in both groups; however, this observation needs to be confirmed by an additional prospective study.


   Acknowledgment Top


I would like to thank Prof. Abdullah Al-Sayarri, Dr. Fayz Al-Hejali, and Dr. Said Al-Gamedi for their help to arrange the interview with the patients, provide me with pertinent laboratory results, and for their support in reviewing and editing the manuscript. Also, I would like to thank Dr. Hani Tamimi for reviewing all statistics and data analysis and Dr. Waleid AlQadi, and Dr. Hithm Khogair and all dialysis staff in both hospitals for their support. Special thanks are due for the King Abdullah International Medical Research Centre for funding and supporting this study. [52]

 
   References Top

1.Ibrahim MA, Kordy MN. End-stage renal disease (ESRD) in Saudi Arabia. Asia-Pacific journal of public health/Asia-Pacific Academic Consortium for Public Health. 1992;6(3):140-5.  Back to cited text no. 1
    
2.Shaheen FA, Al-Khader AA. Epidemiology and causes of end stage renal disease (ESRD). Saudi J Kidney Dis Transpl 2005;16(3):277-81.  Back to cited text no. 2
    
3.Jondeby MS, De-Los Santos GG, Al-Ghamdi AM, et al. Caring for hemodialysis patients in Saudi Arabia. Past, present and future. Saudi Med J 2001;22(3):199-204.  Back to cited text no. 3
    
4.Jean G, Piperno D, Francois B, Charra B. Sleep apnea incidence in maintenance hemodialysis patients: influence of dialysate buffer. Nephron 1995;71(2):138-42.  Back to cited text no. 4
    
5.Mucsi I, Molnar MZ, Rethelyi J, et al. Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 2004; 19(7):1815-22.  Back to cited text no. 5
    
6.Hanly P. Sleep apnea and daytime sleepiness in end-stage renal disease. Seminars in dialysis. 2004;17(2):109-14.  Back to cited text no. 6
    
7.Holley JL, Nespor S, Rault R. Characterizing sleep disorders in chronic hemodialysis patients. ASAIO transactions/American Society for Arti-ficial Internal Organs 1991;37(3):M456-7.  Back to cited text no. 7
    
8.Walker S, Fine A, Kryger MH. Sleep complaints are common in a dialysis unit. Am J Kidney Dis 1995;26(5):751-6.  Back to cited text no. 8
    
9.Sabbatini M, Pisani A, Crispo A, et al. Sleep quality quality in patients with chronic renal failure: A 3-year longitudinal study. Sleep Med 2008;9(3): 240-6.  Back to cited text no. 9
    
10.Parker KP, Bliwise DL, Bailey JL, Rye DB. Daytime sleepiness in stable hemodialysis patients. Am J Kidney Dis 2003;41(2):394-402.  Back to cited text no. 10
    
11.Pai MF, Hsu SP, Yang SY, Ho TI, Lai CF, Peng YS. Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia. Renal Failure 2007;29(6):673-7.  Back to cited text no. 11
    
12.Wadhwa NK, Seliger M, Greenberg HE, Bergofsky E, Mendelson WB. Sleep related respiratory disorders in end-stage renal disease patients on peritoneal dialysis. Perit Dial Int 1992;12(1):51-6.  Back to cited text no. 12
    
13.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. 13
    
14.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. 14
    
15.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. 15
    
16.Parker KP. Sleep and dialysis: a research-based review of the literature. ANNA journal/American Nephrology Nurses' Association. 1997;24(6): 626-39; quiz 40-1.  Back to cited text no. 16
    
17.Argekar P, Griffin V, Litaker D, Rahman M. Sleep apnea in hemodialysis patients: risk factors and effect on survival. Hemodial Int 2007;11(4):435-41.  Back to cited text no. 17
    
18.Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230-5.  Back to cited text no. 18
    
19.Tang SC, Lam B, Ku PP, et al. Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 2006;17(9): 2607-16.  Back to cited text no. 19
    
20.Rodriguez A, Stewart D, Hotchkiss M, Farrell P, Kliger A, Finkelstein F. Sleep apnea in CAPD. Adv Peritoneal Dial 1995;11:123-6.  Back to cited text no. 20
    
21.Stepanski E, Faber M, Zorick F, Basner R, Roth T. Sleep disorders in patients on continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 1995; 6(2):192-7.  Back to cited text no. 21
    
22.Wadhwa NK, Mendelson WB. A comparison of sleep-disordered respiration in ESRD patients receiving hemodialysis and peritoneal dialysis. Adv Peritoneal Dial 1992;8:195-8.  Back to cited text no. 22
    
23.Terzano MG, Parrino L, Cirignotta F, et al. Studio Morfeo: insomnia in primary care, a survey conducted on the Italian population. Sleep Med 2004;5(1):67-75.  Back to cited text no. 23
    
24.Leger D, Guilleminault C, Dreyfus JP, Delahaye C, Paillard M. Prevalence of insomnia in a survey of 12,778 adults in France. J Sleep Res 2000;9(1):35-42.  Back to cited text no. 24
    
25.Iliescu EA, Yeates KE, Holland DC. Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplant 2004;19(1):95-9.  Back to cited text no. 25
    
26.Iliescu EA, Coo H, McMurray MH, et al. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 2003;18(1):126-32.  Back to cited text no. 26
    
27.Sabbatini M, Minale B, Crispo A, et al. Insomnia in maintenance haemodialysis patients. Nephrol Dial Transplant 2002;17(5):852-6.  Back to cited text no. 27
    
28.Merlino G, Gigli GL, Valente M. Sleep disturbances in dialysis patients. J Nephrol 2008;21 (Suppl 13):S66-70.  Back to cited text no. 28
[PUBMED]  [FULLTEXT]  
29.Kutner NG, Bliwise DL, Brogan D, Zhang R. Race and restless sleep complaint in older chronic dialysis patients and nondialysis community controls. J Gerontol 2001;56(3):P170-5.  Back to cited text no. 29
    
30.Puntriano M. The relationship between dialysis adequacies and sleep problems in hemodialysis patients. Am Nephrol Nurses Assoc 1999;26(4):405-7.  Back to cited text no. 30
    
31.Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C. Epidemiology of restless legs symptoms in adults. Arch Intern Med 2000;160 (14):2137-41.  Back to cited text no. 31
    
32.Roger SD, Harris DC, Stewart JH. Possible relation between restless legs and anaemia in renal dialysis patients. Lancet 1991;337(8756):1551.  Back to cited text no. 32
    
33.Kimmel PL, Miller G, Mendelson WB. Sleep apnea syndrome in chronic renal disease. Am J Med 1989;86(3):308-14.  Back to cited text no. 33
    
34.Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996;28(3):372-8.  Back to cited text no. 34
    
35.Ballard RD. Sleep and medical disorders. Primary Care 2005;32(2):511-33.  Back to cited text no. 35
    
36.Kusleikaite N, Bumblyte IA, Razukeviciene L, Sedlickaite D, Rinkunas K. Sleep disorders and quality of life in patients on hemodialysis. Medicina (Kaunas, Lithuania) 2005;41(Suppl 1):69-74.  Back to cited text no. 36
    
37.Eryavuz N, Yuksel S, Acarturk G, et al. Comparison of sleep quality between hemodialysis and peritoneal dialysis patients. Int Urol Nephrol 2008;40(3):785-91.  Back to cited text no. 37
    
38.Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540-5.  Back to cited text no. 38
    
39.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. 39
    
40.Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28 (2):193-213.  Back to cited text no. 40
    
41.Association AASD. International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manuals. American Sleep Disorders Association, MNRochester, MN, 1997.  Back to cited text no. 41
    
42.Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003;4(2):121-32.  Back to cited text no. 42
    
43.Hallett M, Burden S, Stewart D, Mahony J, Farrell P. Sleep apnea in end-stage renal disease patients on hemodialysis and continuous ambulatory peritoneal dialysis. Asaio J 1995;41(3): M435-41.  Back to cited text no. 43
    
44.Hui DS, Wong TY, Ko FW, et al. Prevalence of sleep disturbances in Chinese patients with endstage renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2000;36(4): 783-8.  Back to cited text no. 44
    
45.Bahammam AS, Al-Rajeh MS, Al-Ibrahim FS, Arafah MA, Sharif MM. Prevalence of symp-toms and risk of sleep apnea in middle-aged Saudi women in primary care. Saudi Med J 2009;30(12): 1572-6.  Back to cited text no. 45
    
46.BaHammam AS, Alrajeh MS, Al-Jahdali HH, BinSaeed AA. Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi males in primary care. Saudi Med J 2008;29(3):423-6.  Back to cited text no. 46
    
47.Yang JY, Huang JW, Chiang CK, et al. Higher plasma interleukin-18 levels associated with poor quality of sleep in peritoneal dialysis patients. Nephrol Dial Transplant 2007;22(12): 3606-9.  Back to cited text no. 47
    
48.Winkelmann J, Stautner A, Samtleben W, Trenkwalder C. Long-term course of restless legs syndrome in dialysis patients after kidney transplantation. Mov Disord 2002;17(5):1072-6.  Back to cited text no. 48
    
49.Auckley DH, Schmidt-Nowara W, Brown LK. Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation. Am J Kidney Dis 1999;34(4):739-44.  Back to cited text no. 49
    
50.Anastassov GE, Trieger N. Edema in the upper airway in patients with obstructive sleep apnea syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86(6):644-7.  Back to cited text no. 50
    
51.Eryavuz N, Yuksel S, Acarturk G, et al. Comparison of sleep quality between hemodialysis and peritoneal dialysis patients. Int Urol Nephrol 2008;40(3):785-91.  Back to cited text no. 51
    
52.Tang SC, Lam B, Yao TJ, et al. Sleep apnea is a novel risk predictor of cardiovascular morbidity and death in patients receiving peritoneal dialysis. Kidney Int 2010;77(11):1031-8.  Back to cited text no. 52
    

Top
Correspondence Address:
Hamdan Al-Jahdali
Adjunct Professor at McGill University, Associate Professor, Head of Pulmonary Division, Medical Director of Sleep Disorders Centre, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh
Saudi Arabia
Login to access the Email id


PMID: 21912020

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

This article has been cited by
1 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]
2 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]
3 Health-related quali{dotless
Turkmen, K. and Yazici, R. and Solak, Y. and Guney, I. and Altintepe, L. and Yeksan, M. and Tonbul, H.Z.
Hemodialysis International. 2012; 16(2): 198-206
[Pubmed]
4 Xerostomia in patients on chronic hemodialysis
Bossola, M. and Tazza, L.
Nature Reviews Nephrology. 2012; 8(3): 176-182
[Pubmed]



 

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


 
    Abstract
   Introduction
   Methods
   Results
   Discussion
   Acknowledgment
    References
    Article Tables
 

 Article Access Statistics
    Viewed3360    
    Printed109    
    Emailed0    
    PDF Downloaded806    
    Comments [Add]    
    Cited by others 4    

Recommend this journal