title: Objective and subjective sleep disorders in automated peritoneal dialysis.
abstract: BACKGROUND
  Automated peritoneal dialysis (APD) is one of the fastest growing dialysis modalities. It is unknown whether sleep and mood are disturbed while performing repeated overnight exchanges.
  
  
  OBJECTIVE
  In this report, we aim to describe and compare the prevalence of sleep-disordered breathing (SDB), periodic limb movements (PLMS), poor sleep quality (SQ), and depression among APD patients compared with stages 3b-5 (estimated glomerular filtration rate ≤44 ml/min/1.73 m2) chronic kidney disease (CKD) and hemodialysis (HD) patients.
  
  
  METHODS
  This is a cross-sectional, descriptive study.
  
  
  METHODS
  Study participants were recruited from outpatient nephrology clinics, local dialysis centers, and the Thomas E. Starzl Transplant Institute in Western Pennsylvania between April 2004 and July 2009.
  
  
  METHODS
  There were 186 participants in this study including 22 APD patients, 89 CKD patients, and 75 HD patients.
  
  
  METHODS
  In-home polysomnography was performed and two questionnaires were completed, the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9).
  
  
  METHODS
  SDB and PLMS were quantified by in-home unattended polysomnography; poor SQ was defined by a score >5 on the PSQI, and the presence of moderate to severe depression was defined by a score >5 on the PHQ-9.
  
  
  RESULTS
  The APD patients had a median age of 37.5 years, were predominantly female (72.7 %), and had a median body mass index (BMI) of 23.8 kg/m2. In univariate analyses, APD patients had significantly lower apnea-hypopnea index compared to HD patients by 12.2 points (likelihood ratio test p = 0.008) and revealed the least percent of TST with nocturnal hypoxemia compared to CKD patients by 2.7 points, respectively (likelihood ratio test p = 0.01). The APD group had also significantly greater stages 3 to 4 sleep compared to the CKD patients by 8.6 points (likelihood ratio test p = 0.009). In multivariate analyses and after adjustment for age, gender, race, and BMI, both APD and HD patients had higher average PSQI scores than CKD patients by 2.54 and 2.22 points, respectively (likelihood ratio test p = 0.005). No other comparisons of sleep parameters among groups reached statistical significance.
  
  
  CONCLUSIONS
  The limitations of this study are the small sample size of the APD population and the demographic and clinical differences among the three study groups.
  
  
  CONCLUSIONS
  Despite differences in univariate analyses, after multivariate adjustment, APD patients had similar sleep parameters and sleep architecture and as poor SQ and symptoms of depression as HD patients. Future studies with larger APD cohorts are needed.
authors.affiliation: Nephrology Division, Department of Medicine, University of New Mexico, 901 University Blvd. SE, Suite 150, MSC 04-2785, Albuquerque, NM 87106 USA.
authors.forename: Maria-Eleni
authors.initials: ME
authors.lastname: Roumelioti
authors.affiliation: Nephrology Division, Department of Medicine, University of New Mexico, 901 University Blvd. SE, Suite 150, MSC 04-2785, Albuquerque, NM 87106 USA.
authors.forename: Christos
authors.initials: C
authors.lastname: Argyropoulos
authors.affiliation: Nephrology Division, Department of Medicine, University of New Mexico, 901 University Blvd. SE, Suite 150, MSC 04-2785, Albuquerque, NM 87106 USA.
authors.forename: Vernon Shane
authors.initials: VS
authors.lastname: Pankratz
authors.affiliation: Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Jhamb
authors.affiliation: Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA.
authors.forename: Filitsa H
authors.initials: FH
authors.lastname: Bender
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Strollo
authors.affiliation: Nephrology Division, Department of Medicine, University of New Mexico, 901 University Blvd. SE, Suite 150, MSC 04-2785, Albuquerque, NM 87106 USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
keywords: Automated peritoneal dialysis; Chronic kidney disease; Depression; Hemodialysis; Hypoxemia; Periodic limb movements; Sleep quality; Sleep-disordered breathing