title: Sleep disturbance and depressive affect in patients treated with haemodialysis.
abstract: BACKGROUND
  Sleep disorders and depression are prevalent conditions in patients with end-stage kidney disease. These co-morbidities have significant overlap and compounded morbidity and mortality burden. This overlap presents challenges to optimal clinical assessment and treatment. The goal of this study was to assess the prevalence of sleep disturbance in patients on maintenance haemodialysis, and to assess the impact of depressive affect.
  
  
  OBJECTIVE
  This was a single-site, single group, cross-sectional study of 69 English-speaking patients undergoing maintenance haemodialysis. Self-reported assessments included those of sleep quality (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory), daytime sleepiness (Epworth's Sleepiness Scale), a dialysis-specific sleep questionnaire, and standard laboratory values. No objective sleep information was collected.
  
  
  METHODS
  All participants were well dialysed, and represented all four daily shifts. Fifty-eight per cent reported clinically significant sleep difficulty, with elevated yet sub-threshold daytime sleepiness. Mean depressive affect was also elevated, yet sub-diagnostic and was positively correlated with increased age.
  
  
  RESULTS
  Participants scoring above the diagnostic threshold for depression had significantly more disturbed sleep quality, more daytime sleepiness and had more problems sleeping due to restless leg syndrome than people with minimal depressive affect.
  
  
  CONCLUSIONS
  Poor sleep quality is prevalent in patients on maintenance haemodialysis, and is associated with increased daytime sleepiness. Depression further compounds this relationship, and is significantly associated with increased daytime sleepiness and restless leg syndrome.
authors.affiliation: College of Medicine, Downstate Medical Center Brooklyn, New York, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Maung
authors.affiliation: Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA.
authors.forename: Ammar El
authors.initials: AE
authors.lastname: Sara
authors.affiliation: Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA.|City University of New York Queens College, Queens, New York, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Cohen
authors.affiliation: Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA.
authors.forename: Cherylle
authors.initials: C
authors.lastname: Chapman
authors.affiliation: Medicine, Renal Division, Downstate Medical Center Brooklyn, New York, USA.
authors.forename: Subodh
authors.initials: S
authors.lastname: Saggi
authors.affiliation: Psychiatry and Behavioral Science, Downstate Medical Center Brooklyn, New York, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cukor
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects*; D057566:Self Report; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: Chronic kidney disease; Depression; Sleep