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

ABSTRACT

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