title: Fragmented sleep: an unrevealed problem in peritoneal dialysis patients.
abstract: OBJECTIVE
  The aim of this study was to describe the sleep-wake cycle, sleep quality, fatigue and Health Related Quality of Life (HRQoL) measured with questionnaires, actigraphy and a sleep diary during a one-week period in patients undergoing peritoneal dialysis (PD) treatment at home. A further aim was to explore differences compared with patients with coronary artery disease (CAD) and individuals from the general population.
  
  
  METHODS
  In this study one-week actigraphy registration, four questionnaires (Uppsala Sleep Inventory, SF-36, FACIT-fatigue, International Restless Legs Study Groups' form) and a sleep diary were used.
  
  
  RESULTS
  Data from 68 participants and 470 nights were collected. PD patients (n = 28) had more fragmented sleep (p < 0.001) and worse sleep efficiency (SE%) (p < 0.0001) than the CAD (n = 22) and the population (n = 18) groups. Pruritus (57%), restless legs (46%) and fatigue (89%) were prevalent in PD patients. Pruritus correlated with fragmented sleep (r = -0.45, p = 0.01) and SE (r = -0.49, p = 0.01). In HRQoL, the physical component score was decreased in the PD and CAD groups (p < 0.01) compared to the population group.
  
  
  CONCLUSIONS
  To the authors' knowledge this study is the first to demonstrate that PD patients have deteriorated sleep, with serious fragmentation measured by a one-week actigraphy registration. Further, PD patients exhibit worse sleep quality than CAD patients and individuals in the population. Evaluation of sleep in clinical practice is highly recommended since PD patients are vulnerable individuals with extended self-care responsibilities and at risk for comorbidity secondary to insufficient sleep. Future research on whether PD patients' sleep problems and fatigue can be improved by an individual non-pharmacological intervention programme is required.
authors.affiliation: Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden. pia.yngman.uhlin@liu.se
authors.forename: Pia
authors.initials: P
authors.lastname: Yngman-Uhlin
authors.forename: Anna
authors.initials: A
authors.lastname: Johansson
authors.forename: Anders
authors.initials: A
authors.lastname: Fernström
authors.forename: Sussanne
authors.initials: S
authors.lastname: Börjeson
authors.forename: Ulla
authors.initials: U
authors.lastname: Edéll-Gustafsson
mesh_terms: D056044:Actigraphy; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011537:Pruritus / Q000453:epidemiology; D011788:Quality of Life; D012148:Restless Legs Syndrome / Q000453:epidemiology; D012892:Sleep Deprivation / Q000453:epidemiology / Q000209:etiology*; D020178:Sleep Disorders, Circadian Rhythm / Q000453:epidemiology; D011795:Surveys and Questionnaires