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Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
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
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 23-24, 3402-3417 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed at evaluate effects of a individually designed nonpharmacological intervention on sleep, activity and fatigue in peritoneal dialysis (PD) by use of both actigraphy registration and self-assessed questionnaires.

Design: A prospective multiple baseline single-case experimental design.

Methods: Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study. Two interventions were separately implemented. First, a pressure relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires.

Results: Totally 315 sleep-wake cycles from nine individuals were evaluated. Of the nine measured outcome variables i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index (MFI), number of steps, metabolic equivalent unit (METs), sleep efficiency and fatigue, three patients improved clinically significantly in five or more of the outcomes. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements.

Conclusions: This study shows that patients on peritoneal dialysis treatment have a wide variety of sleep problems and that an individual sleep hygiene and sleep scheduling program can be applied with clinically significant improvements even in this heterogeneous and frail patient group. The intervention should be easy to use in daily clinical routines.

Place, publisher, year, edition, pages
Blackwell Publishing, 2012. Vol. 21, no 23-24, 3402-3417 p.
Keyword [en]
Peritoneal dialysis, single-case research design, sleep hygiene, nonpharmacological treatment, insomnia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-68040DOI: 10.1111/j.1365-2702.2012.04282.xISI: 000310978000010OAI: oai:DiVA.org:liu-68040DiVA: diva2:415408
Available from: 2011-05-06 Created: 2011-05-06 Last updated: 2014-02-27Bibliographically 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, PiaFernström, AndersBörjeson, SussanneEdéll-Gustafsson, Ulla
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