Subjective Assessment of Sleep Quality and Excessive Daytime Sleepiness in Conventional Hemodialysis Population: A Single-Center Experience

Abstract

Introduction

Sleep disturbances are common in patients with end-stage kidney disease on hemodialysis (hemodialysis population: HDP). Higher rates of primary sleep disorders, demographic characteristics, metabolic abnormalities, and the efficacy of treatment place HDP at higher risk. The pattern observed is delayed onset of sleep, frequent awakening episodes, insomnia, sleep apnoea, excessive daytime sleepiness, restless leg syndrome, abnormal limb movements, pain in limbs, confusion, and nightmares. Two commonly used subjective assessment scores are the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and the Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness.

Objective

Subjective assessment of sleep using PSQI and ESS scores in HDP and correlation with clinical and demographic characteristics.

Patients and Methods

A cross-sectional descriptive study of 148 patients with ESKD undergoing in-center hemodialysis. From June 2021 to October 2021 in Madurai medical college, Madurai, India. Subjective assessment with PSQI and ESS scores was done to identify sleep quality and daytime sleepiness, respectively.

Results

The median PSQI score was 6 (IQ:4–10), and as much as 68.24% scored >5 on the PSQI (poor sleepers). The median ESS score of the study participants was 4 (Iq range 3–7), and 19.59% had a total ESS score of more than 10 (excessive daytime sleepiness). The mean age of the participants was 44±14.5. Age more than 60, lower body mass index, unemployment, higher dialysis vintage of more than 2 years, lower hemoglobin, high calcium-phosphorus product are statistically significant for both PSQI and ESS scores.

Conclusion

The prevalence of poor sleep quality and excessive daytime sleepiness is high in HDP. Subjective assessment scores (PSQI and ESS) on the bedside are valuable tools in identifying sleep quality and EDS where objective assessment methods are not feasible and will help in the short time identification and management of sleep disturbances.

Keywords:

• sleep quality
• excessive daytime sleepiness
• PSQI
• ESS
• hemodialysis population
• poor sleepers

Ethical Statement

The study does not involve any human or animal experiments, and no new therapeutic interventions were done. The study was a cross-sec survey. The methodology was approved by the Institutional ethical committee of Madurai medical college, Madurai, India. Informed written consent was obtained from all patients who were taken in the study. This study was conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors made equal contributions to conception and design, acquisition of data, or analysis and interpretation of data; contributed in drafting the article or revising it critically for intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.

Additional information

Funding

No funding support to be disclosed.