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Fragmented sleep: An unrevealed problem in peritoneal dialysis patients
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.ORCID iD: 0000-0002-9786-7326
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2011 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 45, no 3, 206-215 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of this study was to describe the sleep--wake cycle, sleep quality, fatigue and Health Related Quality of Life (HRQoL) measured with questionnaires, actigraphy and a sleep diary during a one-week period in patients undergoing peritoneal dialysis (PD) treatment at home. A further aim was to explore differences compared with patients with coronary artery disease (CAD) and individuals from the general population. Material and methods. In this study one-week actigraphy registration, four questionnaires (Uppsala Sleep Inventory, SF-36, FACIT-fatigue, International Restless Legs Study Groups form) and a sleep diary were used. Results. Data from 68 participants and 470 nights were collected. PD patients (n == 28) had more fragmented sleep (p andlt; 0.001) and worse sleep efficiency (SE%) (p andlt; 0.0001) than the CAD (n == 22) and the population (n == 18) groups. Pruritus (57%), restless legs (46%) and fatigue (89%) were prevalent in PD patients. Pruritus correlated with fragmented sleep (r == --0.45, p == 0.01) and SE (r == --0.49, p == 0.01). In HRQoL, the physical component score was decreased in the PD and CAD groups (p andlt; 0.01) compared to the population group. Conclusions. To the authors knowledge this study is the first to demonstrate that PD patients have deteriorated sleep, with serious fragmentation measured by a one-week actigraphy registration. Further, PD patients exhibit worse sleep quality than CAD patients and individuals in the population. Evaluation of sleep in clinical practice is highly recommended since PD patients are vulnerable individuals with extended self-care responsibilities and at risk for comorbidity secondary to insufficient sleep. Future research on whether PD patients sleep problems and fatigue can be improved by an individual non-pharmacological intervention programme is required.

Place, publisher, year, edition, pages
Informa Healthcare , 2011. Vol. 45, no 3, 206-215 p.
Keyword [en]
Actigraphy, coronary artery disease, fatigue, health, related quality of life, insomnia, peritoneal dialysis, sleep disturbance, pruritus, restless legs
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67151DOI: 10.3109/00365599.2011.557025ISI: 000288379800007OAI: oai:DiVA.org:liu-67151DiVA: diva2:407899
Note
Original Publication: Pia Yngman Uhlin, Anna Johansson, Anders Fernström, Sussanne Börjeson and Ulla Edéll-Gustafsson, Fragmented sleep: An unrevealed problem in peritoneal dialysis patients, 2011, SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY, (45), 3, 206-215. http://dx.doi.org/10.3109/00365599.2011.557025 Copyright: Informa Healthcare http://informahealthcare.com/ Available from: 2011-04-01 Created: 2011-04-01 Last updated: 2013-09-03Bibliographically approved
In thesis
1. Sleep Problems in Patients on Peritoneal Dialysis: Prevalence, Effects on Daily Life and Evaluation of Non-Pharmacological Interventions
Open this publication in new window or tab >>Sleep Problems in Patients on Peritoneal Dialysis: Prevalence, Effects on Daily Life and Evaluation of Non-Pharmacological Interventions
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sleep problems affect a considerable number (49-86%) of patients undergoing peritoneal dialysis (PD) treatment. Insomnia i.e. difficulties to initiate and/or maintain sleep or too early wakening, combined with daytime symptoms, seems to be the dominating problem. Despite these facts there is a lack of research in PD-patients, especially studies with objective data on the sleep-wake cycle and evaluation of sleep promoting non-pharmacological  interventions.

The overall aim of this thesis was to describe sleep problems from different perspectives, and how these problems affect daily life and health in patients treated with PD at home. The aim was also to evaluate an individualised non-pharmacological intervention for improvement of sleep quality outcomes.

Four studies were conducted during eight years, starting in 2002. Patients from six hospitals in the south-east of Sweden were invited to participate. In addition, data from a reference group with Coronary Artery Disease and a population group were used for comparisons with PD-patients in one of the studies. Data was collected by self-reported questionnaires, actigraphy registrations and interviews. Sleep was evaluated in a 17-week single-case study with an intervention focusing on sleep hygiene advice.

Data from a total of 700 sleep-wake cycles was collected in the patients’ homes. The main findings clearly demonstrated that PD-patients have seriously fragmented sleep compared to the CAD- and population group, and that the PD-patients have a high prevalence of insomnia. The sleep was mainly disturbed by pruritus and Restless Legs Syndrome (RLS). Daytime impairments and a frequent napping behaviour were detected. The prevalence of fatigue was also reported to be extremely high. The patients described that an ever-present tiredness and poor sleep had consequences in their everyday life both physically, mentally, socially and existentially. The nurse-led intervention demonstrated that individual, non-pharmacological sleep interventions can improve sleep and daytime activities in PD-patients.

This thesis elucidates that deteriorated sleep with serious fragmentation leads to a variety of daytime impairments and fatigue. By adopting “renal supportive care” in clinical work a more elaborate assessment and individualised non-pharmacological treatment of sleep problems may improve sleep quality and activity in frail patients undergoing peritoneal dialysis at home.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 103 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1233
Keyword
Fatigue, insomnia, peritoneal dialysis, renal supportive care, sleep, self-care management, sleep hygiene
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68041 (URN)978-91-7393-207-3 (ISBN)
Public defence
2011-05-13, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings univeristet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-06 Created: 2011-05-06 Last updated: 2013-09-03Bibliographically approved

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Yngman Uhlin, PiaJohansson, AnnaFernström, AndersBörjeson, SussanneEdéll-Gustafsson, Ulla
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Nursing ScienceFaculty of Health SciencesNephrologyDepartment of Medical and Health SciencesDepartment of Nephrology UHLDepartment of Oncology UHL
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