NDT Advance Access originally published online on May 7, 2008
Nephrology Dialysis Transplantation 2008 23(8):2703-2704; doi:10.1093/ndt/gfn048
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Sleep quality and dialysis efficacy affect functional capacity in patients receiving haemodialysis therapy
E-mail: stefanid{at}med.uth.grSir,
Recently Chan et al. published a very interesting article dealing with the effect of nocturnal home haemodialysis (HD) therapy on exercise capacity [1]. The authors investigated 13 patients switching from conventional HD to a home-based—almost daily—nocturnal HD, and showed that the enhanced control of uraemia achieved by nocturnal dialysis significantly increases exercise capacity and duration. These results, apart from being very promising in the area of physical rehabilitation of HD patients, underscore the central pathogenetic role of uraemia in muscle atrophy and exercise intolerance, which in turn lead to reduced physical activity and compromised quality of life of HD patients [2].
In addition, sleep disorders, which are highly prevalent in HD patients, are probably also due to uraemia-related factors, since substantial improvement occurs after switching to nocturnal dialysis [3] or after renal trans- plantation [4].
In a recent issue of your journal, our group presented data showing that HD patients with sleep apnoea disorders demonstrated poorer physical and functional capacity compared to that of non-apneic counterparts [5]. In that study, six different established tests were used for the assessment of physical functioning while a full-night sleep polysomnography was used to assess sleep quality and quantity. The study concluded that the lack of restorative sleep due to sleep apnoea-hypopnoea syndrome (arousal index = 40 events/h) might have independently augmented the uraemia-induced deterioration of functional capacity in HD patients.
From the above it is therefore clear that sleep quality and functional capacity are closely related in HD patients, similar to other patients with chronic disease. Sleep was not investigated in the study by Chan et al. [1]; nevertheless, it is conceivable to conclude that the improvement in exercise duration and capacity found might have been also related to the improvement in sleep quality and quantity secondary to the enhanced uraemic control.
Finally, sleep quality seems to play an important role in the life of HD patients, affecting functional capacity and health status. It remains to be seen whether direct or indirect means of improving sleep in HD patients would also improve mortality and morbidity.
Conflict of interest statement. None declared.
Department of Nephrology, School of Medicine, University of Thessaly, Larissa, Greece
References
- Chan CT, Notarius CF, Merlocco AC, et al. Improvement in exercise duration and capacity after conversion to nocturnal home haemodialysis. Nephrol Dial Transplant (2007) 22:3285–3291.
[Abstract/Free Full Text] - Johansen KL, Shubert T, Doyle J, et al. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. Kidney Int (2003) 63:291–297.[CrossRef][Web of Science][Medline]
- Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med (2001) 344:102–107.
[Abstract/Free Full Text] - Auckley DH, Schmidt-Nowara W, Brown LK. Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation. Am J Kidney Dis (1999) 34:739–744.[Web of Science][Medline]
- Sakkas GK, Gourgoulianis KI, Karatzaferi C, et al. Haemodialysis patients with sleep apnoea syndrome experience increased central adiposity and altered muscular composition and functionality. Nephrol Dial Transplant (2008) 23:336–344.
[Abstract/Free Full Text]
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