Sleep disorders in Egyptian hemodialysis patients in Mansoura Urology and Nephrology center

Many patients with kidney failure undergoing dialysis therapy suffer from sleep disturbances. The prevalence of such sleep disorders is higher when compared to the general population. Patients were recruited from the 3 haemodilaysis units of Urology and Nephrology Center, Mansoura University, Egypt over 4 months period. Eighty eight patients [41.59 +/- 16.3 years] who satisfied our inclusion criteria were enrolled in our study. The demographic and clinical data including insomnia as well as the biochemical parameters were collected by the attending nephrologists. Other sleep disorders such as restless leg syndrome [RLS], obstructive sleep apnoea syndrome [OSAS], excessive daytime sleepiness [EDS], narcolepsy and sleep walking were investigated by questionnaire of the International Restless Legs Syndrome Study Group [IRLSSG], the Berlin Questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders [ICSD] and the specific questions of Hatoum's sleep questionnaire, respectively. Sleep disorders were prevalent in our patients [79.5%] and such prevalence was statistically significant [Chi-squared=30.7, p=<0.0001]. The most common sleep abnormality was insomnia [65.9%], followed by RLS [42%], OSAS [31.8%], snoring [27.3%], EDS [27.3%] and narcolepsy [15.9%] while the least was sleep walking [3.4%]. Insomnia correlated with anemia [r=o.31, p=0.003], anxiety [r=0.279, p=0.042], depression [r=0.298, p=0.24] and RLS [r=0.327, p=0.002]. Also, RLS correlated with hypoalbuminemia [r=0.41, p=<0.0001], anemia [r=0.301 and p=0.046], hyperphosphatemia [r=0.343 and p=0.001], and excessive daytime sleepiness correlated with OSAS [r=0.5, p=<0.0001], snoring [r=0.341, p=0.001], and social worry [r=0.27, p=0.011]. Of note, no correlation was observed between the evaluated sleep disorders and patients' gender. The indicatives for insomnia among our study population were inadequate dialysis [OR=8.71, p=0.001], anemia [OR=3.58, p=0.012], hypoalbuminemia [OR=2.71, p=0.044] and RLS [OR=8.50, p=0.0003]. However, anemia [OR=2.67, p=0.034], malnurishment [OR=9.23, p=0.0002] and hyperphosphatemia [OR=5.14, p=0.0005] were the associates of RLS. Sleep disorders are quite common in the Egyptian hemodialysis populations especially those who are anemic, malnourished; and underdialyzed. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results and population-specific sleeppromoting interventions during clinical practice are warranted

Duplex carotid ultrasonography in patients with ischemic heart disease

This study was designed to assess the the extracranial carotid arteries by a simple non invasive inexpensive repititlve tool to search for atherosclerotic changes and their correlation with similar ischemic coronary artery disease in similar age groups. The material of the study comprised 68 subjects: 53 patients with various types of ischemic heart disease and 15 subjects as a control group. Our results showed the following: Significant positive correlation between all lipogram parameters including total cholesterol/HDL cholesterol ratio hyperuriceamia and carotid atherosclerosis. Significant positive correlation between echocardiographic left atrial diameter, left ventricular hypertrophy and carotid atherosclerosis. Significant increase in carotid atherosclerosis in patients with transmural MI and non-Q wave MI when compared to those with stable and unstable angina. Carotid atherosclerosis is more in patients with stable angina than in those with unstable angina. The overall conclusion of the study is that, there is a close relationship between coronary and carotid atherosclerosis, both sharing more or less the same risk factors. The degree of carotid atherosclerosis can be used as a mirror for coronary atherosclerosis so it can be used as a non invasive procedure for assessment of patients prepared for coronary angiogram. Carotid atherosclerosis goes hand in hand with coronary atherosclerosis so, the incidence of carotid plaques or increase intima media thickness with subsequent transient ischemic attacks or other neurological events are more in patients with transmural MI than those with non Q-wave MI, and in the later than those with stable or unstable angina