Fatigue and Pruritus Impact Sleep Quality in Hemodialysis Patients.

Purpose: This study assesses sleep quality amongst hemodialysis (HD) patients and identifies contributing factors, which include demographic and clinical factors and significant symptoms associated with HD (ie, fatigue and pruritus).

Patients and methods: In this cross-sectional design, 116 participants were recruited from HD units of two hospitals in Saudi Arabia. Three measures were used to identify predictors of sleep quality among HD patients, including the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), and the 5-D itch scale. Demographic and clinical profiles were also obtained. Univariate and multiple regression analyses were used to determine significant factors associated with sleep quality during HD.

Results: The mean global PSQI score was 6.77±3.23, with 56.9% of participants scoring 5 or more, indicating poor sleep. Sleep latency achieved the highest mean PSQI score (1.70 ±0.94), and 'use of sleep medication components' the lowest (0.36 ±0.83). Increased age, lower educational status, higher fatigue, and pruritus were associated with poorer sleep. Controlling for status and age suggested that fatigue and pruritus independently influenced HD patients' sleep quality (F (4, 111) = 10.89, P = <0.001). There were positive relationships between increased levels of fatigue and pruritus and poor quality of sleep.

Conclusion: This is the first study to examine fatigue, pruritus, and sleep quality in HD patients. Findings will assist dialysis clinicians to develop appropriate management strategies to mitigate factors causing poor sleep for such patients. Intervention programs targeting self-management of fatigue and pruritus symptoms could potentially improve patients' sleep quality.