Change search
ReferencesLink to record
Permanent link

Direct link
Sleep Problems in Patients on Peritoneal Dialysis: Prevalence, Effects on Daily Life and Evaluation of Non-Pharmacological Interventions
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
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 [en]
Fatigue, insomnia, peritoneal dialysis, renal supportive care, sleep, self-care management, sleep hygiene
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-68041ISBN: 978-91-7393-207-3OAI: oai:DiVA.org:liu-68041DiVA: diva2:415415
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
List of papers
1. Self-reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home
Open this publication in new window or tab >>Self-reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home
2006 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 12, no 3, 143-152 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe habitual sleep, daytime symptoms, sleep-disturbing factors, current sleep during 1 week and fatigue in patients with peritoneal dialysis treatment at home and also discover predictions for sleep quality outcome. The knowledge should increase possibilities for supportive nursing health care. Fifty-five patients answered two mailed questionnaires and filled in a sleep diary. Of these, 60% had moderate, persistent sleep problems combined with daytime symptoms. Nocturnal awakenings with difficulties falling asleep again and a sleep duration predicted as 57% of sleep quality. Nocturnal pruritus and 'difficulties finding a comfortable sleeping position' were significant sleep-disturbing factors. Sleep quality predictors means progress in knowledge about the complexity of the situation for peritoneal dialysis patients. Poor sleep, daytime symptoms, sleep-disturbing factors and chronic fatigue need to be enlightened, especially for the nephrology nurses who are in a unique position to give supportive nursing health care.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-34576 (URN)10.1111/j.1440-172X.2006.00566.x (DOI)21950 (Local ID)21950 (Archive number)21950 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-05-06Bibliographically approved
2. Circling around in tiredness: perspectives of patients on peritoneal dialysis
Open this publication in new window or tab >>Circling around in tiredness: perspectives of patients on peritoneal dialysis
Show others...
2010 (English)In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, Vol. 37, no 4, 407-413 p.Article in journal (Refereed) Published
Abstract [en]

The experience of tiredness linked to poor sleep in patients on peritoneal dialysis was explored using the qualitative method phenomenology. Eight women and six men in southeast Sweden were interviewed. The patients' descriptions were characterized by a circular structure "circling around in tiredness." This study illustrates the problems of tiredness and illuminates the need for healthcare professionals to assess the impact of tiredness and highlight the need for strategies to improve the patient's situation.

Place, publisher, year, edition, pages
Journal of the American Nephrology Nurses' Association, 2010
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-59529 (URN)20830948 (PubMedID)
Available from: 2010-09-20 Created: 2010-09-17 Last updated: 2015-06-10Bibliographically approved
3. Fragmented sleep: An unrevealed problem in peritoneal dialysis patients
Open this publication in new window or tab >>Fragmented sleep: An unrevealed problem in peritoneal dialysis patients
Show others...
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
Keyword
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:nbn:se:liu:diva-67151 (URN)10.3109/00365599.2011.557025 (DOI)000288379800007 ()
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
4. Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment
Open this publication in new window or tab >>Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment
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
Keyword
Peritoneal dialysis, single-case research design, sleep hygiene, nonpharmacological treatment, insomnia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68040 (URN)10.1111/j.1365-2702.2012.04282.x (DOI)000310978000010 ()
Available from: 2011-05-06 Created: 2011-05-06 Last updated: 2014-02-27Bibliographically approved

Open Access in DiVA

Sleep Problems in Patients on Peritoneal Dialysis : Prevalence, Effects on Daily Life and Evaluation of Non-Pharmacological Interventions(1019 kB)3089 downloads
File information
File name FULLTEXT01.pdfFile size 1019 kBChecksum SHA-512
2fdcce65f5389d3d3c2bead6f56e2a253dc911caa28ce7bd34c0f9072db353fe631b32788d48826a4b788fcfee80ad7de4e76be7c7759d7512bdd2826f156220
Type fulltextMimetype application/pdf
cover(3039 kB)22 downloads
File information
File name COVER01.pdfFile size 3039 kBChecksum SHA-512
0b2dc424c62e40877aed93ba11b4443d1eb18e1f1c97b4d689e718f9b14a3e51ec4e0994d86829613c31efeadc53d54b92f8f1910de4e9bc566e6b6a364117b7
Type coverMimetype application/pdf

Search in DiVA

By author/editor
Yngman-Uhlin, Pia
By organisation
Nursing ScienceFaculty of Health SciencesDepartment of Nephrology UHL
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 3089 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 843 hits
ReferencesLink to record
Permanent link

Direct link