ABSTRACT
INTRODUCTION: Although hemodialysis (HD) has prolonged the survival of patients with end-stage renal disease (ESRD), it has also adversely affected the sleep and emotional state of these patients. We evaluated the impact of HD on sleep duration, quality, and other sleep-related disorders. METHODS: We recruited consecutive adult patients visiting our tertiary care dialysis unit. We included only ESRD patients who had an estimated glomerular filtration rate (eGFR) of <15 mL/min/1.73m2. We excluded patients with unrelated comorbidities or on medications that could affect sleep. Basic demographic information, anthropometric data, and appropriate lab investigations were obtained. Objective information related to their sleep duration and quality was asked using a predefined proforma. Subjective sleep scores were obtained by using the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and insomnia severity index (ISI). For comparison, the patients were divided into HD and conservative treatment (CT) groups based on their treatment modality. The baseline characteristics of the patients were noted. The Shapiro-Wilk test was used to test normality. Correlations were obtained by using Student's t-test for parameters that were normally distributed and the Mann-Whitney-Wilcoxon test for those that were not. RESULTS: Of the 56 patients we studied, 59% were males. The average age and body mass index (BMI) were 45.7 years and 20.98 kg/m2, respectively. Overall, 41% of patients were assigned to the HD group, and the remaining to the CT group. The CT group had fewer comorbidities compared to the HD group. The average sleep duration was similar in both groups (HD: 6.64 hours, CT: 6.49 hours). There was a weak-to-moderate positive correlation between the sleep scores. Overall, one-half of the patients had excessive daytime sleepiness (EDS) (46.43%) and insomnia (48.21%), and two-thirds of them were poor sleepers (66.07%). Symptoms suggestive of sleep-disordered breathing (SDB) were seen in 25% of patients, restless legs syndrome (RLS) in 19.64% of patients, and periodic limb movement disorder (PLMD) in 44.64% of patients. Patients undergoing HD had poorer sleep quality compared to the CT group (p=0.038). The odds of developing poor sleep were 3.6 times higher in the HD group. CONCLUSION: This cross-sectional study focuses on the quantification of objective and subjective deterioration of sleep quality in ESRD patients on HD. The prevalence of EDS (63.64%), insomnia (51.52%), and poor sleep quality (84.84%) in the HD group was more than the previously reported values. The PSQI, ESS, and ISI scores were higher in HD patients, indicating poorer sleep quality. Our study highlights the underestimation of sleep disorders in HD patients in underserved areas. The results warrant a meticulous evaluation of the same by a keen nephrologist, followed by referral to sleep providers where necessary.
ABSTRACT
INTRODUCTION: Occupational stress is common to each and every organization at various levels of hierarchy. The police organization is no exception to this. Rather policing is widely recognized as more stressful than any other occupation, nature of work, irregular duty hours, and many more factors, which can trigger stress. The present study was done to highlight some of these stressful factors in Mumbai police. MATERIALS AND METHODS: Simple as well as systematic random sampling technique was adopted to get equal representation from each zone as well as region from Mumbai police. Occupational stress index (OSI) questionnaire was prepared, pilot tested, and validated for screening stress. RESULT: We screened 276 policemen for occupational stress. Seventy-three percent of them were in the 30-50 years age group, and most of them (49%) studied up to H.S.C. Ninety-one percent were married and 56% had reported duty hours 12-16 h/day. Seventy-one percent were addicted to any of the substance. After screening we found 73% moderately stressed, whereas 18% highly stressed policemen. Sociodemographic factors which were age group (50-58 years), duration of service in years (>25 years), duration of duty hours (>16 h/day), addiction habits, and number of monthly holidays (no holiday). We found role ambiguity, under participation, role overload, strenuous working condition, and unprofitability as predominant scales in OSI. So prevention as well as management of stress in policemen is the necessity of the current situation. This stress can be managed at organizational level by adopting right techniques, whereas at individual level by habituating right behavior and attitude.
