Sleep Disturbance and Fatigue in Renal Transplant Patients: A Pilot Study

Background:  Renal disease is the ninth leading cause of death in the United States. An estimated 80,000 are diagnosed annually with chronic renal failure, and over 400,000 Americans are receiving renal replacement therapy, dialysis or renal transplantation, to sustain life.  When a patient receives a renal transplant (RT), and no longer has renal failure, it has been assumed that any prior sleep problems are resolved.  These patients had experienced uremia with symptoms that include fatigue and day/night reversal. Day/night reversal or circadian rhythm disturbances and sleep problems have been recognized as an important issue in dialysis patients. However, the extent to which sleep problems continue after RT remains unclear.

Purpose:  The purpose of this pilot study was to categorize types of sleep problems in patients who have experienced renal transplantation, test recruitment procedures for a larger study, determine feasibility of questionnaires and actigraphy monitors, and gather preliminary data regarding valid and reliable measures for sleep disturbance and fatigue.

Design and Methods:  A pilot study was conducted with the screening of 10 participants from a renal transplant clinic in a western U.S. state. Four participants met the criteria for a sleep disturbance and continued the study. In addition to actigraphy monitoring as a measure of sleep, biomarkers included hemoglobin for anemia and hemoglobin A_1C as an indicator of glucose metabolism related to fatigue level along with relevant personal and treatment variables. 

Results: Four of the 10 participants had sleep disturbance and continued in the study. Even though there were only 4 participants, self-report of sleep quality correlated with actigraphy in all 4 participants.  The better the self-report, the better the sleep efficiency and the more minutes of sleep.  The lab values (Creatinine/BUN/Hgb/Hct) and the sleep variables (fatigue, sleep quality, sleep efficiency) revealed that the better the sleep and the more minutes of sleep, the lower the creatinine and BUN.

 

Conclusions: The pilot study aims were achieved and the plan to do a larger study is appropriate.  Sleep disturbance and fatigue has not been fully studied in renal transplant patients and further study is needed - in this population - for best and appropriate interventions.