Patients on hemodialysis report ‘debilitating effects’ with coexisting sleep apnea
After conducting qualitative interviews with patients on hemodialysis and newly diagnosed sleep apnea, researchers from South Wales, Australia, found many patients experienced disturbed and unrefreshed sleep.
According to Ginger Chu, MN, of John Hunter Hospital, and colleagues, “the debilitating effects of sleep disturbance is profound.”
“The importance of sleep to patients with [chronic kidney disease] CKD was highlighted in a cross-sectional study of 100 hemodialysis patients, which demonstrated that patients were more willing to increase dialysis time to improve fatigue and sleep quality, than to extend life,” the researchers added. “A recent study of a consultation group involving hemodialysis patients and caregivers identified sleep as a top priority, ranked higher than mortality.”
Due to these findings, the researchers sought to further explore the symptomatic relationship between sleep apnea and sleep disturbance, while also acquiring perspectives from the patients who are impacted.
First, polysomnography was used to assess sleep apnea and objective sleep parameters, while the Epworth Sleepiness Scale was used to assess daytime symptoms. Researchers noted the severity of sleep apnea did not appear to affect patients’ sleep duration, sleep efficiency or self-reported Epworth Sleepiness Scale score.
Interviews with 26 patients revealed that many experienced broken or disturbed sleep and did not feel refreshed upon waking. Broken sleep was categorized as a cycle of sleeping, waking and dozing off again. Many reported uncontrolled chronic pain as a cause for broken sleep, while others pointed to dialysis as an important contributor.
“Some interviewees felt that it was harder to sleep after dialysis because dialysis made them more alert; whereas others felt sleepy and would often sleep during the dialysis treatment but then have sleep difficulties that evening,” the researchers noted. “Post dialysis symptoms such as cramping and physical discomfort were also offered as contributors to sleep disturbance.”
For those who commonly woke up feeling “unrefreshed,” the researchers found this was especially bothersome because the fatigue did not improve regardless of the amount of sleep that was had. Other patients reported poor sleep impacted their ability to physically function, which some expressed made them feel “useless,” leading to concurrent impacts on their mental well-being.
The ability to self-manage illness was also important with researchers finding that some participants would “omit medication and/or dialysis due to a lack of sleep and tiredness.”
Finally, some patients reported a “soldiering on” attitude, which the researchers described as accepting poor sleep as one of many chronic conditions to which they had to adjust. Others described life as not worth living and had considered ceasing dialysis treatments.
“The important clinical implication of this study is that we have observed different symptom presentations of sleep apnea (eg, disturbed sleep vs non-disturbed sleep; excessive daytime sleepiness vs. non-excessive daytime sleepiness and unrefreshed vs. non-unrefreshed sleep) in hemodialysis patients,” the researchers wrote. “Given that sleep apnea is common and usually severe, and symptom burden is high in patients with kidney failure, understanding how the disease affects patients will allow individualized strategies towards the treatment and improve symptom burdens.”
They added that because most patients in the study who were diagnosed with severe obstructive sleep apnea had not been treated, there is a the need for “a more systematic assessment of sleep disorders in patients with chronic kidney disease receiving dialysis.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.