MO832SYMPTOM BURDEN AND QUALITY OF SLEEP IN MAINTENANCE HAEMODIALYSIS PATIENTS
Authors: Trbojević Stanković Jasna , Milošević Saša , Andrić Branislav , Hadzibulic Edvin , Birđozlić Fatmir , Marjanović Zoran , Pešić Snežana 
Published: May 2021

Abstract

Background and Aims
The number of patients with end-stage renal disease is growing rapidly worldwide and their survival on haemodialysis (HD) is increasing as a result of technique and treatment improvements. Nevertheless, longer survival and increasing complexity of the comorbid disorders contribute to a series of symptoms which affect patients’ physical and mental health. In the present study we aimed to examine the symptom distress and quality of sleep in patients treated with chronic HD.

Method
In this cross-sectional study, we recruited 304 (179 males and 125 females, age range 20 - 85 years, time on dialysis 3 - 324 months) out of 372 HD patients from five centres. All patients were under stable condition, without any severe acute comorbidities, and able to understand and fill-in the self-administered questionnaires. Standard laboratory parameters and Kt/V were determined in all patients. Quality and patterns of sleep were assessed by the Pittsburgh Sleep Quality Index (PSQI), while physical and emotional symptoms and their severity were evaluated by the Dialysis Symptom Index (DSI). Other relevant demographic and clinical data were obtained from patients’ medical records. The results were analyzed with independent sample T test and χ2 statistic.

Results
The average PSQI was 7.62±4.44, average symptom burden 15.49±12.85, and average symptom severity 23.38±18.78. Almost two thirds of the patients (63.8%) had poor sleep quality. The average sleep duration, latency and efficiency were 6.85±1.75 hours, 36.01±34.99 minutes and 81.51±21.57% respectively. Nearly half of the patients (45%) used sleep medications.
Women, unemployed and diabetic patients had significantly worse quality of sleep than men (8.41±4.33 vs. 7.08±4.43; p=0.001), employed (7.75±4.47 vs. 4.38±1.89; p&lt;0.01) and nondiabetic (8.89±4.59 vs. 7.36±4.40; p=0.041) patients respectively. Other demographic (age, level of education, marital status, smoking habit), clinical (body mass index, comorbidities, dialysis vintage, shift, and adequacy, type of membrane and vascular access) and standard laboratory parameters were not significantly associated with sleep quality.
Poor sleepers had significantly higher symptom burden (17.81±12.97 vs. 11.42±9.78; p&lt;0.01) and symptom severity (27.67±19.73 vs. 15.81±14.16; p&lt;0.01). The most prevalent and at the same time the most bothersome symptoms were difficulty becoming sexually aroused (63.2%), feeling tired or lack of energy (60.5%), decreased interest in sex (57.6%), feeling nervous (57.2%) and dry skin (53.3%). Shortness of breath (p=0.011), dizziness (p=0.005), restless legs (p=0.011), tingling in feet (p=0.005), lack of energy (p=0.001), cough (p=0.001), dry mouth (p=0.017) and bone/joint pain (p=0.016) were significantly more prevalent in poor sleepers.

Conclusion
Patients on HD experience high number of symptoms and often have poor quality of sleep which may affect their well-being. These results support the likely importance of routine symptom assessment in dialysis centres to guide systematic symptom management and provide appropriate psychosocial and clinical support.