Cognitive-behavioral therapy for sleep disturbance in patients undergoing peritoneal dialysis: a pilot randomized controlled trial.
BACKGROUND
Greater than 50% of dialysis patients experience sleep disturbances. Cognitive-behavioral therapy (CBT) is effective for treating chronic insomnia, but its effectiveness has never been reported in peritoneal dialysis (PD) patients and its association with cytokines is unknown. We investigated the effectiveness of CBT in PD patients by assessing changes in sleep quality and inflammatory cytokines.


METHODS
Randomized control study with parallel-group design.


METHODS
24 PD patients with insomnia in a tertiary medical center without active medical and psychiatric illness were enrolled.


METHODS
The intervention group (N = 13) received CBT from a psychiatrist for 4 weeks and sleep hygiene education, whereas the control group (N = 11) received only sleep hygiene education.


METHODS
Primary outcomes were changes in the Pittsburgh Sleep Quality Index and Fatigue Severity Scale scores, and secondary outcomes were changes in serum interleukin 6 (IL-6), IL-1beta, IL-18, and tumor necrosis factor alpha levels during the 4-week trial.


RESULTS
Median percentages of change in global Pittsburgh Sleep Quality Index scores were -14.3 (interquartile range, -35.7 to - 6.3) and -1.7 (interquartile range, -7.6 to 7.8) in the intervention and control groups, respectively (P = 0.3). Median percentages of change in global Fatigue Severity Scale scores were -12.1 (interquartile range, -59.8 to -1.5) and -10.5 (interquartile range, -14.3 to 30.4) in the intervention and control groups, respectively (P = 0.04). Serum IL-1beta level decreased in the intervention group, but increased in the control group (P = 0.04). There were no significant differences in changes in other cytokines.


CONCLUSIONS
This study had a small number of participants and short observation period, and some participants concurrently used hypnotics.


CONCLUSIONS
CBT may be effective for improving the quality of sleep and decreasing fatigue and inflammatory cytokine levels. CBT can be an effective nonpharmacological therapy for PD patients with sleep disturbances.
Department of Internal Medicine, Division of Nephrology, Far Eastern Memorial Hospital, Taipei, Taiwan.
Hung-Yuan
HY
Chen
Chih-Kang
CK
Chiang
Hsi-Hao
HH
Wang
Kuan-Yu
KY
Hung
Yue-Joe
YJ
Lee
Yu-Sen
YS
Peng
Kwan-Dun
KD
Wu
Tun-Jun
TJ
Tsai
D015928:Cognitive Behavioral Therapy / Q000379:methods*; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D016207:Cytokines