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Am J Kidney Dis. 2006 Aug;48(2):277-84.

Sleep behavior disorders in a large cohort of chinese (Taiwanese) patients maintained by long-term hemodialysis.

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An Hsin Chia-Yi Clinic.



Disorders of sleep behavior and sleep-related breathing disorders are common in hemodialysis patients. Most such evidence is based on studies involving small numbers of patients.


We undertook a large multicenter analysis of sleep behavior in more than 700 Taiwanese patients on maintenance hemodialysis therapy for 6 months to 20-plus years by using self-administered questionnaires: the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for risk for sleep apnea, validated for the general population. Patients also completed a questionnaire to assess symptoms related to restless legs and periodic limb movements (PLMs). Sleep behavior was analyzed in relation to demographic and dialysis-related parameters provided by the participating dialysis centers.


Sleep disturbance was very common in this cohort, with problems of insomnia (66.6%) exceeding those related to daytime sleepiness (17.8%). Sleep disturbances were associated with restless legs syndrome (RLS)/PLM and a high risk for sleep apnea, determined by using the Berlin Questionnaire. Older age increased the odds of daytime sleepiness, but not insomnia. Lower dialysis dose (single-pool Kt/V) increased the likelihood of daytime sleepiness and was associated with greater rates for RLS/PLM and risk for sleep apnea. Use of antihypertensive medications (a probable surrogate for more severe hypertension) was associated strongly with high risk for sleep apnea. Smoking was associated with RLS/PLM and risk for sleep apnea, whereas consumption of stimulant beverages (coffee and tea) had contrary effects on RLS/PLM and risk for sleep apnea and were not implicated in measures of insomnia or daytime sleepiness. A greater likelihood of insomnia for greater hemoglobin levels and greater likelihood of daytime sleepiness for patients administered vitamin D analogues were not explained by the available data.


Sleep disorders and sleep-related breathing disorders are common in hemodialysis patients. Greater attention in the care of dialysis patients needs to be directed to the diagnosis and management of sleep disorders.

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