Association between restless legs syndrome and depression in patients with chronic kidney disease

Szentkirályi, András; Molnar, Miklos Z.; Czira, Maria E.; Deák, György; Lindner, Anett; Szeifert, Lilla; Torzsa, Péter; Vámos, Eszter; Zoller, Rezső; Mucsi, István; Novák, Márta

doi:10.1016/j.jpsychores.2009.05.004

Cited by 57 publications

(38 citation statements)

References 43 publications

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“…Some recent studies among patients with ESRD have demonstrated an association between poor sleep and depression, but have been limited by both small sample sizes and limited ability to adjust for potential confounders [39,40,41,42]. Other recent work in the Hungarian kidney transplant and dialysis population has demonstrated significant correlations between sleep and depressive symptoms [43,44]. Restless legs syndrome was associated with a high prevalence of depressive symptoms and diminished quality of life in a large sample of transplanted and waitlisted patients [44].…”

Section: Discussionmentioning

confidence: 99%

Impact of Sleep Quality on Cardiovascular Outcomes in Hemodialysis Patients: Results from the Frequent Hemodialysis Network Study

et al. 2011

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Background: Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients. Methods: Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality. Results: The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001). Conclusion: These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Impact of Sleep Quality on Cardiovascular Outcomes in Hemodialysis Patients: Results from the Frequent Hemodialysis Network Study

et al. 2011

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“…45 The original instrument was used in an epidemiologic survey 46 and the Hungarian version was used in our earlier studies involving different populations with CKD. [47][48][49] Comorbidity was assessed by the modified Charlson Comorbidity Index 50 completed by the main responsible transplant physician of the participant. Information about medication use was obtained from the questionnaires and the medical charts.…”

Section: Assessment Of Insomnia Restless Legs Syndrome and Comorbidmentioning

confidence: 99%

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

Rónai

Szentkirályi

Lázár

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Both depression and sleep complaints are very prevalent among kidney transplant (kTx) recipients. However, details of the complex relationship between sleep and depression in this population are not well documented. Thus, we investigated the association between depressive symptoms and sleep macrostructure parameters among prevalent kTx recipients. Methods: Ninety-five kTx recipients participated in the study (54 males, mean ± standard devation age 51 ± 13 years, body mass index 26 ± 4 kg/m 2 , estimated glomerular filtration rate 53 ± 19 ml/min/1.73 m 2 ). Symptoms of depression were assessed by the Center for Epidemiologic Studies -Depression Scale (CES-D). After 1-night polysomnography each recording was visually scored and sleep macrostructure was analyzed. Results: The CES-D score was significantly associated with the amount of stage 2 sleep (r = 0.20, P < .05), rapid eye movement (REM) latency (r = 0.21, P < .05) and REM percentage (r = −0.24, P < .05), but not with the amount of slow wave sleep (r = −0.12, P > .05). In multivariable linear regression models the CES-D score was independently associated with the amount of stage 2 sleep (β: 0.205; confidence interval: 0.001-0.409; P = .05) and REM latency (β: 0.234; confidence interval: 0.001-0.468; P = .05) after adjustment for potential confounders. I NTRO DUCTI O NDepression is one of the most prevalent mental health conditions in patients with chronic kidney disease (CKD) [1][2][3][4] ; furthermore, it is an important determinant of impaired quality of life. 5,6 Among kidney transplant (kTx) recipients, depression is associated with reduced adherence and also with increased morbidity, graft loss, and mortality. [7][8][9][10][11][12][13] Poor sleep and various sleep problems are also frequent complaints among kTx recipients.14,15 Earlier we reported that chronic insomnia was independently associated with the presence of depression in kTx recipients. 16 In the general population there is a strong and bidirectional relationship between depression and sleep.17 This is also reflected in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition definition of major depression (MD), 18 as sleep complaints are core symptoms of MD. Several objective sleep parameters are different in patients with MD than in healthy control patients. Patients with MD have decreased amounts of slow wave sleep (SWS) and shortened rapid eye movement (REM) latency with increased amounts of REM sleep. The exact mechanisms and factors that may link depression to poor clinical outcomes among kTx recipients are not yet well defined. In a recent review focusing on kTx and depression, 23 sleep is not mentioned. This may be due to the complete lack of polysomnography (PSG) studies that assess the association between sleep and depression in this population. The frequent co-occurrence of subjective sleep complaints and depression among kTx recipients 16 suggests that the relationship between the two conditions may be similar to the association described in the g...

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“…One focused on kidney transplant recipients and dialyzed patients on transplantation waiting list. 18 The other one included CKD patients in different stages, with and without dialysis. 19 In the dialysis studies, 29 studies were in hemodialysis (HD) setting, and three studies were in peritoneal dialysis (PD) setting.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three of these studies were from the Transplantation and Quality of Life-Hungary Study (TransQoL-HU Study), a cross-sectional study focusing on investigating sleep, mood disorders, and quality of life. 18,22,23 In the setting of dialysis, the prevalence of RLS in individual studies ranged from 6.6 to 69.8%, and the pooled prevalence was 28.4% (95%CI, 24.6-32.6) Table 4 depicts the univariate meta-regression analyses. As shown in the table, serum iron, blood urea nitrogen (BUN), creatinine, and complication (peripheral neuropathy) did not modify the estimate of prevalence.…”

Section: Prevalencementioning

confidence: 99%

Prevalence of restless legs syndrome in chronic kidney disease: a systematic review and meta-analysis of observational studies

et al. 2016

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Introduction: Nowadays prevalence of restless legs syndrome (RLS) in chronic kidney disease (CKD) patients was reported in many studies, while the results varied. The aim of our study was to investigate the prevalence of RLS in this population, considering different data collecting measures and diagnostic criteria. Methods: MEDLINE, Embase, PsycINFO, and Scopus databases were searched for relevant studies. We limited the analyses to studies using clinical interview or questionnaire for diagnosis. Univariate meta-regression analysis was preformed to assess the effects of the disease-related covariates on prevalence estimates. Comprehensive Meta-Analysis 2.0 was used to perform the meta-analysis. Results: Fifty-one studies were included in the analysis. Prevalence of RLS was varied by renal function and diagnostic methods. Overall prevalence in CKD populations was 24.2% (95%CI, 20.1-28.7). Pooled prevalence of RLS was higher in patients diagnosed by questionnaire than by clinical interview [26.2% (95%CI, 17.9-36.5) vs. 23.6% (95%CI, 19.6-28.1)]. When grouped by CKD setting, the prevalence was 28.4% (95%CI, 24.6-32.6) in dialysis patients, followed by early stages patients [9.9% (95%CI, 5.4-17.5)], and kidney transplant recipients [6.7% (95%CI, 5.6-7.8)]. Conclusions: Our meta-analysis suggested that more than one-quarter of CKD sufferers, especially those who were on dialysis, were plagued by RLS. Higher sensitivity of diagnostic criteria in interview may be valuable for timely treatment.

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Association between restless legs syndrome and depression in patients with chronic kidney disease

Cited by 57 publications

References 43 publications

Impact of Sleep Quality on Cardiovascular Outcomes in Hemodialysis Patients: Results from the Frequent Hemodialysis Network Study

Impact of Sleep Quality on Cardiovascular Outcomes in Hemodialysis Patients: Results from the Frequent Hemodialysis Network Study

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients

Prevalence of restless legs syndrome in chronic kidney disease: a systematic review and meta-analysis of observational studies

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