Sleep Quality and Its Affecting Factors among Hemodialysis Patients: A Multicenter Cross-Sectional Study

Association between muscular strength and sleep quality in older adults undergoing hemodialysis: a cross-sectional study

PURPOSE

Older adults undergoing hemodialysis experience improved survival rates but often suffer from sleep disorders, resulting in adverse health outcomes. This study aims to assess the association between handgrip strength (HGS), a key indicator of muscular strength, and sleep quality in older adults undergoing hemodialysis.

METHODS

This cross-sectional and analytical study assessed 150 older adults undergoing hemodialysis selected by simple randomization. Data on demographics, clinical parameters, HGS, and sleep quality (PSQI) were collected and analyzed using descriptive and inferential statistics with SPSS version 20.

RESULTS

The mean age of the participants was 65.61 ± 4.07 years. Mean mid-upper arm circumference (MUAC) and calf circumference (CC) were 29.59 cm and 36.96 cm, respectively. The mean HGS was 28.7 ± 8.55 kg, with males exhibiting higher HGS (37.72 ± 6.17 kg) than females (23.55 ± 5.38 kg). The mean PSQI score was 6.71, with 54.1% reporting poor sleep quality. Sleep quality was significantly associated with income source, underlying diseases, Charlson Comorbidity Index (CCI), BMI, MUAC, CC, HGS, and blood levels of potassium and creatinine. A moderate negative correlation (r = - 0.438, p < 0.001) was observed between HGS and PSQI scores, indicating better sleep quality with greater muscular strength. Elevated potassium levels increase the risk of poor sleep.

CONCLUSIONS

Older adults undergoing hemodialysis frequently experience poor sleep quality, which is associated with lower muscular strength. These findings highlight the importance of implementing targeted interventions, such as strength-training programs, to improve muscular strength and, consequently, sleep quality in this vulnerable population.

Beyond dialysis: Assessing therapeutic regimen compliance and sleep quality in chronic renal failure patients undergoing maintenance hemodialysis in Saudi Arabia

BACKGROUND

Given its potential to impact physical and mental health, sleep quality is one of the most significant clinical outcomes among hemodialysis patients. Patients undergoing hemodialysis are required to adhere to an intricate treatment plan that consists of regular hemodialysis treatments, dietary and fluid restrictions, and a multi-drug regimen.

AIM

Investigate the relationship between adherence to a therapeutic regimen and sleep quality among chronic renal failure patients undergoing maintenance hemodialysis.

METHOD

A descriptive correlational research design was followed. The study was conducted at the hemodialysis units in Hafr Albatin City, specifically at Hafr Albatin Central Hospital and King Khaled Hospital, Saudi Arabia. A convenience sample of 100 adult patients was selected for the study. The Hemodialysis Patients Adherence Questionnaire and Pittsburgh Sleep Quality Index were utilized to collect the data in 5 months from September 20, 2023 to February 15, 2024.

RESULTS

The study revealed that more than half of the studied patients adhered to the therapeutic regimen, while (46%) did not adhere to it. More than half of the patients had poor sleep quality and were nonadherent to diet and fluid restrictions. Overall adherence score is negatively correlated with the global sleep quality score (r = -0.368, p < 0.001), indicating that poorer sleep quality is associated with lower overall adherence to the therapeutic regimen.

CONCLUSION

While a significant proportion of the patients demonstrated adherence to overall therapeutic regimens, including dialysis sessions and medication intake, there was notable nonadherence to fluid and diet restrictions. Poor sleep quality, prevalent among two-thirds of the participants, correlates negatively with adherence to therapeutic regimens.

Fatigue and Pruritus Impact Sleep Quality in Hemodialysis Patients

Purpose

This study assesses sleep quality amongst hemodialysis (HD) patients and identifies contributing factors, which include demographic and clinical factors and significant symptoms associated with HD (ie, fatigue and pruritus).

Patients and Methods

In this cross-sectional design, 116 participants were recruited from HD units of two hospitals in Saudi Arabia. Three measures were used to identify predictors of sleep quality among HD patients, including the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), and the 5-D itch scale. Demographic and clinical profiles were also obtained. Univariate and multiple regression analyses were used to determine significant factors associated with sleep quality during HD.

Results

The mean global PSQI score was 6.77±3.23, with 56.9% of participants scoring 5 or more, indicating poor sleep. Sleep latency achieved the highest mean PSQI score (1.70 ±0.94), and 'use of sleep medication components' the lowest (0.36 ±0.83). Increased age, lower educational status, higher fatigue, and pruritus were associated with poorer sleep. Controlling for status and age suggested that fatigue and pruritus independently influenced HD patients' sleep quality (F (4, 111) = 10.89, P = <0.001). There were positive relationships between increased levels of fatigue and pruritus and poor quality of sleep.

Conclusion

This is the first study to examine fatigue, pruritus, and sleep quality in HD patients. Findings will assist dialysis clinicians to develop appropriate management strategies to mitigate factors causing poor sleep for such patients. Intervention programs targeting self-management of fatigue and pruritus symptoms could potentially improve patients' sleep quality.

Perceived Health Needs, Social Support, and Depression Among Patients with Myocardial Infarction: A Cross-Sectional Study

BACKGROUND

Cardiovascular diseases are the leading cause of mortality globally. Myocardial infarction (MI), a major type of cardiovascular disease, presents long-term challenges for patients. Recognizing patients' perceived health needs and the factors that influence them is crucial for providing comprehensive care and improving outcomes.

AIM

This paper explores the perceived health needs, levels of depression, and social support among MI patients, as well as investigates the correlations between these factors.

METHODS

A cross-sectional study was conducted at King Salman Specialist Hospital from March to June 2024, enrolling 244 MI patients through convenience sampling. Data collection was performed using the following three validated questionnaires: the Cardiac Patient Learning Needs Inventory (CPLNI) to assess the learning needs of MI patients, the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression levels, and the Oslo Social Support Scale (OSSS-3) to measure social support. Statistical analysis was carried out using IBM SPSS Statistics, Version 27.

RESULTS

Patients aged 40 years or older and those who were employed exhibited greater learning needs (p < 0.001). Female patients were more depressed than males (p = 0.008). Higher social support was reported by the female patients, those with a family history of MI, and those who were employed (p = 0.002, 0.002, and 0.003, respectively). The total mean score for perceived learning needs was 3.72, with the highest needs in "other pertinent information", "medication information", and "anatomy and physiology". Depression was indicated in 45.1% of MI patients, with significantly higher depression levels in female than in male patients. Additionally, a significant positive correlation was found between social support and perceived learning needs (r = 0.205, p = 0.001), as well as a negative correlation between social support and depression (r = -0.441, p < 0.001).

CONCLUSIONS

Addressing both the physical and psychological needs is essential for MI patients. Comprehensive educational programs and mental health support services are necessary for improving outcomes. Personalized patient education and routine depression screenings should be integrated into post-MI care. Future research should examine longitudinal changes in learning needs and mental health status.

Assessing Daily Function and Sleep Disorders in Hemodialysis Patients with End-Stage Renal Disease

BACKGROUND

Chronic, end-stage renal disease significantly impacts patients' daily activities and sleep quality, particularly those undergoing hemodialysis. However, there is limited research on the extent of these challenges and their correlation with this population.

AIM

This study aims to assess the level of activity of daily living and the prevalence of sleep disturbances in patients with end-stage renal disease undergoing hemodialysis.

METHOD

A cross-sectional study involved 130 patients receiving hemodialysis in two public General Hospitals in Greece. The Barthel Index was used to measure daily living activity, while the Athens Insomnia Scale assessed sleep disorders. The data were analyzed using SPSSV25.0.

RESULTS

Of the 210 questionnaires, 130 were returned fully completed (response rate 62%). Most of the sample participants suffered from comorbidities (76.9%). The total Barthel Index score showed moderate dependence for patients, significantly related to the years and hours of dialysis (p = 0.007 and p = 0.000, respectively). The total score of the Athens Insomnia Scale was also significantly associated with age (p = 0.029), marital status (p = 0.015) and the years and hours of hemodialysis (p = 0.004 and p = 0.001, respectively). A statistically significant difference was recorded between the daily activity of patients with end-stage renal failure and their sleep quality (p = 0.000) Finally, the physical activity level of the participants was related to the existence of another physical health (p = 0.000) or mental health problem (p = 0.000).

CONCLUSIONS

Hemodialysis patients with chronic, end-stage renal disease experience significant challenges in maintaining daily activities and are prone to sleep disorders. These findings suggest a need for integrated care strategies that address both physical function and sleep quality to improve the overall well-being of this population.

Correlation of objective and subjective sleep parameters with fatigue and depression in kidney transplant recipients

OBJECTIVES

Sleep quality in kidney transplant recipients is closely associated with symptoms of fatigue and depression. Although subjective assessment tools like the Pittsburgh Sleep Quality Index and the Richards-Campbell Sleep Questionnaire (RCSQ) are widely used to evaluate sleep quality, there is a lack of studies utilizing polysomnography for objective evaluation. This study aims to investigate the correlation between sleep quality, fatigue, and depression in kidney transplant recipients using both subjective and objective methods, providing scientific evidence for improving their quality of life.

METHODS

The cross-sectional study conveniently sampled 50 kidney transplant recipients from a transplant center in a general hospital between August 2018 and March 2020. Subjective and objective sleep parameters were evaluated using the RCQS and polysomnography, respectively. The Fatigue Severity Scale was used to assess fatigue, and the Hamilton Depression Scale was employed to measure depression levels.

RESULTS

A lower proportion of rapid eye movement (REM) sleep was associated with increased fatigue. Additionally, higher wake time percentages and poorer sleep quality were significantly correlated with greater depression severity.

CONCLUSIONS

This study underscores the critical importance of effectively managing sleep quality in kidney transplant recipients and addressing their fatigue and depression symptoms. These findings lay a foundation for developing targeted nursing and therapeutic strategies.

Sleep quality among emergency nurses and its influencing factors during COVID-19 pandemic: a cross-sectional study

Background

COVID-19 has probably contributed to sleep disturbance among nurses, especially those working at emergency departments (EDs). Sleep disorders in nurse managers can negatively impact their health and impair work performance and decision-making. This study aimed to explore the quality of sleep among nurses working in EDs and its influencing factors during the COVID-19 pandemic.

Method

In this study, a cross-sectional design was employed to assess the sleep quality of nurses working in EDs during the COVID-19 pandemic. The research recruited a convenience sample of emergency nurses, who were selectively sourced from four hospitals in Hail City. This recruitment occurred over the period from April to July 2022. Descriptive data analysis was conducted using SPSS, with the significance level set at 0.05.

Results

Among the 216 participants in the study, the majority (55.6%) were aged between 30 and 39 years, and 73.6% were female. Additionally, 64.4% were married, while 69.4% had a bachelor's degree, 20% held a diploma, and the remaining had a master's degree. Notably, a significant 81.5% of the nurses reported poor sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), with an overall mean score of 10.55 indicating poor sleep. The study highlighted that poor sleep quality among nurses was linked to being female, being married, and not exercising regularly. Better sleep was associated with nurses who manage fewer patients per shift and have adequate monthly income.

Conclusion

The prevalence of poor sleep quality among Emergency nurses during the COVID-19 pandemic is high. There is a pressing need for targeted interventions to enhance sleep quality among ED nurses. Improving sleep quality is not only essential for the wellbeing of these nurses but is also likely to contribute to better patient care.

Poor sleep quality and associated factors among adult chronic kidney disease patients

Background

Poor sleep quality is a common concern in chronic kidney disease (CKD) patients, which can accelerate the progression of chronic renal disease and negatively impact their health-related quality of life, potentially leading to greater morbidity and mortality rates. It can also have an effect on the immune system, cognitive function, and emotional well-being of CKD patients. Furthermore, poor sleep quality may contribute to drug noncompliance and decreased participation in the entire treatment plan. Nonetheless, no research has been undertaken in Ethiopia on the prevalence of poor sleep quality and its associated factors among CKD patients.

Objective

This study aimed to assess the prevalence of poor quality of sleep and associated factors among chronic kidney disease patients at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals in 2020.

Methods

A cross-sectional study design was implemented at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals between February and April 2020. The study participants were chosen through systematic random sampling techniques. The Pittsburgh Sleep Quality Index (PSQI), a validated assessment tool, was utilized to measure sleep quality. A PSQI total score > 5 was used as an indicator of poor sleep quality. Subsequently, the data obtained were entered into Epi Data version 3.0 and then transferred to STATA 14 for analysis. Both bivariable and multivariable binary logistic regression analyses were performed to recognize factors associated with poor sleep quality. In the multivariable logistic regression analysis, variables demonstrating a p-value of ≤0.05 were considered statistically associated to poor sleep quality.

Results

In this study, 424 CKD patients were included. Among screened CKD patients, 42.9% tested positive for poor sleep quality with a 95% CI (38 to 47%). Independent predictors of poor sleep quality among CKD patients were common mental disorder [AOR = 1.8, 95% CI (1.19-2.89)], anemia [AOR = 2.7, 95% CI (1.71-4.36)], declined eGFR between 60 and 89.9 [AOR = 1.6; 95% CI (2.28-5.54)], 30-59.9 [AOR = 2.6, 95% CI (1.53-4.43)], and ≤ 30 [AOR = 3.8, 95% CI (1.17-12.61)], age > 50 years [AOR = 1.7(1.11-2.69)] and duration of disease 2.9 [AOR = 2.9, 95% CI (1.77-4.90)].

Conclusion

In our study, almost 1 out of 2 CKD patients assessed for poor sleep quality tested positive. It was noted that poor sleep quality was more frequent among CKD patients with common mental disorders, anemia, decreased eGFR levels, individuals aged over 50 years, and those with a longer duration of the disease. Consequently, it's advised to regularly screen these CKD patients for poor sleep quality.

The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: a cross-sectional correlational design

Background

Patients on hemodialysis (HD) are more likely to experience sleep problems and fatigue that may affect their health outcomes. Management of these patients with social support may improve their sleep quality and fatigue as well as their health.

Aim

This study aimed to assess the influence of social support on sleep quality and fatigue levels among HD patients.

Methods

A cross-correlational study was conducted among 260 conveniently sampled HD patients from four dialysis centers in Hail and Al-Qassim cities of Saudi Arabia from Jun 2022 to January 2023. Besides sociodemographic data, the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF) and the Oslo Social Support Scale (OSSS-3) were used to assess sleep quality, fatigue levels and social support, respectively. Chi-square test was used to determine the association between categorical variables, while Pearson's correlation coefficient was used to test the correlation between sleep quality, fatigue, and social support.

Results

Poor sleep and high fatigue were significantly higher in older patients compared to younger patients (p <0.001), while strong social support was significantly lower in older patients than younger and middle-aged ones (p = 0.001). On the other hand, poor sleep and high fatigue were significantly higher in males than females (p = 0.022 and p <0.001, respectively), while strong social support was significantly higher in females than males (p <0.001). Married patients showed significantly poorer sleep than single ones (p = 0.019), but single patients received significantly stronger social support. Retired patients showed significantly poorer sleep, higher fatigue and weaker social support than other groups (p <0.001). There was a significant negative correlation between fatigue and sleep quality among HD patients, where patients with more fatigue had poorer sleep (r = -0.510, p <0.001). A significant positive correlation was found between social support and sleep quality, where patients with stronger social support had more normal sleep (r = 0.415, p <0.001). However, a significant negative correlation was found between social support and fatigue, where patients with stronger social support had lower levels of fatigue (r = -0.479, p <0.001).

Conclusion

Saudi patients on HD who have stronger social support have better sleep quality and reduced fatigue levels than those with less social support. There is a need to design and implement intervention studies with structured social support programs, and to evaluate their effectiveness on improving sleep and reducing fatigue among HD patients.