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Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial.

Abstract

BACKGROUND

End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown.

STUDY DESIGN

A nonrandomized uncontrolled trial. Patients served as their own controls.

SETTING & PARTICIPANTS

Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session.

INTERVENTIONS

Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions.

OUTCOMES & MEASUREMENTS

At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated.

RESULTS

After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored.

LIMITATIONS

Small sample size and a nonrandomized uncontrolled study design.

CONCLUSIONS

Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.

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  • Authors+Show Affiliations

    ,

    Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands. bcp.koch@meandermc.nl

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    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Circadian Rhythm
    Female
    Health Surveys
    Humans
    Kidney Failure, Chronic
    Male
    Melatonin
    Middle Aged
    Polysomnography
    Renal Dialysis
    Salvia
    Sleep
    Treatment Outcome
    Wakefulness

    Pub Type(s)

    Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18950916