Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease(CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

TCM Treatment for 63 Cases of Senile Dyssomnia

In order to study the therapeutic effects of the TCM drugs on senile dyssomnia, 121 such patients were randomly divided into a treatment group of 63 cases (given the TCM drugs) and a control group of 58 cases (given estazolam). The changes shown in the SDRS and HAMA scores and the other indexes were observed in both of the two groups to evaluate the therapeutic effects. The results showed that the effective rate was 76.3% in the treatment group, and it was 69.1% in the control group; and that the TCM drugs had better effects in improving such symptoms as lethargy, dry mouth, and rebound of insomnia. Therefore, it can be concluded that the effect of the TCM drugs is better for senile dyssomnia than that of the Western drug estazolam.

Heat rate variability and dyssomnia and their correlations to neurological defects in cerebral infarction patients complicated by insomnia A concurrent non-randomized case-control study

BACKGROUND： Heart rate variability refers to the beat-to-beat alteration in heart rate. It is usually a slight periodic variation of R-R intervals. Much information of autonomic nerve system balance can be obtained by measuring the heart rate variability of patients. It remains to be shown whether heart rate variability can be used as an index for determining the severity of insomnia and cerebral infarction. OBJECTIVE： This study aimed to analyze the correlation for each frequency spectrum parameter of heart rate variability with an insomnia index, as well as the degree of neurological defects in patients with simple cerebral infarction and cerebral infarction complicated by insomnia. The goal was to verify the feasibility of frequency spectrum parameters for heart rate variability as a marker for insomnia and cerebral infarction. DESIGN： A case-control observation. SETTING： Department of Neurology, First Hospital Affiliated to China Medical University. PARTICIPANTS： Sixty inpatients, and/or outpatients, with cerebral infarction were admitted to the 202 Hospital of Chinese PLA between December 2005 and October 2006, confirmed by CT, and recruited to the study. According to the insomnia condition （insomnia is defined by a Pittsburgh Sleep Quality Index score 〉 7）, the patients were assigned to a simple cerebral infarction group and a cerebral infarction complicated by insomnia group, with 30 subjects in each group. Thirty additional subjects, who concurrently received examinations and were confirmed to not suffer from cerebral infarction and insomnia, were recruited into the control group. Written informed consent was obtained from each subject for laboratory specimens. The protocol was approved by the Hospital＇s Ethics Committee. METHODS： Following admission, each subject＇s neurological impairment was assessed with the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index. Heart rate variability of each subject was measured with an autonomic nerve analyzer （Weijin Science and Technology Co., Ltd., Taiwan）. Each frequency spectrum parameter of heart rate variability was obtained, including very low frequency, low frequency, high frequency, total power, R-R interval, and its mean square. In addition, percentage of low frequency, high frequency, and ratio of low frequency to high frequency were calculated. For each heart rate frequency spectrum parameter, the difference between groups was analyzed. Moreover, correlations of each frequency spectrum parameter with insomnia and disease condition were analyzed. Data from each index, which were not normally distributed, were processed by logarithmic transformation. The t-test was used for the comparison of intergroup differences. Single-factor linear regression analysis and t-test were used for the analysis of factor-factor correlation and coefficient of correlation, respectively. MAIN OUTCOME MEASURES： （1） Differences of scores in the National Institutes of Health Stroke Scale and Pittsburgh Sleep Quality Index between the simple cerebral infarction group and the cerebral infarction complicated by insomnia group. （2） Differences of heart rate variability parameters between the simple cerebral infarction group and the control group. （3） Correlation of heart rate variability parameters, the Pittsburgh Sleep Quality Index score, and the neurological impairment score. RESULTS： Sixty patients and thirty healthy controls were included in the final analysis. （1） The scores of the Pittsburgh Sleep Quality Index and the neurological impairment were significantly higher in the cerebral infarction complicated by insomnia group compared to the simple cerebral infarction group （P 〈 0.05-0.01）. （2） R-R interval was significantly longer in the simple cerebral infarction group than in the control group, while R-R interval variance and high-frequency band were significantly lower in the simple cerebral infarction group compared to the control group （P 〈 0.05）. （3） For cerebral infarction patients with insomnia, the Pittsburgh Sleep Quality Index score was significantly positively correlated with neurological impairment （r = 0.54, P 〈 0.01）. The low-frequency band, very low-frequency band, high-frequency band, R-R interval variance, total power, R-R interval, and the percentage of high-frequency were significantly negatively correlated with the National Institutes of Health Stroke Scale score （r =4）.45 to 4）.90, P 〈 0.054）.01） and with the Pittsburgh Sleep Quality Index scores （r = 4）.56 to 4）.36, P 〈 0.054）.01）. CONCLUSION： Each heart rate variability parameter can be used as an index for assessing dyssomnia and neurologic impairment （r =4）.56 to 4）.36, P 〈 0.054）.01）.

Clinical Study on Combined Needle-embedding and Medication for Depressive Sleep Disorder

Objective： To observe the clinical efficacy of combined needle-embedding and SSRIs for depressive sleep disorder. Method： Upon admission, 71 depression cases were randomized into needle-embedding group of 24 cases, using combined needle-embedding and SSRls, acupuncture group of 21 cases, using combined acupuncture and SSRIs, and medication group of 26 cases, using SSRIs alone. Alter 1, 2, 4 and 6 weeks of treatment, the HAMD sleep scores were compared. Result： The HAMD sleep scores in the needle-embedding and acupuncture group were remarkably superior to the medication group and there was significant statistical difference after 1, 2 and 4 weeks of treatment （P〈0.01）. However, there was no statistical difference after 6 weeks of treatment. Conclusion： SSRIs can improve HAMD sleep scores. The combined needle-embedding or acupuncture with SSRIs can work faster and better than medication alone. There was no statistical difference between needle-embedding and acupuncture group, however, needle-embedding can reduce the treatment frequencies and therefore has more active clinical meaning.

Clinical Observations on Curative Effect of TCM Massage on Dyssomnia of Infants

Objective:To observe the curative effect of TCM massage on difficulty in falling asleep, waking during night and other sleep disorder of infants. Methods: The 51 outpatients were treated by basic recipe for massage treatment and modified recipe according to syndromes. Results: The total Athens Insomnia Scale (AIS) score 3.2800±1.5784 after treatment is lower than 9.2400±1.4286 before treatment (P<0.01), there is statistical difference in AIS scores before and after treatment. Conclusion: TCM massage can remarkably improve sleep condition of infants with dyssomnia.