The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Wei, Cheng‐Yu; Chung, Tieh-Chi; Wu, Shu-Chun; Chung, Chian-Fang; Wu, Wen-Pyng

doi:10.3109/0886022x.2010.541578

Cited by 17 publications

(11 citation statements)

References 39 publications

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“…It seemed to be caused by impairment of the cardiovascular autonomic control characterized by withdrawal in parasympathetic modulation and predominance in sympathetic tone (28). As in previous studies (17)(18)(19)(20)(29)(30)(31)(32)(33), our results showed that stage 5 CKD patients exhibited a marked reduction in HRV indices relative to age-and sex-matched controls, indicating that sympathetic hyperactivity may play an important role in increasing the risk of CVD among ESRD patients.…”

Section: Discussionsupporting

confidence: 73%

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Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Zhang

Sun

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Lower heart rate variability implies increased risk of cardiovascular disease. This study aimed to evaluate the relationship between mineral metabolism and heart rate variability and longitudinal changes of heart rate variability after parathyroidectomy in stage 5 CKD patients.Design, setting, participants, & measurements This cross-sectional study included 118 stage 5 CKD patients, 87 controls, and a prospective study in two subgroups classified as successful (n=17) and unsuccessful (n=4) parathyroidectomy follow-up enrolled from March of 2011 to December of 2012. Blood examination and 24-hour Holter for heart rate variability were measured.Results Most heart rate variability indices were lower in stage 5 CKD patients. In multivariate stepwise regression models, serum intact parathyroid hormone was correlated with mean normal-to-normal R-R intervals, mean heart rate, and very low frequency, serum calcium was correlated with SD of 5-minute average of normal R-R intervals, and serum phosphorus was correlated with very low frequency and low frequency/high frequency. Compared with baseline, the successful parathyroidectomy subgroup had significant improvements in mean normal-to-normal R-R intervals, mean heart rate, SD of normal-to-normal R-R intervals, SD of 5-minute average of normal R-R intervals, very low frequency, high frequency, and low frequency/high frequency. There was no significant change of heart rate variability in patients after unsuccessful parathyroidectomy.Conclusions Disorders of mineral metabolism are associated with decreased heart rate variability in stage 5 CKD. Successful parathyroidectomy may contribute to reverse this cardiovascular disease risk in severe secondary hyperparathyroidism patients.

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Section: Discussionsupporting

confidence: 73%

“…Previous studies have shown a marked reduction of HRV indices in ESRD patients (17)(18)(19)(20). To our knowledge, few studies have evaluated the correlation between SHPT and HRV in ESRD patients.…”

Section: Introductionmentioning

confidence: 98%

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Zhang

Sun

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…We found no relationship between the ESS value and HR or HRV measurements; previous studies in other populations also found little relation. 54 , 55 Sleep quality scores, referring to the night of PSG specifically, showed only very small correlations, being inversely related to the mean HR in wake ( R =−0.13) and the percentage HR dipping ( R =−0.12). The former relation is plausible, if perhaps higher HR during wake reflects a form of hyperarousal that influences the perception of sleep quality.…”

Section: Discussionmentioning

confidence: 99%

Heart rate phenotypes and clinical correlates in a large cohort of adults without sleep apnea

Huang¹,

Goparaju²,

Chen³

et al. 2018

NSS

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BackgroundNormal sleep is associated with typical physiological changes in both the central and autonomic nervous systems. In particular, nocturnal blood pressure dipping has emerged as a strong marker of normal sleep physiology, whereas the absence of dipping or reverse dipping has been associated with cardiovascular risk. However, nocturnal blood pressure is not measured commonly in clinical practice. Heart rate (HR) dipping in sleep may be a similar important marker and is measured routinely in at-home and in-laboratory sleep testing.MethodsWe performed a retrospective cross-sectional analysis of diagnostic polysomnography in a clinically heterogeneous cohort of n=1047 adults without sleep apnea.ResultsWe found that almost half of the cohort showed an increased HR in stable nonrapid eye movement sleep (NREM) compared to wake, while only 13.5% showed a reduced NREM HR of at least 10% relative to wake. The strongest correlates of HR dipping were younger age and male sex, whereas the periodic limb movement index (PLMI), sleep quality, and Epworth Sleepiness Scale (ESS) scores were not correlated with HR dipping. PLMI was however significantly correlated with metrics of impaired HR variability (HRV): increased low-frequency power and reduced high-frequency power. HRV metrics were unrelated to sleep quality or the ESS value. Following the work of Vgontzas et al, we also analyzed the sub-cohort with insomnia symptoms and short objective sleep duration. Interestingly, the sleep–wake stage-specific HR values depended upon insomnia symptoms more than sleep duration.ConclusionWhile our work demonstrates heterogeneity in cardiac metrics (HR and HRV), the population analysis suggests that pathological signatures of HR (nondipping and elevation) are common even in this cohort selected for the absence of sleep apnea. Future prospective work in clinical populations will further inform risk stratification and set the stage for testing interventions.

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“…The auricular branch of the vagus nerve links the acupressure stimulation and vagal regulation. AAT might trigger vagal regulation and correct the overactivity of sympathetic nerves which plays a crucial role in chronic hemodialysis patients with insomnia [ 20 ]. Therefore, auricular acupressure might be effective in improving sleep quality for hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Auricular acupressure for insomnia in hemodialysis patients: study protocol for a randomized controlled trial

Yang

et al. 2018

Trials

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BackgroundPatients on maintenance hemodialysis (MHD) frequently complain of insomnia. Poor sleep quality impairs their quality of life and adversely affects long-term outcome. Previously we applied auricular acupressure therapy (AAT) for MHD patients with insomnia and yielded favorable results. AAT probably improves sleep quality by stimulating the vagus nerve and inhibiting sympathetic overactivity. However, the efficacy of AAT for insomnia in this population is still lacking. The proposed randomized controlled trial (RCT) will evaluate the efficacy and safety of AAT for improvement of sleep quality in MHD patients with insomnia.Methods/designThe proposed study is a multi-center, double-blind (participants and assessors), parallel-group RCT. A total of 112 participants with insomnia will be recruited from six hemodialysis centers in Guangzhou, China, and randomly allocated in a 1:1 ratio to receive auricular acupressure on either active points (AA group) or control points (points irrelevant to insomnia management, SAA group). The treatment will last for 8 weeks prior to a follow-up period of 12 weeks. Evaluation by blinded assessors at baseline, at 8 weeks (end of treatment) as well as at 4-week, 8-week and 12-week follow-ups (after intervention) will include Pittsburgh Sleep Quality Index (PSQI) scores and average weekly dose of hypnotics. The primary endpoint is clinical response rate (percentage of participants who reach a reduction of PSQI global score ≥ 3 in each group) at 8 weeks from baseline. Secondary endpoints include the changes in PSQI scores over time from baseline, as well as the changes in weekly dose of hypnotics.DiscussionThis paper describes the rationale and design of a double-blind RCT that aims to determine the efficacy and safety of AAT for insomnia of hemodialysis patients. If successful, this project will provide evidence of the efficacy and safety of AAT for insomnia of hemodialysis patients.Trial registrationClinicalTrials.gov, Identifier: NCT03015766. Registered on 22 December 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2546-2) contains supplementary material, which is available to authorized users.

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The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Cited by 17 publications

References 39 publications

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Heart rate phenotypes and clinical correlates in a large cohort of adults without sleep apnea

Auricular acupressure for insomnia in hemodialysis patients: study protocol for a randomized controlled trial

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