A Novel Application of a Biopsychosocial Theory in the Understanding of Disturbed Sleep before and after Kidney Transplantation

Abstract

Study Objectives: Sleep and fatigue difficulties appear to be highly prevalent among individuals with end-stage renal disease and individuals who have received a kidney transplant. While there is some evidence of biopsychosocial factors predicting sleep disturbance in these populations, previous studies have relied on single time point retrospective measurements. Methods: The study utilized a 2-week prospective measurement approach, including one night of polysomnographic measurement, nightly sleep diaries, and self-report measures of health, sleep, and mood. Results: The current study demonstrates that a number of psychological and behavioral factors, including negative mood, quality of life, napping, and caffeine consumption, are related to sleep disturbance among pre-and post-kidney transplant patients. This study also found that many of these factors have different relationships with sleep disturbance when comparing pre-and post-kidney transplant patients. Conclusions: These results suggest that such factors may be worthwhile areas for intervention in treating the symptoms of insomnia among pre-and posttransplant recipients. A nuanced approach to understanding sleep problems is likely warranted when conceptualizing insomnia and developing a treatment plan. I NTRO DUCTI O NSleep complaints are common among individuals with endstage renal disease (ESRD) and patients who have received kidney transplantation (KTX).1-6 While on dialysis, patients report that sleep disturbance is one of their most prominent symptom complaints.1 Compared to dialysis, kidney transplantation is considered the treatment of choice for ESRD due to longer patient survival, fewer morbidities, and better quality of life. Unfortunately, little is known about the relationship between ESRD and sleep or the impact of KTX on that relationship. The research that does exist suggests that the rates of common sleep disorders including insomnia (50% to 75% v 9%), restless legs syndrome (30% to 80% v 5% to 15%), and sleep apnea (~24%), are higher in ESRD than in the general population, and ESRD patients are also at risk for more severe sleep apnea.2-7 The rates of these disorders tend to decrease following KTX (expect apnea), but nonetheless remain elevated compared to normative estimates.8 While considerable research has focused on predictors of sleep apnea and restless legs syndrome (RLS), relatively little research has focused on insomnia in these populations. Additionally, due to a reliance on cross-sectional designs and retrospective assessment of insomnia, previous research has been unable to provide greater insights into sleep's relationships with ESRD. Previous research has been largely atheoretical and has examined insomnia in relative isolation without consideration of important biopsychosocial relationships that may be relevant in the context of ESRD and KTX. Biopsychosocial Correlates of Sleep and End-Stage Renal DiseaseThere are several biopsychosocial factors which have been found to be associated with ESRD including age, sex, medical ...

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