title: Parathyroidectomy improves the quality of sleep in maintenance hemodialysis patients with severe hyperparathyroidism.
abstract: Sleeping disorders are very common in patients with chronic kidney disease on dialysis (CKD5D) and are an emerging risk factor able to predict mortality. Parathyroid hormone (PTH) although considered a pivotal uremic toxin has rarely been associated with sleep disorders in uremia. In a study from our laboratory PTH concentrations failed to distinguish patients with sleep disorders from those without. In a study performed by Chou et al a 97% prevalence of insomnia was found in patients undergoing hemodialysis requiring parathyroidectomy. Surgery reduced PTH and increased sleeping hours within 3 months. The aim of this study was to study the effects of parathyroidectomy on the sleep disorders of insomniacs on maintenance hemodialysis. The study was performed in 16 insomniac patients on maintenance hemodialysis who successfully underwent surgery with autotransplantation of autologous parathyroid tissue (40 mg) under the skin of the forearm. Patients (5 F and 11 M) were studied from 1 month before surgery to 1 year after. Sleep disorders were assessed by means of a 27-item questionnaire--Sleep Disorder questionnaire (SDQ)--that identified sleeping disorders according to Diagnostic and Statistical Manual of Mental Disorders - IV Edition (DSM-IV) criteria. The Charlson Comorbidity Index (CCI) was also measured along with systolic and diastolic blood pressure, Hb, PTH, Ca, P. A 95.5% prevalence of sleep disorders was found pre operatively. Patients slept 4.90+/-1.2 hours, Ca averaged 10.09+/-0.54 mg/dL, Phosphate 5.5+/-1.93, CCI 9.8+/-1.1, PTH 1498+/-498 ng/mL. After 1 year follow-up 2 out 16 patients had normal sleep, 6 out 16 patients had subclinical sleep disorders and 8 remained insomniacs (p=0.008, Mc Nemar Test for paired data, insomniacs vs. no disturbance + subclinical disorders). Sleeping hours increased up to 6.0+/-1.24 (p<0.05), PTH was normalized, the Charlson Comorbidity Index was reduced (p<0.05) as were plasma calcium and phosphate (p<0.01). The study indicates that insomnia in patients with severe hyperparathyroidism on maintenance hemodialysis is ameliorated by parathyroidectomy.
authors.affiliation: Division of Endocrine Surgery, Second University of Naples, Naples, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Esposito
authors.forename: Concetta Maria
authors.initials: CM
authors.lastname: Cesare
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: De Santo
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cice
authors.forename: Alessandra F
authors.initials: AF
authors.lastname: Perna
authors.forename: Eleonora
authors.initials: E
authors.lastname: Violetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Bilancio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Celsi
authors.forename: Filomena
authors.initials: F
authors.lastname: Annunziata
authors.forename: Simona
authors.initials: S
authors.lastname: Iannelli
authors.forename: Natale G
authors.initials: NG
authors.lastname: De Santo
authors.forename: Massimo
authors.initials: M
authors.lastname: Cirillo
authors.forename: Antonio
authors.initials: A
authors.lastname: Livrea
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001794:Blood Pressure; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012720:Severity of Illness Index; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium