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      Relación entre calidad del sueño, ansiedad y depresión en pacientes con enfermedad renal crónica en hemodiálisis Translated title: Relationship between sleep quality, anxiety and depression in patients with chronic kidney disease on hemodialysis

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          Abstract

          Resumen Introducción: Los trastornos de sueño tienen una alta prevalencia en los pacientes con Enfermedad Renal Crónica en Hemodiálisis. Un descanso insuficiente o de mala calidad influye negativamente en la actividad cotidiana siendo causa o consecuencia de estados depresivos o ansiosos. Objetivo: Evaluar la calidad del sueño en pacientes en hemodiálisis y su relación con los niveles de depresión y ansiedad. Material y Método: Estudio observacional descriptivo con inclusión de 28 pacientes en hemodiálisis durante febrero de 2017. Se recogieron datos sociodemográficos, se administró el test Pittsburg de Calidad del Sueño, y se valoró el estado cognitivo con el examen Minimental y la depresión y ansiedad con la Hospital Anxiety and Depression Scale (HADS). Resultados: El 82,14% (n=23) presentó insomnio según el test de Pittsburg. Los resultados obtenidos con el HADS fueron positivos para ansiedad en un 21% (n=6) y positivos para depresión en un 35% (n=10). Los resultados en el test Pittsburg se correlacionaron positivamente con los niveles de ansiedad (p=0,004) y depresión (p=0,049). El grado de depresión se correlacionó negativamente con ausencia de deterioro cognitivo (p=0,010). Conclusiones: La calidad del sueño en los pacientes examinados es mala y se pueden relacionar con los resultados de depresión y ansiedad encontrados. Según estos resultados, incluiremos información sobre hábitos de sueño saludables en el proceso de educación a pacientes en hemodiálisis, así como pretendemos mejorar la detección y tratamiento especializado de la ansiedad y depresión.

          Translated abstract

          Abstract Introduction: Sleep disorders have a high prevalence in patients with chronic kidney disease (CKD) on hemodialysis (HD). Insufficient or poor quality rest negatively influences daily activity, being the cause or consequence of depressive or anxious states. Objective: To evaluate the quality of sleep of patients on hemodialysis and the relationship with levels of depression and anxiety. Material and Method: Descriptive observational study including 28 HD patients during February 2017. Sociodemographic data were collected, the Pittsburg Sleep Quality test was administered, the cognitive status was assessed with the Mini-Mental test and anxiety and depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Results: According to the Pittsburg Sleep Quality test, 82.14% (n=23) presented insomnia. HADS was positively related to anxiety in 21% (n=6) of population and to depression in 35% (n=10). The results in the Pittsburgh test correlated positively with levels of anxiety (p=0.004) and depression (p=0.049). The degree of depression correlates negatively with the absence of cognitive impairment (p=0.010). Conclusions: The sleep quality in the examined patients is poor and can be related with the depression and anxiety results. According to that results, we will include information about healthy sleep habits in the HD patients’ education process, as well as we intend to improve management and specialized treatment of anxiety and depression.

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          Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas

          Introducción: La escala de Ansiedad y Depresión Hospitalaria (HADS-Hospital Anxiety and Depression Scale, Zigmond y Snaith, 1983) se ha convertido en un popular instrumento clínico diseñado para evaluar ansiedad y depresión, encontrándose evidencias de que aplicado a diversas poblaciones parece tener tan buenas propiedades de detección cómo otros instrumentos. Numerosos trabajos en muestra española comprueban sus propiedades psicométricas y puntos de corte. Nuestro objetivo es unificar los resultados de estudios realizados en muestras españolas para concretar directrices que orienten en la aplicabilidad e interpretación de sus puntuaciones. Método: Revisión bibliográfica. Resultados: Se seleccionaron 15 artículos, a) se confirma que las propiedades psicométricas del HAD en diferentes muestras son óptimas, b) se presenta cierta variabilidad de puntos de corte para cada población y c) determinados ítems muestran débil carga factorial e ítem-test. Discusión: se plantea qué ítems deben reconsiderarse para un HAD abreviado. Se sugiere valorar la escala total de distrés.
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            Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients.

            Nocturnal hypoxemia secondary to sleep apnea has long been implicated as a cardiovascular risk factor in renal failure, but to date there is no study that links nocturnal hypoxemia to cardiovascular outcomes in end-stage renal disease. Fifty uremic patients on regular dialysis treatment without primary sleep apnea, pulmonary diseases, or other illnesses that may cause sleep apnea underwent pulse oximetry studies during night and were followed up for 32 mo. Average nocturnal SaO(2), minimal SaO(2), and the number of episodes of hypoxemia were similar in patients who died during the follow-up and in patients who survived, and none of these parameters predicted all-cause mortality. Average nocturnal SaO(2) was significantly lower (P = 0.006) in patients who had cardiovascular events during the follow-up (94.7 +/- 2.9%) than in event-free patients (97.1 +/- 1.3%). In a Cox model, average nocturnal SaO(2) was the second factor in rank explaining these outcomes. In this model a 1% decrease in average nocturnal SaO(2) was associated with a 33% increase in the incident risk of fatal and nonfatal cardiovascular events. Furthermore the risk of cardiovascular events was 5.05 times higher in patients with average nocturnal SaO(2) <95% (95% CI 1.61 to 15.86) than in those above this threshold (P = 0.005). This study adds weight to the hypothesis that nocturnal hypoxemia in dialysis patients represents an important cardiovascular risk factor.
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              Sleep-disordered breathing predicts cardiovascular events and mortality in hemodialysis patients.

              Sleep-disordered breathing (SDB), characterized by repetitive apnea and hypopnea during sleep, is a risk factor for cardiovascular disease. However, the links between SDB and cardiovascular events in hemodialysis (HD) patients have not been clearly evaluated. We followed the clinical outcome of 94 HD patients, who underwent overnight pulse oximetry on dialysis day. The SDB group was defined as 3% oxygen desaturation index (ODI) over five events per hour, and the others were the normal group. The primary outcome was cardiovascular events and death. We used Kaplan-Meier curve and Cox proportional hazard model for survival analyses. Forty-four patients (46.8%) were classified into the SDB group. Body mass index, diabetes mellitus, 3% ODI and Epworth sleepiness scale were significantly higher, and duration of dialysis, Kt/V, normalized protein catabolism rate and hemoglobin were lower in the SDB group than in the normal group. During a median 55 months of follow-up, Kaplan-Meier analysis revealed that the SDB group had a significantly higher rate of cardiovascular events and all-cause mortality than the normal group. Age, cardiothoracic ratio, serum albumin and 3% ODI were predictors of cardiovascular events and all-cause mortality at univariate Cox regression analysis. In the adjusted analysis, SDB is an independent predictor of increased cardiovascular events (hazard ratio 3.10; 95% confidence interval (CI), 1.35-7.12; P = 0.008) and all-cause mortality (hazard ratio 2.81; 95% CI, 1.07-7.41; P = 0.037). SDB is an independent risk factor for cardiovascular events and mortality in HD patients. Effective and earlier treatment for these patients is needed to improve clinical outcome.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                enefro
                Enfermería Nefrológica
                Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (Madrid, Madrid, Spain )
                2254-2884
                2255-3517
                December 2018
                : 21
                : 4
                : 369-376
                Affiliations
                [1] orgnameHospital del Mar orgdiv1Servicio de Nefrología Spain
                Article
                S2254-28842018000400369
                10.4321/s2254-28842018000400006
                8f70cba6-6c6f-4029-9a83-dfc9fd2bef52

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 26 December 2017
                : 15 September 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 8
                Product

                SciELO Spain

                Categories
                Originales

                calidad del sueño,insomnio,depresión,ansiedad,hemodiálisis,quality of sleep,insomnia,depression,anxiety,hemodialysis

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