Poor sleep in organ transplant recipients: self-reports and actigraphy

Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden

OBJECTIVE

This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer.

METHODS

Lung cancer patients on active oncological treatment ( N = 108; 74.1% stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep.

RESULTS

Higher discrimination ( b = 5.52, 95% confidence interval [CI] = 2.10-8.94) and constrained disclosure ( b = 0.45, 95% CI = 0.05-0.85) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress ( b = 0.19, 95% CI = 0.09-0.29) and physical symptoms ( b = 0.28, 95% CI = 0.17-0.40) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI = 0.13-1.96) and physical symptoms (indirect effect = 1.58, 95% CI = 0.37-2.79) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI = < 0.01-0.17) and physical symptoms (indirect effect = 0.13, 95% CI = 0.01-0.25).

CONCLUSIONS

Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.

Sleep Patterns in Patients After Solid Organ Transplantation Including Gender and Age Differences. Survey Results From One Transplantation Centre in Poland

INTRODUCTION

Sleep plays a crucial role in maintaining health. Transplant patients are exposed to numerous stressors and are at risk of sleep disturbances. The aim of this study was to assess the sleep patterns of transplant patients.

METHODS

An anonymous paper survey was carried out among patients from one transplant center in Poland. Respondents were asked about the quality and quantity of sleep and the overall impact of the transplantation on their night rest. Data were collected from June to November 2023.

RESULTS

Data were obtained from 212 respondents (122 males and 90 females), aged 48.38 ± 13.68. The positive impact of transplantation on sleep hygiene was indicated by 57.4% of respondents, 28.9% observed no impact, and 13.6% rated the impact as negative. Our study showed that sleep is more satisfying in males than in females (62.8% of males and 46.7% of females). The analysis revealed that 38.9% of females need 30 minutes more than men to fall asleep. Additionally, females tend to get up half an hour later compared to men. About 71.9% of males declared good well-being the next day compared to 62.2% of females. Furthermore females declared more sleepiness the next day. The study also showed that older transplant recipients (over 50 years-of-age) report more frequent awakenings at night.

CONCLUSIONS

The data collected showed differences in sleep patterns according to gender and age. Females and older patients should be screened for sleep disturbances during post-transplantation care.

Sleepiness and Health-Related Quality of Life Among Kidney Transplant Recipients in a Low-Middle Income Country: A Cross-Sectional Study

This study aims to describe daytime sleepiness and health-related quality of life (HRQoL) among Lebanese kidney transplant (KT) recipients and to examine the medical, psychosocial and transplant factors related to them. It is a cross-sectional multi-center study involving KT recipients >18 years. Daytime sleepiness was assessed using ESS Questionnaire. HRQoL was measured using the SF-36 questionnaire. Social support was self-reported. A multivariable regression analysis evaluated factors associated with daytime sleepiness and HRQoL in our sample. 118 patients were recruited over a 2 years period. Excessive daytime sleepiness was prevalent in 12.7%. It was associated with Diabetes Mellitus (OR 3.97, 95% CI 0.94-16.81, p = 0.06) and obesity (OR 1.13, 95% CI 1.02, 1.27, p = 0.02). Social support and higher eGFR were associated with better scores on the MCS (β 24.13 p < 0.001 and β 0.26 p < 0.01) and the PCS (β 15.48 p < 0.01 and β 0.22 P 0.02). Conversely, depression and hospitalization were negatively associated with the MCS (β -27.44, p < 0.01 and β -9.87, p < 0.01) and the PCS (β -0.28.49, p < 0.01 and β -10.37, p < 0.01).

Sleep Quality and Related Factors Among Liver Transplant Recipients in Korea: A Cross-Sectional Study

BACKGROUND

Poor sleep quality is common after liver transplantation, which lowers health-related quality of life. However, the detection and management of sleeping difficulties in liver transplant recipients have been limited.

PURPOSE

This study was designed to assess sleep quality in liver transplant recipients in Korea and associated factors, including symptom experience, depression, and family support, using the theory of unpleasant symptoms as a theoretical framework.

METHODS

This cross-sectional study of 149 liver transplant recipients in a Korean tertiary hospital was conducted in 2019. Data were obtained using several structured self-report questionnaires, including the Pittsburgh Sleep Quality Index, Modified Transplant Symptom Occurrence and Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale-Revised, and Family Support Scale. Multiple linear regression was used to determine the factors associated with sleep quality.

RESULTS

The prevalence of sleep disturbance was 55% in the sample. Low sleep quality was associated with being female and with having a higher symptom experience, higher depressive symptoms, and lower family support. In the multiple linear regression analysis, depression and symptom experience was shown to significantly affect sleep quality.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The liver transplant recipients in this study reported poor sleep quality. The factors associated with the sleep quality included depression and symptom experience. To enhance sleep quality, interventions designed to reduce depression and symptoms related to liver transplantation should be provided. The results of this study may be used to develop nursing strategies to improve sleep quality in liver transplant recipients.

Factors Affecting Anxiety of Kidney Transplant Recipients According to Donor Type: A Descriptive Study

PURPOSE

High anxiety among kidney transplant recipients has negative psychosocial consequences for health quality. This study aims to determine the risk factors that affect levels of anxiety in recipients of kidney transplants according to living and deceased donor types.

DESIGN

The study was conducted using a descriptive correlational research method.

METHODS

The study conducted research with 330 kidney transplant recipients (from 261 live and 69 cadaver donors) who agreed to participate between February and July 2019. Participants completed the State-Trait Anxiety Inventory, which assesses state and trait anxiety.

FINDINGS

Participants had low state anxiety and moderate trait anxiety scores. A statistically significant, positive, moderate correlation was found between state anxiety scale and trait anxiety scale mean scores of recipients of kidney transplants from both living and deceased donors. According to a regression analysis of trait anxiety scores of transplant recipients from living donors, positive independent risk factors for anxiety include kidney transplant recipients with a low income, receiving kidneys from male donors, drug noncompliance, sleep disorders, and mental problems.

CONCLUSIONS

Both kidney transplant recipients from living and deceased donors had low state anxiety and moderate trait anxiety. Nurses should develop effective intervention strategies that continue throughout life to reduce the anxiety of kidney transplant recipients.

Incidence and prevalence of depressive, anxiety, and insomnia symptoms among adult liver transplant recipients: A systematic review and meta-analysis

OBJECTIVE

Psychological morbidity among transplant recipients may negatively impact post-transplantation outcomes. Our objectives were to compute pooled incidence and prevalence estimates for depressive, anxiety, and insomnia symptoms among adults who underwent liver transplant.

METHODS

Electronic searches of MEDLINE, PubMed Central, CINAHL, and Google Scholar were carried out from inception to October 2022 to identify observational studies conducted among adult liver transplant recipients which measured depression, anxiety, and/or insomnia. We used the Joanna-Briggs tool for study quality appraisal.

RESULTS

Sixty-five studies (pooled N = 12,183) provided data for meta-analysis. The one-year pooled point prevalence rate for depressive symptoms was 25% (95% Confidence Intervals [CI]: 20% to 30%; I² = 94%; 37 studies; N = 6088) while that of anxiety and insomnia symptoms were 29% (95% CI: 21% to 38%; I² = 96%; 28 studies; N = 4016) and 28% (95% CI: 16% to 43%; I² = 98%; 14 studies; N = 1834), respectively. The findings remained robust across subgroup and sensitivity analyses. Most included studies had low or moderate risk of bias.

CONCLUSIONS

Depressive, anxiety, and insomnia symptoms are commonly prevalent following liver transplantation. Our findings, though limited by high heterogeneity across analyses, have important implications for screening, management, and prevention of psychological morbidity in this group.

SYSTEMATIC REVIEW REGISTRATION

This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD 42021276008).

Association Between the Fatigue and Sleep Quality of Kidney Transplant Recipients: The Mediating Role of Rumination

ABSTRACT

Sleep disorders persist in renal transplant patients. Previous studies have showed that fatigue and rumination are an important determinant of sleep quality. However, very few studies have explored the mediating role of rumination in the relationship between fatigue and sleep quality in kidney transplant recipients. A descriptive cross-sectional research design was implemented, and 192 kidney transplant patients completed the short questionnaire about their recent experiences of fatigue, rumination, and sleep quality. The prevalence of sleep disorders among kidney transplant recipients was 19.3%. With rumination as a partial mediator, fatigue indirectly affected the patients' sleep quality. This indirect effect was 0.10 (95% confidence interval, 0.154-0.419). Our results indicate that the incidence of sleep disorders after renal transplantation was high, and the more tired kidney transplant recipients become, the more likely they are to ruminate, which leads to a decline in sleep quality.

What are the sleep characteristics among early kidney transplant recipients? An objective and subjective measurement from China

OBJECTIVE

To evaluate the sleep quality by self-reported questionnaires and polysomnography (PSG) among early kidney transplant recipients (KTRs) and to further explore their correlation.

DESIGN

This was a prospective and cross-sectional analysis of the sleep characteristics among early kidney transplant recipients through an objective and subjective measurement.

PARTICIPANTS

Patients with end stage renal disease on the transplant waiting list and after kidney transplantation were from a major organ transplantation center in Southern China (n = 83).

PRIMARY AND SECONDARY OUTCOME MEASUREMENTS

Objective outcomes: PSG, noise and light. Subjective outcomes: demographic and clinical questionnaires, self-reported pain and Richards Campbell sleep questionnaire (RCSQ). After agreement with the informed consent, participants first completed demographic and clinical questionnaires, then worn the PSG within 5-10 days after kidney transplantation. Both noise, light and self-reported pain were monitored during sleep. After completion of PSG, the RCSQs were filled out next morning.

RESULTS

A total of 298 patients were recruited and 83 participants were finally analyzed. The total RCSQ mean score was 51.0±18.9mm. The prevalence of poor sleep quality among early KTRs was 45.1%. Most of PSG characteristics were significantly correlated with their corresponding RCSQ items. And the total RCSQ scores were significantly correlated with the number of awakenings, the N2 percentage and the total sleep time (r = 0.79, 0.47 and 0.40, P<0.05) respectively. Noise was a statistically significant factor affecting the subjective sleep quality.

CONCLUSIONS

The sleep quality in early KTRs measured by both PSG and RCSQ exhibits consistency with each other. Sleep disruption always remains a substantial problem and is affected by self-reported noise among early KTRs. The RCSQ is easily applicable and interpretable so that it can be used for future daily clinical practice.

Changes in actigraphy metrics associated with PROMIS measures after orthopaedic surgery

AIM

This study examined the feasibility of integrating actigraphy devices into orthopaedic surgical settings to assess the concurrent validity between objective actigraphy data and PROMIS measures. Additionally, the association between changes in actigraphy data and longitudinal changes in PROMIS measures was examined.

METHODS

Data were collected from 17 participants using actigraphy devices the week prior to and after orthopaedic surgery from 02/2019 to 03/2020. Participants completed PROMIS measures (Physical Function, Sleep Disturbance, Pain Interference) preoperatively and up to 6 months postoperatively. Nonparametric correlations (r_s ) assessed for concurrent validity. Linear mixed-effects models examined the association between changes in actigraphy data and PROMIS measures.

RESULTS

Prolonged wake after sleep onset was associated with increased sleep disturbances (r_s  = 0.49; p = 0.045) and pain interference (r_s  = 0.51; p = 0.04). Changes in pain interference were correlated with increased awakenings (r_s  = 0.54; p = 0.03). Increased wake after sleep onset was associated with worsening sleep disturbance (β = 0.12; p = 0.01) and pain interference scores over the postoperative period (β = 0.12; p = 0.02).

CONCLUSIONS

This study is among the first to examine changes in objective actigraphy data and longitudinal PROMIS measures following orthopaedic surgery and illustrates the feasibility of incorporating actigraphy into surgical settings to evaluate postoperative recovery.

A Scoping Review of the Literature on Sleep Quality in Adult Lung Transplant Recipients

Introduction: Lung transplant recipients face challenging postoperative complications and are at risk for poor sleep quality. Sleep quality, as a complex clinical phenomenon, has multiple subjective and objective connotations. Measures and definitions of sleep quality are not standardized. Objective: A scoping review methodology was used to systematically map the relevant literature, provide an overview of available sleep quality measures, and to identify knowledge gaps. Methods: A systematic search of published and gray literature enabled knowledge synthesis of the last 10 years of evidence documenting sleep quality in lung transplant recipients. The search revealed 246 articles with only 12 sources meeting the eligibility criteria. Results: Sources varied in terms of definitions and measures of sleep quality. Subjective, objective, or a combination of both measures were used across the relevant literature with findings confirming that poor sleep quality was common in lung transplant recipients. Significant associations with poor sleep quality included younger age, female gender, exposure to tacrolimus, anxiety, and depression. Discussion: Systematic literature assessing sleep quality in lung transplant recipients is sparse and lacks conceptual and operational definitions. Future research can focus on designing prospective observational studies. Subjective and objective measures for sleep quality need to be validated in lung transplant recipients. Further rigorous research is needed to standardize measures of sleep quality and to further examine potential risk factors that affect sleep after lung transplantation.

Self-reported poor quality of sleep in solid organ transplant: A systematic review

BACKGROUND

High quality sleep of sufficient duration is vital to overall health and wellbeing. Self-reported poor quality of sleep, sleep reported as irregular in timing, marked by frequent awakenings, or shortened in duration, is common across the solid-organ transplant trajectory.

AIM

This Systematic Review aimed to summarize available literature on rates of self-reported poor quality of sleep among solid organ transplant candidates and recipients.

METHODS

A systematic search of published literature was conducted in PubMed/MEDLINE, Embase, Web of Science, CINHAL, and PsychInfo databases with no date restrictions. Original articles in the English language describing self-reported quality of sleep using standardized questionnaires in adults either waitlisted for, or who received a solid organ transplant (heart, lung, kidney, liver, pancreas, or multi-solid organ) were included.

RESULTS

Of a potential 2054 articles identified, 44 were included (63.6% renal transplant, 20.5% liver transplant, 11.4% lung transplant, and 4.5% included multiple organ transplant populations), with the majority (68.2%) focusing only on post-transplant populations. No included articles focused solely on heart or pancreas transplant populations. On average, the transplant population with the greatest improvement in quality of sleep (reported as poor sleep quality, insomnia, sleep disturbance, or sleep dissatisfaction) from transplant candidacy to post-transplantation were renal transplant (from 53.5% pre, to 38.9% post) followed by liver transplant patients (from 52.8% pre, to 46.3% post), while lung transplant patients remained similar pre- to post-transplantation (55.6% pre, to 52% post). Poor quality of sleep was frequently associated with anxiety and depression, poorer quality of life, restless legs syndrome, and higher comorbidity.

CONCLUSIONS

Reports of poor quality of sleep are highly prevalent across all solid-organ transplant populations, both pre- and post-transplantation. Future studies should assess quality of sleep longitudinally throughout all phases of the transplantation trajectory, with more research focusing on how to optimize sleep in solid organ transplant populations.

Effect of Music on Fatigue, Comfort, and Vital Signs in Patients After Liver Transplant Surgery: A Randomized Controlled Trial

This randomized controlled clinical trial was conducted to determine the effect of music therapy on fatigue, comfort and vital signs of the liver transplant patients. The study sample comprised 120 adult patients (60 in the experimental and 60 in the control group) who met the inclusion criteria and agreed to participate in the study. In the experimental group, the researcher performed music therapy. After applying music therapy once to patients for 30 minutes, their fatigue, comfort, and vital signs were evaluated. No treatment was performed in the control group. According to music therapy follow-ups after liver transplantation, mean scores of fatigue levels were lower, comfort levels were higher, and vital signs were normal, with a statistical significance in the experimental group compared with the control group in all measurements before and after music therapy (P < .001). The study should be repeated using different parameters.

Sleep quality and its association with health-related quality of life of patients on lung transplantation waitlist in Japan

PURPOSE

Poor quality of sleep is a common feature in patients with various lung diseases and affects their health-related quality of life (HRQL). We evaluated sleep quality and HRQL in patients on the waitlist for lung transplantation in Japan.

METHODS

In this prospective study, patient-reported and physiological data were collected from patients newly registered on the waitlist for lung transplantation in Japan. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and HRQL using the St. George's Respiratory Questionnaire (SGRQ). The frequency of poor sleep quality, correlations between sleep quality and various clinical parameters, and predictive factors of sleep quality were examined.

RESULTS

Of 193 patients, the three most-frequent indications for lung transplantation were interstitial pneumonia (n = 96), pulmonary complications of hematopoietic stem cell transplantation (n = 25), and pulmonary hypertension (n = 17). Poor sleep quality (PSQI > 5) was observed in 102 patients (53%) and was significantly associated with worse Hospital Anxiety and Depression Score (HADS), worse SGRQ score, worse modified Medical Research Council Dyspnea score, and shorter 6-min walk distance. However, it was not associated with sex, pulmonary function, interstitial pneumonia, or arterial blood gas. Stepwise multiple regression analysis indicated that poor sleep quality was explained significantly by HADS anxiety (23%) and SGRQ Symptoms (10%).

CONCLUSION

Poor sleep quality was found to be common among patients on the lung transplantation waitlist in Japan. The two most significant factors responsible for impaired sleep quality were anxiety and respiratory symptoms. Additional care should be taken to ensuring a better quality of sleep for such patients.

Psychological and Psychopathological Aspects of Kidney Transplantation: A Systematic Review

Kidney transplantation is a serious event that involves profound psychological, relational and social changes both for the patient and his family context. Assessment of personality profile, awareness of disease, family and social support of the patient candidate for kidney transplantation are necessary because factors not adequately considered, can influence the success of the transplant and alter the psychological stability of the patient. The present study aims to provide a systematic review of the literature of the last twelve years (2006-2018), focusing in particular on patient's readiness level and illness management and on possible psychopathology. Sixty-two studies were examined. Based on the Downs and Black checklist, most studies (n = 32) were of high quality; 15 of which related to lifestyle, health education, and therapeutic adherence in post-renal transplantation, 17 studies concerned the possible existence of psychopathology and cognitive impairment of renal deceased transplanted subjects. The literature used has shown that the population of kidney transplant patients is exposed to a high risk of psychiatric disorders with repercussions on the quality of life and the risk of rejection. Therefore, an adequate pre-transplant psychosocial assessment is necessary, which allows a more in-depth knowledge of the candidate to plan coping strategies and possible post-transplant psychotherapy.

A Scoping Review of Key Health Items in Self-Report Instruments Used Among Solid Organ Transplant Recipients

The overall aim of this scoping review of the literature is twofold: (1) to provide an overview of all instruments that have been used to assess health-related quality of life (HRQoL) after solid organ transplantation and (2) to provide a list of health items they include to support future studies on the development of a new-generation HRQoL instrument. All studies that administered any form of HRQoL instrument to post-transplant solid organ recipients were identified in a comprehensive search of PubMed (MEDLINE), Embase, and Web of Science, with a cut-off date of May 2018. The search used various combinations of the following keywords: lung, heart, liver, kidney, or pancreas transplantation; quality of life; well-being; patient-reported outcome; instrument; questionnaire; and health survey. In total, 8013 distinct publications were identified and 1218 of these were selected for review. Among the instruments applied, 53 measured generic, 51 organ-specific, 271 domain-specific, and 43 transplant-specific HRQoL. A total of 78 distinct health items grouped into 16 sub-domains were identified and depicted graphically. The majority of publications did not report a logical rationale for the choice of specific HRQoL instrument. The most commonly used types of instruments were generic health instruments, followed by domain-specific instruments. Despite the availability of transplant-specific instruments, few studies applied these types of instruments. Based on the 78 items, further research is planned to develop a patient-centered, transplant-specific HRQoL instrument that is concise, easy to apply (mobile application), and specifically related to the health issues of solid organ recipients.

Does Kidney Transplantation Affect Sleep and Fatigue in Patients With Kidney Disease?

Supplemental Digital Content is available in the text.

Sleep disorders and fatigue are highly prevalent in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients but there is limited evidence on the effect of kidney transplant (KTx) on these.

Sleep Quality and Related Psychosocial Variables Among Renal Transplant Patients

BACKGROUND

Several studies have examined sleep quality in the post renal transplant population of China, but few studies have actually confirmed the related psychosocial variables of sleep quality in renal transplant recipients with home care.

OBJECTIVES

This study investigates sleep quality and its related psychosocial variables among renal transplant patients.

METHODS

This is a cross-sectional study using a convenient sampling approach. Self-report questionnaires were applied to 485 renal transplant patients. All participants completed the General Data Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Flourishing Scale.

RESULTS

A total of 438 valid questionnaires were included in the analysis. The global PSQI score was 5.86 (SD, 3.20), significantly lower than the norm; 128 (29.2%) recipients were classified as having poor sleep quality (global PSQI > 7). In the component score of PSQI, sleep onset latency was the highest; the others from high to low are sleep disturbance, daytime dysfunction, subjective sleep quality, sleep efficiency, sleep duration, and use of hypnotic medication. A total of 19.6% reported sleeping fewer than 6 hours a night, 64.8% reported that they had to get up to use the bathroom, and 50.0% woke up in the middle of the night or early morning at least 1 night per week in the past month. Significant differences in the PSQI scores were observed in renal transplant patients of different sex, age, residence, career, length of post-renal transplant period, comorbidity, kidney function, and depressive symptoms (P < .05). The PSQI scores were positively correlated with depression (Self-Rating Depression Scale) (P < .01) but negatively correlated with inquisitiveness (Three-Dimensional Inventory of Character Strengths-inquisitiveness) and psychological well-being (Flourishing Scale) (P < .01).

CONCLUSION

The sleep quality of renal transplant patients was lower than that of the general population. Character strengths and well-being can increase the level of sleep quality in renal transplant patients. Psychosocial intervention is necessary for improving the sleep quality of renal transplant recipients in China.

Change of sleep quality from pre- to 3 years post-solid organ transplantation: The Swiss Transplant Cohort Study

BACKGROUND

Poor sleep quality (SQ) is common after solid organ transplantation; however, very little is known about its natural history. We assessed the changes in SQ from pre- to 3 years post-transplant in adult heart, kidney, liver and lung recipients included in the prospective nation-wide Swiss Transplant Cohort Study. We explored associations with selected variables in patients suffering persistent poor SQ compared to those with good or variable SQ.

METHODS

Adult single organ transplant recipients enrolled in the Swiss Transplant Cohort Study with pre-transplant and at least 3 post-transplant SQ assessment data were included. SQ was self-reported pre-transplant (at listing), then at 6, 12, 24 and 36 months post-transplant. A single SQ item was used to identify poor (0-5) and good sleepers (6-10). Between organ groups, SQ was compared via logistic regression analysis with generalized estimating equations. Within the group reporting persistently poor SQ, we used logistic regression or Kaplan-Meier analysis as appropriate to check for differences in global quality of life and survival.

RESULTS

In a sample of 1173 transplant patients (age: 52.1±13.2 years; 65% males; 66% kidney, 17% liver, 10% lung, 7% heart) transplanted between 2008 and 2012, pre- transplant poor SQ was highest in liver (50%) and heart (49%) recipients. Overall, poor SQ decreased significantly from pre-transplant (38%) to 24 months post-transplant (26%) and remained stable at 3 years (29%). Patients reporting persistently poor SQ had significantly more depressive symptomatology and lower global quality of life.

CONCLUSION

Because self-reported poor SQ is related to poorer global quality of life, these results emphasize the need for further studies to find suitable treatment options for poor SQ in transplant recipients.

A prospective cohort study on posttraumatic stress disorder in liver transplantation recipients before and after transplantation: Prevalence, symptom occurrence, and intrusive memories

OBJECTIVE

This study aimed at increasing the understanding of posttraumatic stress disorder (PTSD) in liver transplant patients by describing the course of PTSD, symptom occurrence, psychological co-morbidity, and the nature of re-experiencing symptoms.

METHODS

A prospective cohort study was performed among 95 liver transplant recipients from before transplantation up until one year post-transplantation. Respondents filled out a questionnaire regarding psychological functioning (PTSD, anxiety, and depression) before, and at 3, 6, and 12months post-transplantation. Both quantitative and qualitative methods were used to analyze the data.

RESULTS

Before transplantation, respectively 10.5% and 6.3% of the respondents were identified as possible cases of full or partial PTSD. In all cases, co-morbid conditions of anxiety and/or depression were present. After transplantation, no new onset of full PTSD was found. New onset of possible partial PTSD was found in six respondents. Arousal symptoms were the most frequently reported symptoms, but may not be distinctive for PTSD in transplant patients because of the overlap with disease- and treatment-related symptoms. Re-experiencing symptoms before transplantation were mostly related to waiting for a donor organ and the upcoming surgery; after transplantation this was related to aspects of the hospital stay.

CONCLUSIONS

In our group of liver transplant patients, PTSD symptomatology was more present before transplantation than after transplantation. Being diagnosed with a life-threatening disease seemed to be the main stressor. However, when a diagnosis of PTSD is suspected, assessment by a clinician is warranted because of the overlap with mood and anxiety disorders, and disease- and treatment-related symptoms.

Quality of sleep in renal transplant recipients and patients on hemodialysis

BACKGROUND

Sleep disorders are very common in patients with chronic kidney disease and they may not always subside after kidney transplantation.

AIM AND METHODS

The aim of this cross-sectional study was to evaluate the self-reported quality of sleep, insomnia problems in particular, and examine the factors that disturb sleep of kidney transplant recipients (KTx: n=152) in comparison to age- and sex-matched patients on dialysis (HD: n=67) and participants with normal renal function (NOR: n=49), through the administration of the Athens Insomnia Scale (AIS) at least six months after transplantation. Clinical and laboratory data, as well as health-related quality of life, depression, anxiety, post-traumatic stress symptoms, and the presence of restless legs syndrome (RLS) and pruritus were investigated in relation to sleep problems.

RESULTS

The highest mean AIS score was observed in the transplant patients (KTx: 4.6±13.3 vs. HD: 3.8±8.1 vs. NOR: 2.4±10.2); both KTx and HD patients had a lower quality of sleep compared to participants with normal renal function. Multiple linear regression analysis showed that the determinants of the total AIS score were the frequency of post-traumatic stress symptoms, depression, RLS, diastolic blood pressure, and pain (all p<0.0001).

CONCLUSION

Although amelioration of renal function post-transplantation improves several aspects of quality of life, it does not seem to have a beneficial effect on self-reported sleep.

The effect of renal transplantation on quality of sleep in former dialysis patients

Data on sleep quality in renal transplanted (RTX) patients are scarce, and longitudinal studies are lacking. The purpose of this study was to assess the prevalence of sleep complaints in RTX patients and identify variables associated with improvement in sleep quality. In a longitudinal study, 301 dialysis patients were followed for up to 5.5 years, during which time 142 were transplanted. Out of the transplanted patients, a total of 110 were eligible for inclusion. Sleep quality and depression were assessed with the validated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), and data were collected during dialysis and after RTX. Based on PSQI scores, 59% were characterized as poor sleepers after RTX compared to 75% when in dialysis (P = 0.016). A total of 46% experienced a clinical relevant improvement in overall sleep quality, while 21% experienced a clinical relevant deterioration. In multivariable analyses, clinical meaningful change in sleep quality was not associated with either depressive symptoms assessed with BDI or other clinical variables. Sleep quality improved after RTX in nearly half of the patients, but poor sleep quality was prevalent in RTX patients. Therefore, sleep quality should routinely be assessed in RTX patients.

Restless Legs Syndrome Following Lung Transplantation: Prevalence and Relationship With Tacrolimus Exposure

CONTEXT

Complications following lung transplantation are common and significantly reduce quality of life, and increase morbidity and mortality. Increasing evidence suggests sleep disorders are prevalent following lung transplantation, but factors associated with their development are not known.

OBJECTIVES

We sought to evaluate the prevalence of restless legs syndrome (RLS) in a lung transplant population and determine if a relationship exists between RLS and exposure to immunosuppressant medications.

DESIGN, SETTING, AND PARTICIPANTS

Subjects were recruited through the University of Wisconsin Hospital and Clinics Lung Transplant Clinic (N = 125). Participants (N = 81) completed sleep questionnaires, including the four RLS diagnostic criteria, insomnia severity index, and Sheehan disability scale. Cumulative tacrolimus exposure was determined in 62 subjects by calculating an area under the curve (AUC) to assess for a relationship with restless legs syndrome.

RESULTS

Prevalence of RLS was 35 percent. Cumulative mean ± SEM tacrolimus exposure was similar in patients with RLS versus those without RLS (17446 ± 1855 ng days/mL vs. 15303 ± 1643 ng days/mL, respectively; p = 0.42). Insomnia severity index scores (12.5 ± 1.0 vs 6.8 ± 0.7, p < 0.0001) and Sheehan disability scores (7.8 ± 1.3 vs 3.6 ± 0.6, p = 0.003) were significantly higher in those with vs those without RLS symptoms, respectively.

CONCLUSIONS

Our data confirms increased prevalence of RLS following lung transplantation reported by previous studies. RLS symptoms were not related to estimated tacrolimus exposure. Predictors of RLS following lung transplantation need to be further investigated to better identify and control RLS symptoms and reduce associated insomnia and disability.

Patterns and Predictors of Sleep Quality Within the First Year After Lung Transplantation

Context:

Sleep quality affects health and self-management in chronic illness. Limited research has examined patterns and predictors of sleep quality and its impact on self-management and health-related quality of life (HRQOL) among lung transplant recipients (LTRs).

Objective:

The aims of this study were to identify the patterns, predictors, and impact of poor sleep quality on self-management behaviors and HRQOL the first year after lung transplantation.

Methods:

Secondary analysis of 75 LTRs who participated in a randomized controlled trial. Pittsburgh Sleep Quality Index (PSQI) was administered at baseline, 2, 6, and 12 months after transplant; 12-month PSQI was dichotomized categorizing good versus poor sleepers. Predictors were measured at the time of transplant; self-management and HRQOL were measured at 12 months. Logistic regression identified predictors of poor sleep. Correlations examined poor sleep quality, self-management behaviors, and HRQOL.

Results:

Sleep quality was relatively stable during the first year, and 24 of the 75 (32%) of the sample met criteria for poor sleep quality at 12 months. The only multivariate predictor of poor sleep was female gender (odds ratio = 3.421; P = .026); the mental component of HRQOL was the only outcome associated with poor sleep ( r = −.348; P < .01).

Conclusion:

Nearly one-third of LTRs reported persistent poor sleep through year 1. More females reported poor sleep quality, and sleep quality was inversely related to mental HRQOL by 12 months. Knowledge of these relationships may help identify LTRs at the greatest risk for poor sleep and guide strategies to promote sleep and optimize HRQOL.

Health-related quality of life and sleep among Chinese children after living donor liver transplantation

LDLT is a well-established treatment for most terminal liver diseases in children. Survival rates have improved, yet few studies have considered HRQoL or sleep problems in LDLT recipients. In this cross-sectional study, we enrolled 51 children who had undergone LDLT in Renji Hospital. PedsQL(™) 4.0 Generic Core Scales, PedsQL(™) 3.0 Transplant Module, and Pediatric Sleep Questionnaire were used to assess outcomes. Of all participants, 11.8% (6/51) reported low total HRQoL scores. Participants' scores on most HRQoL subscales were comparable to the scores of healthy children. However, compared with solid organ transplant recipients, LDLT recipients scored significantly lower in About My Medicines II (t = 3.092, p = 0.002) and Worry (t = 2.760, p = 0.006). Sleep problems (41.2%) were common among participants. Hierarchical regression analyses showed that SRBD accounted for significant variance in HRQoL on total generic HRQoL (R(2) = 0.446, p < 0.001), psychosocial health (R(2) = 0.372, p = 0.001), physical health (R(2) = 0.345, p = 0.003), total transplant-specific HRQoL (R(2) = 0.514, p < 0.001), About My Medicines I (R(2) = 0.365, p = 0.013), My Transplant and Others (R(2) = 0.334, p = 0.005), Pain and Hurt (R(2) = 0.544, p < 0.001), Worry (R(2) = 0.401, p = 0.001), Treatment Anxiety (R(2) = 0.526, p < 0.001), How I Look (R(2) = 0.221, p = 0.040), and Communication (R(2) = 0.343, p = 0.012). In conclusion, sleep problems are non-negligible in children after LDLT and predicted significant variance on HRQoL.

Pancreas and islet transplantation: psychological themes pre- and posttransplant

PURPOSE OF REVIEW

To date, islet and whole pancreas transplantation have been largely researched and reported separately. Therefore, for the first time, this review seeks to examine together the recently reported psychological issues as they relate to the two different types of transplantation.

RECENT FINDINGS

In relation to pancreas transplantation, recent findings indicate potential issues relating to energy levels, including sleep problems; mood problems (anxiety, depression, traumatic stress); social interactions; and identity issues. Similarly, the research on islet allotransplantation (ITA) indicates mood disruptions associated with Type I diabetes mellitus (T1DM), which seem to improve as a result of treatment with ITA.

SUMMARY

The review indicates a need for more research to guide effective intervention to optimize psychological recovery post islet and/or pancreas transplantation for patients with T1DM. Effective psychological intervention for this group relies on researchers eliciting more detailed knowledge of pretransplant psychosocial issues, not only in relation to how these might vary by transplant group, but also in relation to patient health status vis-à-vis microvascular complications and glycaemic control, and how these issues change across the whole transplant journey.