title: Daytime sleepiness in renal transplant recipients is associated with immunosuppressive non-adherence: a cross-sectional, multi-center study.
abstract: BACKGROUND
  The aims of this study were to determine the prevalence of immunosuppressive non-adherence (NA) in renal transplant patients and describe whether the degree of daytime sleepiness (DS) and depressive symptomatology are associated with immunosuppressive NA.
  
  
  METHODS
  Using a cross-sectional design, 926 home-dwelling renal transplant recipients who were transplanted at one of three Swiss transplant centers provided data by self-report. The Basel Assessment of Adherence Scale for immunosuppressive was used to measure the following: taking, timing, and overall NA to immunosuppressive medication. DS was assessed with the Epworth Sleepiness Scale (ESS) (cut-off ≥6 for DS) and the Swiss Transplant Cohort Study DS item (cut-off ≥4 for DS), and depressive symptomatology was assessed with the Depression, Anxiety, and Stress Scale (cut-off>10). An ordinal logistical regression model was applied for statistical analysis.
  
  
  RESULTS
  The prevalence of the ESS-DS was 51%. NA for taking, timing, and the median overall NA level assessed by 0-100% visual analog scale (VAS) was 16%, 42%, and 0%, respectively. Based on the multivariate analysis, DS was significantly associated (p < 0.001) with taking (1.08 [1.04-1.13]), timing (1.07 [1.03-1.10]), and overall NA (1.09 [1.05-1.13]). Very similar results were found for the Swiss Transplant Cohort Study DS item.
  
  
  CONCLUSIONS
  DS is associated with immunosuppressive medication NA in renal transplant recipients. Admittedly, the association's strength is limited.
authors: Institute of Nursing Science, University of Basel, Basel, Switzerland; Division of Transplant Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
authors: Hanna
authors: H
authors: Burkhalter
authors: Anna
authors: A
authors: Wirz-Justice
authors: Christian
authors: C
authors: Cajochen
authors: Terri E
authors: TE
authors: Weaver
authors: Jürg
authors: J
authors: Steiger
authors: Thomas
authors: T
authors: Fehr
authors: Reto M
authors: RM
authors: Venzin
authors: Sabina
authors: S
authors: De Geest
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D011795:Surveys and Questionnaires; D013557:Switzerland
chemical_list: D007166:Immunosuppressive Agents
keywords: daytime sleepiness; medication adherence; renal transplantation