Factors Associated With Insomnia in Patients Undergoing Hemodialysis

Abstract

Introduction: Insomnia is the most common sleep disorder among patients on hemodialysis and has a strong relation with fatigue, depression, low immune system, increased risk of cardiovascular problems, and low quality of life. The aim of this study was to explore the factors associated with insomnia in patients undergoing hemodialysis.Methods: In this cross-sectional study, 100 patients on hemodialysis (75 males and 25 females) from a hemodialysis center in Greece were included. Insomnia was assessed via the "Athens Insomnia Scale (AIS)" and a questionnaire about demographic and clinical characteristics. The Kruskal-Wallis, Mann-Whitney tests, and Spearman's rho criterion were used to evaluate the association between insomnia score and patients' characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' insomnia.Results: Statistically significantly high levels of insomnia were found in patients over the age of 60 years (p = 0.002), in divorced/widowed patients (p = 0.007), in patients who had comorbid diseases (p = 0.001), in patients who felt tired after hemodialysis (p = 0.001), in those who had continuous fatigue (p = 0.001) and change in body image (p = 0.003), in those who often had itching (p = 0.007) and stiffness in joints (p = 0.001) and in patients who had limitations in the clothes they could wear (p = 0.001).Conclusions: The findings of this study showed that insomnia had a strong association with increased age of patients, comorbidities, fatigue, change in body appearance, pruritus, and limitation in clothes they could wear. Therefore, there is a necessity for early assessment of sleep quality and effective treatment of sleep disorders in hemodialysis patients in order to reduce morbidity and mortality and improve the quality of their life.

Factors Associated With Fatigue in Patients Undergoing Hemodialysis

“…The present study also found that patients who had insomnia had statistically significantly high levels of physical or mental fatigue. These findings are in line with those of a previous study [ 27 ]. It can be assumed that sleep disorders have a strong relationship with fatigue since they lead to daytime sleepiness, poor concentration, and increased levels of inflammatory cytokines in patients’ blood [ 10 ].…”

Depression Among Hemodialysis Patients: Related Factors and the Impact of Insomnia and Fatigue

“…This study also showed that an increase in physical or mental fatigue and an increase in insomnia score indicated an increase in depression levels. Insomnia causes daytime sleepiness and lack of energy, which is regarded as a significant factor for fatigue [ 6 ]. It can be assumed that lack of energy leads to low physical well-being and social isolation, increasing depressive disorders in dialysis patients [ 13 ].…”

“…Moreover, depression is strongly associated with insomnia and fatigue in hemodialysis patients [ 6 ]. More specifically, patients with insomnia have difficulty initiating and maintaining regular sleep while they have tiredness, lack of energy during the day, and increased fatigue [ 6 ].…”

“…Moreover, depression is strongly associated with insomnia and fatigue in hemodialysis patients [ 6 ]. More specifically, patients with insomnia have difficulty initiating and maintaining regular sleep while they have tiredness, lack of energy during the day, and increased fatigue [ 6 ]. Increased fatigue leads to low levels of physical activity, general muscle weakness, and lack of concentration, which negatively affect patients’ ability to work, take care of their families, and achieve personal goals, leading to emotional problems and depressive disorders [ 7 ].…”

Factors Affecting Pain in Hemodialysis and Non-pharmacological Management

“…Additionally, inadequate pain management can cause sleep disturbances and reduced adherence to hemodialysis treatment [ 8 , 4 ]. Chronic pain is associated with frequent hospital admissions, decreased quality of life, and high mortality rates [ 1 , 12 ]. It has been found that a significant proportion of dialysis people have increased pain, both during dialysis and non-dialysis days [ 13 ].…”