Full text is available at the source.
Interventions for improving sleep quality in people with chronic kidney disease
May 27, 2019The Cochrane database of systematic reviews
Ways to improve sleep quality in people with long-term kidney disease
AI simplified
Abstract
Sixty-seven studies involving 3427 participants were reviewed to assess interventions for sleep quality in individuals with chronic kidney disease (CKD).
- Relaxation techniques had uncertain effects on sleep quality, duration, health-related quality of life, depression, anxiety, and fatigue.
- Exercise probably decreased depression and fatigue but had uncertain effects on sleep quality.
- Acupressure may slightly improve sleep latency and duration, but its overall effectiveness on sleep quality is uncertain.
- The evidence regarding the adverse effects of therapies was very uncertain.
- No studies were designed to examine sleep interventions for children with CKD.
AI simplified
BACKGROUND: Sleep disorders are commonly experienced by people with chronic kidney disease (CKD). Several approaches for improving sleep quality are used in clinical practice including relaxation techniques, exercise, acupressure, and medication.
OBJECTIVES: To assess the effectiveness and associated adverse events of interventions designed to improve sleep quality among adults and children with CKD including people with end-stage kidney disease (ESKD) treated with dialysis or kidney transplantation.
SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 8 October 2018 with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) or quasi-randomised RCTs of any intervention in which investigators reported effects on sleep quality. Two authors independently screened titles and abstracts of identified records.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias for included studies. The primary outcomes were sleep quality, sleep onset latency, sleep duration, sleep interruption, and sleep efficiency. Risks of bias were assessed using the Cochrane tool. Evidence certainty was assessed using the GRADE approach. We calculated treatment estimates as risk ratios (RR) for dichotomous outcomes or mean difference (MD) or standardised MD (SMD) for continuous outcomes to account for heterogeneity in measures of sleep quality.
MAIN RESULTS: Sixty-seven studies involving 3427 participants met the eligibility criteria. Thirty-six studies involving 2239 participants were included in meta-analyses. Follow-up for clinical outcomes ranged between 0.3 and 52.8 weeks (median 5 weeks). Interventions included relaxation techniques, exercise, acupressure, cognitive-behavioural therapy (CBT), educational interventions, benzodiazepine treatment, dopaminergic agonists, telephone support, melatonin, reflexology, light therapy, different forms of peritoneal dialysis, music, aromatherapy, and massage. Incomplete reporting of key methodological details resulted in uncertain risk of bias in many studies.In very low certainty evidence relaxation techniques had uncertain effects on sleep quality and duration, health-related quality of life (HRQoL), depression, anxiety, and fatigue. Studies were not designed to evaluate the effects of relaxation on sleep latency or hospitalisation. Exercise had uncertain effects on sleep quality (SMD -1.10, 95% CI -2.26 to 0.05; I= 90%; 5 studies, 165 participants; very low certainty evidence). Exercise probably decreased depression (MD -9.05, 95% CI -13.72 to -4.39; I= 0%; 2 studies, 46 participants; moderate certainty evidence) and fatigue (SMD -0.68, 95% CI -1.07 to -0.29; I= 0%; 2 studies, 107 participants; moderate certainty evidence). Compared with no acupressure, acupressure had uncertain effects on sleep quality (Pittsburgh Sleep Quality Index (PSQI) scale 0 - 21) (MD -1.27, 95% CI -2.13 to -0.40; I= 89%; 6 studies, 367 participants: very low certainty evidence). Acupressure probably slightly improved sleep latency (scale 0 - 3) (MD -0.59, 95% CI -0.92 to -0.27; I= 0%; 3 studies, 173 participants; moderate certainty evidence) and sleep time (scale 0 - 3) (MD -0.60, 95% CI -1.12 to -0.09; I= 68%; 3 studies, 173 participants; moderate certainty evidence), although effects on sleep disturbance were uncertain as the evidence certainty was very low (scale 0 - 3) (MD -0.49, 95% CI -1.16 to 0.19; I= 97%). In moderate certainty evidence, acupressure probably decrease fatigue (MD -1.07, 95% CI -1.67 to -0.48; I= 0%; 2 studies, 137 participants). Acupressure had uncertain effects on depression (MD -3.65, 95% CI -7.63 to 0.33; I= 27%; 2 studies, 137 participants; very low certainty evidence) while studies were not designed to evaluate the effect of acupressure on HRQoL, anxiety, or hospitalisation. It was uncertain whether acupressure compared with sham acupressure improved sleep quality (PSQI scale 0 to 21) because the certainty of the evidence was very low (MD -2.25, 95% CI -6.33 to 1.82; I= 96%; 2 studies, 129 participants), but total sleep time may have been improved (SMD -0.34, 95% CI -0.73 to 0.04; I= 0%; 2 studies, 107 participants; low certainty evidence).==There were no studies designed to directly examine and/or correlate efficacy of any interventions aimed at improving sleep that may have been attempted for the spectrum of sleep disordered breathing. No studies reported treatment effects for children. Adverse effects of therapies were very uncertain. 2 2 2 2 2 2 2 2 2 2 2 2 2
AUTHORS' CONCLUSIONS: The evidence base for improving sleep quality and related outcomes for adults and children with CKD is sparse. Relaxation techniques and exercise had uncertain effects on sleep outcomes. Acupressure may improve sleep latency and duration, although these findings are based on few studies. The effects of acupressure were not confirmed in studies in which sham acupressure was used as the control. Given the very low certainly evidence, future research will very likely change the evidence base. Based on the importance of symptom management to patients, caregivers and clinicians, future studies of sleep interventions among people with CKD should be a priority.
Related papers
Dec '19
Psychosocial treatments to prevent and manage depression in dialysis patients
cited by 55 papers
systematic review
Nov '22
Folic acid supplements and malaria risk and severity in people using antifolate malaria drugs in affected areas
cited by 21 papers
systematic review
Oct '23
Effects of Synbiotics, Prebiotics, and Probiotics in People with Long-Term Kidney Disease
cited by 22 papers
systematic review
Apr '24
Home Dialysis Compared to Clinic Dialysis for People with Kidney Failure
cited by 7 papers
systematic review
Oct '18
Low protein diets for adults with chronic kidney disease but no diabetes
cited by 31 papers
systematic review
Oct '20
Low protein diets in adults without diabetes who have long-term kidney disease
cited by 32 papers
systematic review
Aug '18
Phosphate binders for preventing and treating bone and mineral problems in chronic kidney disease
cited by 52 papers
systematic review
Mar '21
Weight Loss Treatments for Overweight or Obese People with Chronic Kidney Disease
cited by 19 papers
systematic review
Sep '20
Alternative and complementary treatments for pain after C-section
cited by 21 papers
systematic review