title: Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia.
abstract: BACKGROUND
  Many patients with end-stage renal disease who are undergoing chronic hemodialysis suffer from sleep disturbance. This paper was designed to study the severity and prevalence of sleep disorders and the factors affecting the syndromes in this unique patient group.
  
  
  METHODS
  We conducted this study by the use of questionnaires. Included in this study were a total of 245 patients at our center who had end-stage renal disease (ESRD) and who received hemodialysis thrice weekly for more than three months. Their demographic data and biochemical and hematologic parameters were analyzed. All patients were asked to complete two questionnaires (in a Chinese version) of the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory second edition (BDI-II), either by themselves or with assistance from the medical staff.
  
  
  RESULTS
  One hundred and sixty-four patients completed both questionnaires with a response rate of 70.4%. Their mean age was 57.9 +/- 11.8 (ranging from 23.1 to 83.7) years old. They had been receiving hemodialysis for an average of 49.1 +/- 50.9 months before the study. The male to female ratio was 77:87. Seventy six (46.3%) patients had diabetes mellitus. The prevalence of sleep disturbance was 74.4% (122/164), defined as PSQI scores >5. The poor sleepers had higher BDI scores and a higher ratio of females comparing to the good sleepers. By a multivariate analysis, the BDI scores and female sex were the independent predictors of the patients being poor sleepers. In analyzing the poor sleepers, the BDI scores, durations of hemodialysis and hemoglobin levels were the independent factors for predicting the global PSQI scores.
  
  
  CONCLUSIONS
  The questionnaire showed a high prevalence of insomnia in the dialytic population. The study also attributes a predictive role in sleep quality to gender, depression, dialytic duration, and hemoglobin levels. The data indicate that in the management of insomnia in this patient group, anemia and depression, both of which are potentially correctable, should be assessed.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Tai-I
authors.initials: TI
authors.lastname: Ho
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology*; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires