title: Non-pharmacological interventions for improving sleep quality in patients on dialysis: systematic review and meta-analysis.
abstract: We conducted a meta-analysis to summarise and quantify the effects of non-pharmacological interventions on sleep quality improvement in uraemic patients on dialysis. We defined the primary outcome as the change of sleep quality before and after interventions (evaluated by polysomonography or subjective questionnaires such as Pittsburgh sleep quality index, PSQI). The change of fatigue scales, inflammatory cytokines and adverse events were analysed as secondary outcomes. Twelve eligible randomised controlled trials and one prospective cohort study were identified. All three identified non-pharmacological interventions could result in a greater PSQI score reduction compared to controls: 1) cognitive-behavioural therapy (CBT) versus sleep hygiene education (standardised mean difference (SMD) 0.85, 95% CI 0.37-1.34); 2) physical training versus no training (SMD 3.36, 95% CI 2.16-4.57) and 3) Acupressure (including other acupoints massages) versus control (SMD 1.77, 95% CI 0.80-2.73). In terms of subscores, we found that CBT may shorten sleep latency, alleviate sleep disturbance and reduce the use of sleep medications. The finding of the cohort study suggested that intradialytic aerobic exercise training improved sleep quality in haemodialysis patients with restless leg syndrome. In conclusion, in dialysis-dependent patients, CBT could shorten sleep latency, alleviate sleep disturbance and reduce the use of sleep medications. Acupressure (including other acupoints massages) and exercise training are promising interventions but the results in these subgroups should be interpreted cautiously due to the concern of methodological quality and potential confounding factors.
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors: Bo
authors: B
authors: Yang
authors: No. 5 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China.
authors: Jiaruo
authors: J
authors: Xu
authors: No. 5 Cadets Company, Second Military Medical University, Shanghai, People's Republic of China.
authors: Qiang
authors: Q
authors: Xue
authors: Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors: Tingting
authors: T
authors: Wei
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors: Jing
authors: J
authors: Xu
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors: Chaoyang
authors: C
authors: Ye
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
authors: Changlin
authors: C
authors: Mei
authors: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China. Electronic address: maozhiguo93@126.com.
authors: Zhiguo
authors: Z
authors: Mao
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy*
keywords: Meta-analysis; Non-pharmacological therapy; Renal dialysis; Renal insufficiency; Sleep disorders