Dr. Manasi Bapat (MB), from the Maimonides Medical Center, Brooklyn, New York, discusses her abstract for the National Kidney Foundation’s 2016 Spring Clinical Meetings (SCM16), Sleep Disturbances in Hemodialysis Patients, with Dr. Kenar Jhaveri, AJKD Blog Editor.

AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2016 Spring Meetings?

MB: According to previous studies, sleep disorders affect 50%-80% of patients with end-stage renal disease (ESRD) on hemodialysis. Management of insomnia in these patients is often a challenge. Optimal treatment of insomnia requires both pharmacological and nonpharmacological therapy (NPT). There are very few studies on the use of nonpharmacological methods to treat insomnia in this patient population. Many patients are treated with medications for insomnia and experience a wide range of side effects from them. Patients with renal disease specifically have been found to be at high risk for harmful effects from sedative hypnotic drugs (SHDs).  Multicomponent non-pharmacological sleep protocols have been tested in older hospitalized patients in prior studies and have proven to be feasible, effective, and non-toxic alternatives to SHDs. Our aim is to improve insomnia in the dialysis population without medications and their adverse effects. As the first step toward this goal, we set out to assess the sleep disturbances in our hemodialysis patient population.

We administered a questionnaire to 385 patients in four outpatient hemodialysis centers. This questionnaire was based on the Pittsburgh Sleep Quality Index (PSQI), which has been deemed reliable and valid in determining sleep quality. Patients were asked about their sleep quality, latency, duration, the effect of sleep disturbance on their quality of life, and other questions related to their sleep habits and lifestyle. Further, the questionnaire addressed what is being done to help their insomnia and whether they use SHDs (if they do take these drugs, it asks whether they have experienced any side effects).  We also asked all our study patients if they have ever been offered NPT for treating insomnia and whether it was an agreeable alternative.

We found that poor sleep in this dialysis population was a common finding. Among these patients, it adversely affected their quality of life about 50% of the time. There was a statistical correlation between a perception of poor sleep with time taken to fall asleep and number of awakenings. Twenty-one percent of patients took medications for sleep on a routine basis. In general, these patients did not feel that these medications significantly improved their quality of sleep. Eighty-eight percent of patients never tried NPT, while 60% were willing to try it.

AJKDblog: Was there any particular shift (time of the day dialysis is performed) that had the most number of sleep disturbances?

MB: The highest prevalence of poor sleep quality (45%) occurred in patients receiving dialysis on the third shift, but this did not reach statistical significance when compared to other shifts. The third shift starts at 2 PM.

There was a statistically significant increase in daytime sleeping in first shift patients, but this did not affect their nighttime sleep quality. The first shift starts at 6 AM.

Across all shifts, there was no correlation between quality of sleep on a particular night and whether or not the patient received a dialysis treatment on that day.

AJKDblog: Where do you and your group go from here?

MB: We plan to start the next step of this study by offering NPT, comprised of education on proper sleep hygiene and a sleep bundle (including chamomile tea, ear plugs, white noise, and essential oils) to our study group. We will then reassess the patients’ quality of sleep. We have learned from the first phase of our study that there is limited response to medications and that most patients are willing to try NPT.  Our hypothesis is that the intervention group will show improved sleep quality compared to the control group and will have a reduction in use of SHDs. We are very excited to proceed with our research as it may lead to be a beneficial, cost-effective treatment for a common problem in the dialysis population.

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All Spring Clinical Meeting abstracts are available in the May issue of AJKD.

Check out more AJKDblog coverage of the NKF’s 2016 Spring Clinical Meetings (#SCM16)!