Predialysis volume overload and patient‐reported sleep duration and quality in patients receiving hemodialysis

Abreo, Andrew; Dalrymple, Lorien S.; Chertow, Glenn M.; Kaysen, George A.; Herzog, Charles A.; Johansen, Kirsten L.

doi:10.1111/hdi.12446

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…Other disorders with potential for volume overload such as end‐stage renal disease have found self‐reported fatigue to be associated with an extracellular water excess 37 . Similarly, increased volume status was associated with fewer hours of sleep and more frequent nighttime awakenings in dialysis patients 38 . Elevated right atrial pressures appear to coincide with an increase in dyspnea, fatigue, and sleep disturbance in PAH, which could be explained by cardiorenal or cardiohepatic syndromes.…”

Section: Discussionmentioning

confidence: 96%

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Symptom phenotypes in pulmonary arterial hypertension: The PAH “symptome”

et al. 2022

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Women with pulmonary arterial hypertension (PAH) experience multiple symptoms, including dyspnea, fatigue, and sleep disturbance, that impair their health-related quality of life (HRQOL). However, we know little about phenotypic subgroups of patients with PAH with similar, concurrent, multiple symptoms. The objectives of this study were to define the "symptome" by symptom cluster phenotypes and compare characteristics such as biomarkers, cardiac structure and function (echocardiography), functional capacity (6-min walk distance), and HRQOL between the groups. This cross-sectional study included 60 women with PAH. Subjects completed an assessment battery: Pulmonary Arterial Hypertension Symptom Scale, Pittsburgh Sleep Quality Index, Multidimensional Dyspnea Profile, Patient-Reported Outcomes Measurement Information System (PROMIS®) Physical Function, PROMIS® Sleep-Related Impairment, and the emPHasis-10. Subjects also underwent transthoracic echocardiography, phlebotomy, 6-min walk distance, and actigraphy. The three symptoms of dyspnea, fatigue, and sleep disturbance were used to define the symptom clusters. Other PAH symptoms, plasma and serum biomarkers, cardiac structure and function (echocardiography), exercise capacity (6-min walk distance), sleep (actigraphy), and HRQOL were compared across phenotypes. The mean age was 50 ± 18 years, 51% were non-Hispanic white, 32% were non-Hispanic Black and 40% had idiopathic PAH.Cluster analysis identified Mild (n = 28, 47%), Moderate (n = 20, 33%), and Severe Symptom Cluster Phenotypes (n = 12, 20%). There were no differences for age, race, or PAH etiology between the phenotypes. WHO functional class (p < 0.001), norepinephrine levels (p = 0.029), right atrial pressure (p = 0.001), physical function (p < 0.001), sleep onset latency (p = 0.040), and HRQOL (p < 0.001) all differed significantly across phenotypes. We identified three

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Section: Discussionmentioning

confidence: 96%

“…37 Similarly, increased volume status was associated with fewer hours of sleep and more frequent nighttime awakenings in dialysis patients. 38 Elevated right atrial pressures appear to coincide with an increase in dyspnea, fatigue, and sleep disturbance in PAH, which could be explained by cardiorenal or cardiohepatic syndromes.…”

Section: Discussionmentioning

confidence: 99%

Symptom phenotypes in pulmonary arterial hypertension: The PAH “symptome”

et al. 2022

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“…In contrast to OSA, only one previous study has examined the relationship between volume overload and sleep quality of the HD population. Abreo and his colleagues [10] reported a negative association between the predialysis volume status measured through BIA and the sleep duration of HD patients. However, a causal relationship was not confirmed, since no intervention was performed.…”

Section: Discussionmentioning

confidence: 99%

“…A previously conducted study reported an improvement regarding sleep apnoea with the help of nocturnal HD [9], which places emphasis on the role played by excess fluid in case of sleep disorders. Furthermore, a recent study reported that an increase in predialysis volume status measured with bioelectrical impedance analysis (BIA) was associated with fewer hours of sleep [10], which leads to the concept of sleep quality improvement with better volume control in chronic HD patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of bioelectrical impedance analysis-guided dry weight adjustment, in comparison to standard clinical-guided, on the sleep quality of chronic haemodialysis patients (BEDTIME study): a randomised controlled trial

et al. 2019

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Background Sleep disturbance is common among chronic haemodialysis patients, which leads to poor quality of life, in addition to increased instances of morbidity and mortality. Hypervolemia has been linked to sleep problems observed in chronic haemodialysis patients, which suggests that optimising one’s fluid status could improve the sleep quality of this patient group. In our study, we subjectively examined and objectively measured sleep parameters, using actigraphy recordings, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and Epworth Sleepiness Scale (ESS), in order to compare bioelectrical impedance analysis (BIA)-guided and standard clinical-guided dry weight adjustment. Methods We randomly selected 19 chronic haemodialysis patients with subclinical hypervolemia, defined as a clinically euvolemic status, despite the ratio of extracellular water to total body water being more than 0.4 in BIA. Furthermore, these patients, who were poor sleepers (PSQI > 5), were assigned to either a BIA-guided dry weight group (BIA group) or a standard clinical-guided one (clinical group). The primary outcome was changes in sleep actigraphy parameters between the groups at 1, 3, and 6 months. Changes observed in the PSQI and ESS score between the two groups over the same period of time were the secondary endpoints. Results The mean age of the participants was 63.53 ± 11.12 years, and 42% of them were male. All sleep parameters measured by means of actigraphy were not significantly different between the two groups. Interestingly, at 3 and 6 months, the subjective sleep quality significantly improved in the BIA group, as reflected by a greater decline in the PSQI score, in comparison with the clinical group (3 months: mean difference − 1.82 [− 3.13 to − 0.51], P = 0.006; 6 months: mean difference − 3.16 [− 4.49 to − 1.83], P < 0.001). However, sleepiness assessed by the ESS was not significantly different between the groups throughout the study. Conclusions Optimisation of the fluid status by employing BIA did not improves sleep actigraphy parameter, however, it significantly ameliorates the subjective sleep quality of chronic haemodialysis patients. This observation should be further explored in larger samples and longer clinical trials. Trial registration This trial was registered at ClinicalTrials.gov ( NCT02825589 ) on July 7, 2016. Electronic supplementary material The online version of this article (10.1186/s12882-019-1405-z) contains supplementary material, which is available to authorized users.

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“…A study of 638 HD patients found that both mild ( N = 149) and substantial ( N = 337) volume overload by bioimpedence were associated with an adjusted 1.9 fold higher risk of frequent nighttime awakenings as well as fewer hours of sleep …”

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confidence: 99%