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      Sleep Quality in Patients on Maintenance Hemodialysis and Peritoneal Dialysis

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          Abstract

          Background:

          Sleep disturbances are common among uremic patients; however, limited data are available on predictors of sleep quality in this population. We assessed sleep quality in patients on hemodialysis (HD) and peritoneal dialysis (PD) and investigated predictors related to sleep quality.

          Methods:

          Patients on maintenance HD and PD were consecutively included from two medical centers in Isfahan city (Iran). They completed the Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression scale. Laboratory tests were done for iron state, kidney function, and electrolytes. Univariate and multivariate analyses were performed to find predictors of sleep quality.

          Results:

          About 90 patients were evaluated (53 males, age = 54.2 ± 15.2 years, disease duration = 5.3 ± 4.5 years). Poor sleep quality was frequent in 86.6% of the cases in each group of HD and PD patients. Patients on HD had poorer sleep quality in terms of total PSQI scores and two dimensions of sleep latency and sleep efficiency ( P < 0.05). Anxiety (β = 0.232, P = 0.027), depression (β = 0.317, P = 0.004), and being on HD (β = 2.095, P = 0.009) were independent predictors of overall poor sleep quality.

          Conclusions:

          Poor sleep quality is highly frequent in patients on maintenance dialysis and mood disorders and being on HD are predictive factors. Further studies are required for better understanding of risk factors associated with poor sleep quality and thus possible treatments in these patients.

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          Most cited references51

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          Sleep and emotions: a focus on insomnia.

          Insomnia disorder is defined as difficulties in initiating/maintaining sleep and/or non-restorative sleep accompanied by decreased daytime functioning, persisting for at least four weeks. For many patients suffering from depression and anxiety, insomnia is a pervasive problem. Many of the aetiological theories of insomnia postulate that heightened emotional reactivity contributes to the maintenance of symptoms. This review focuses on the role of emotional reactivity in insomnia, and how the relationship between insomnia and depression and anxiety may be mediated by emotional reactivity. Furthermore, studies investigating the valence of emotions in insomnia are reviewed. Overall, there is empirical evidence that dysfunctional emotional reactivity might mediate the interaction between cognitive and autonomic hyperarousal, thus contributing to the maintenance of insomnia. Moreover, dysfunctions in sleep-wake regulating neural circuitries seem to be able to reinforce emotional disturbances. It seems plausible that dysfunctional emotional reactivity modulates the relationship between insomnia and depression and anxiety. Considering the interaction between sleep and emotional valence, poor sleep quality seems to correlate with high negative and low positive emotions, both in clinical and subclinical samples. Good sleep seems to be associated with high positive emotions, but not necessarily with low negative emotions. This review underlines the need for future research on emotions in insomnia. (c) 2009 Elsevier Ltd. All rights reserved.
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            The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version

            Background The Hospital Anxiety and Depression Scale (HADS) is a widely used instrument to measure psychological morbidity in cancer patients. This study aimed to translate and test the reliability and validity of the Iranian version of the HADS. Methods The English language version of the HADS was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 167 breast cancer patients and statistical analysis was performed to test the reliability and validity of the HADS. Results In general the Iranian version of the HADS was found to be acceptable to almost all patients (99%). Cronbach's alpha coefficient (to test reliability) has been found to be 0.78 for the HADS anxiety sub-scale and 0.86 for the HADS depression sub-scale. Validity as performed using known groups comparison analysis showed satisfactory results. Both anxiety and depression sub-scales discriminated well between sub-groups of patients differing in clinical status as defined by their disease stage. Conclusion This preliminary validation study of the Iranian version of the HADS proved that it is an acceptable, a reliable and valid measure of psychological distress among cancer patients.
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              Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P).

              There is a high worldwide prevalence of sleep quality disturbances, and sleep disturbances have been associated with numerous diseases. Thus, it is important to assess sleep quality. The Pittsburgh Sleep Quality Index (PSQI) is a self-rating questionnaire that can be completed within 5 min, but no Persian language version is available. We translated the PSQI into Persian and then back into English to ensure the accuracy of the translation. A total of 125 psychiatric patients (generalized anxiety disorder, n = 37; major depression, n = 35; schizophrenia, n = 28; primary insomnia, n = 25) and 133 controls completed our Persian version of this questionnaire. Internal consistency, construct validity, and sensitivity and specificity of the PSQI were assessed. The mean ages (±SD) of the patient and control groups were 36.8 years (±13.9) and 34.2 years (±9.8), respectively (p = 0.08). Cronbach's alpha coefficient for all subjects was 0.77 and was 0.52 for the patient group and 0.78 for the control group. The corrected item-total correlations ranged from 0.30 to 0.75 for the seven component scores of the PSQI. When the general health questionnaire-12 was used as a measure of psychiatric morbidity, it was well correlated with the PSQI scores (r = 0.54, p < 0.001). The sensitivity and specificity of discrimination of insomniac patients from control subjects were 94% and 72% for a PSQI cutoff value of 5 and 85% and 84% for a PSQI cutoff value of 6. The psychometric properties of the Persian version of the PSQI were acceptable.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Medknow Publications & Media Pvt Ltd (India )
                2008-7802
                2008-8213
                February 2013
                : 4
                : 2
                : 165-172
                Affiliations
                [1]Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [1 ]Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
                [2 ]Medical Student’ Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Correspondence to: Dr. Ali Gholamrezaei, Medical Students’ Research Center, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, Iran. E-mail: gholamrezaei@ 123456med.mui.ac.ir
                Article
                IJPVM-4-165
                3604848
                23543042
                1e8bf8c6-9f27-4c0e-bd37-4c72c4550cbd
                Copyright: © International Journal of Preventive Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2012
                : 03 August 2012
                Categories
                Original Article

                Health & Social care
                end-stage renal disease,hemodialysis,peritoneal dialysis,risk factors,sleep disorders

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