Effects of Nocturnal Hemodialysis on Melatonin Rhythm and Sleep-Wake Behavior

[okarol]

Effects of Nocturnal Hemodialysis on Melatonin Rhythm and Sleep-Wake Behavior: An Uncontrolled Trial

Birgit C.P. Koch, PharmD1Corresponding Author Informationemail address, E. Christiaan Hagen, MD, PhD2, J. Elsbeth Nagtegaal, PharmD, PhD1, Jan B.S. Boringa, MD3, Gerard A. Kerkhof, PhD45, Piet M. Ter Wee, MD, PhD6

Received 15 April 2008; accepted 1 August 2008. published online 28 October 2008.
Corrected Proof
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.
Index words: Sleep-wake rhythm, melatonin, nocturnal hemodialysis, polysomnography

1 Department of Clinical Pharmacy, Meander Medical Center, Amersfoort

2 Department of Internal Medicine, Meander Medical Center, Amersfoort

3 Department of Neurology, Meander Medical Center, Amersfoort

4 Department of Psychology, University of Amsterdam, Amsterdam

5 Center for Sleep Wake Disorders, Medical Center Haaglanden, the Hague

6 Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands

Corresponding Author InformationAddress correspondence to Birgit C.P. Koch, PharmD, Meander Medical Center, Department of Clinical Pharmacy, Postal Box 1502/Utrechtseweg 160, 3800 BM Amersfoort, The Netherlands

 Trial registration: www.clinicaltrials.gov; study number: NCT004044456.

http://www.ajkd.org/article/PIIS0272638608012444/abstract

[Rerun]

I know I sleep like a ROCK now.  But, I also know things change so fast with dialysis that next week I may be awake all night.

[Sluff]

Interesting.