Different melatonin rhythms and sleep–wake rhythms in patients on peritoneal dialysis, daytime hemodialysis and nocturnal hemodialysis
Received 12 January 2009; received in revised form 7 April 2009; accepted 27 April 2009.
Abstract
Background
Little comparative data on sleep–wake rhythms in different dialysis groups exist. The aim of this study was to investigate sleep–wake parameters measured with actigraphy and sleep questionnaires as well as melatonin rhythms in automated peritoneal dialysis, conventional daytime hemodialysis and nocturnal hemodialysis patients.
Methods
Conventional daytime dialysis (n=20), nocturnal hemodialysis (n=13) and automated peritoneal dialysis patients (n=6) were included in the study. Melatonin in saliva was sampled at 5 time points (21:00, 23:00, 1:00, 7:00 and 9:00h). Furthermore, actigraphy measurements and sleep questionnaires were performed. All parameters were tested by Kruskall–Wallis test (followed by post hoc Dunn test) to find significant differences (p<0.05).
Results
Although most sleep parameters were impaired in all three groups, conventional daytime dialysis patients had the worst sleep. In nocturnal hemodialysis patients a normal nocturnal melatonin rise was found. In daytime hemodialysis and automated peritoneal dialysis patients this rise was absent.
Conclusions
The study showed impaired sleep parameters in all dialysis patient groups. As automated peritoneal dialysis is also performed during night time, the same effect on normalized melatonin was anticipated as was found in nocturnal hemodialysis. Melatonin seems to play a subordinate role in the sleep–wake rhythm of automated peritoneal dialysis patients.
aDepartment of Clinical Pharmacy, Meander Medical Center, Utrechtseweg 160, 3818 ES Amersfoort, The Netherlands
bDepartment of Internal Medicine, Meander Medical Center, Utrechtseweg 160, 3818 ES Amersfoort, The Netherlands
cDepartment of Nephrology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
dDepartment of Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands
eCenter for Sleep–Wake Disorders, Medical Centre Haaglanden, Lijnbaan 32, 2501 CK The Hague, The Netherlands
Corresponding author. Department of Clinical Pharmacy, Meander Medical Center, Postal Box 1502, 3800 BM Amersfoort, The Netherlands. Tel.: +31 33 8504608; fax: +31 33 8502306.
ABSTRACT