الفهرس 
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Abstract
Patients with chronic disorders including ESRD tend to have more impaired sleep
quality. ESRD adversely affect patients’ social, financial and psychological wellbeing.
Among dialysis patients, the most common problems related to chronic anemia, bone
mineral disease, dialysis adequacy , complications related to dialysis process and sleep
quality.
Sleep disorders in HD patients can result in a lower quality of life, increased mortality
and decreased energy, and they can cause somnolence during the daytime . Sleep
disorders may also increase cardiovascular morbidity and mortality.
Subjective sleep complaints have been presented by more than 65% of patients on
HD. Insomnia, periodic limb movement disorder (PLMD), restless legs syndrome
(RLS) and sleep apnea syndrome (SAS) are common sleep disorders in HD patients. The etiology of sleep disorders in patients on dialysis is not completely clear; however
it is known to be multifactorial. Various conditions, including dialysis, medications,
metabolic abnormalities, malnutrition, fatigue, muscle cramps, peripheral neuropathy
and emotional problems, all common in ESRD can have effects on development of
sleep disturbance in these patients.
The aim of this work is to study the prevalence of subjective sleep quality and the
associated risk factors in relation to hemodialysis shift time in Egyptian
hemodialysis patients.
To achieve this target, we performed this cross sectional study on one hundred and
twenty (120) ESRD patients maintained on regular hemodialysis in hemodialysis unit of Menoufia University Hospital - Egypt during the period from February
2017 to May 2018. Dialysis patients were selected from all timing shifts (morning,
afternoon, evening).
Patients were divided into 3 groups according to hemodialysis shift time
*group 1: patients who undergo hemodialysis in the morning (7-11 a.m.).
*group 2: patients who undergo hemodialysis in the afternoon (12-16 p.m.).
*group 3: patients who undergo hemodialysis in the evening (17-21 p.m.).
In this study, all ESRD patients regularly undergo thrice-weekly hemodialysis for
4 hours per session for more than 3 months. A variety of factors were involved in
the selection process. These included patients’ demographic data, clinical and
laboratory findings, past medical histories. This was done to cover most of the
suspected variables which may have a role in the development of sleep disorders in
ESRD patients.
Patients were subjected to full medical examination, laboratory investigations,
assessment of dialysis adequacy and calculation of KT/V and assessment of sleep
quality using Pittsburgh sleep quality index (PSQI).
The PSQI is a generic, self-applied questionnaire designed to evaluate mainly the
quality of nocturnal sleep and to examine sleep habits and disturbances. It
consists of 19 questions that are combined to form 7 component scores, each of
which can be scored from 0 to 3 (from no difficulty to severe difficulty) .
Maximum score is 21, representing the maximum difficulty in all the seven
domains. The component scores are summed to produce a global score (range 0 to
21). A global PSQI score higher than 5 is indicative of clinically significant poor
sleep quality. Patient groups were compared regarding demographic, clinical, laboratory data and
PSQI.
Results of the present study revealed no statistically significant difference between
studied groups as regard clinical and laboratory data except there was significant
increase in serum sodium in group I (Na= 137 ± 4) and group II (Na= 137 ± 4)
compared to group III ( Na=135 ± 2.9) (p value = 0.008).
In total 120 patients were enrolled in this study, 77 patients (64.2%) had poor sleep
quality.
No significant association was found between subjective Sleep quality and
hemodialysis shift timing (P value = 0.7).
There was high significant positive correlation between sleep quality score and age
( years) ( r = 0.2, p value = 0.03) and between sleep quality score and patients’ body weight (Kg) ( r= 0.8, p value =0.02) .
There was high significant positive correlation between sleep quality score and serum
phosphorus (mg/dl) ( r = 0.2 , P value =0.001) and negative correlation between sleep
quality score and serum albumin (g/dl) ( r = - 0.29, P value=0.004).
There was highly significant negative correlation between sleep quality score and
dialysis adequacy (Kt/V) ( r = - 0.4, P value= 0.0001) .
Age, body weight, DM , HTN, albumin and phosphorus are independent risk
factor for poor sleep quality among the studied hemodialysis patients.