Correlation of sleep quality and cardiac autonomic modulation in hemodialysis patients.

Objectives: Sleep disorders in patients on hemodialysis are frequent, but few studies correlate these disorders with autonomic dysfunction in these patients. This study aimed to verify whether clinical and laboratory variables and heart rate variability are associated with worse sleep quality verified by the Pittsburg subjective scale in patients on hemodialysis. Material and Methods: A cross-sectional study was performed on forty-eight patients. Epidemiological, clinical, and laboratory data were collected. After were performed by recording the heart rate variability and applied Pittsburg questionnaires, Beck anxiety index (BAI), and Beck depression index (BDI). The global PSQI score >5 indicates that a person is a poor sleeper, the patients were divided according to the scores in the Pittsburg questionnaire into good and poor sleepers and the differences between all variables were analyzed. Results: Forty-eight patients were evaluated and the prevalence of 68.7% (n=33) of poor sleep quality was verified. From the depression and anxiety questionnaires, it was found that only 18.7% (n=9) had criteria for depression. In the analysis of the sympathetic dysfunction parameters, it was found that in the group with good sleep quality in the frequency domain (HFm2) and the LFnu in the group with worse sleep quality. There was a positive correlation between sleep quality scores the anxiety and depression scores. It is also verified that the variables LFnu had a positive correlation with higher scores of quality of sleep and HFnu had a negative correlation with the highest scores of quality of sleep. Conclusion: In patients undergoing hemodialysis, the poorest quality of sleep is correlated with worse cardiac autonomic modulation as well as higher scores on the depression and anxiety scales.

A Case-control Study of Exercise and Kidney Disease: Hemodialysis and Transplantation.

We aimed to analyze the effect of an exercise training program in autonomic modulation, and exercise tolerance of hemodialysis and kidney-transplanted patients. 4 groups of exercised and non-exercised patients undergoing hemodialysis and kidney-transplanted subjects had their biochemical tests, and heart rate variability evaluations analyzed. Also, sleep quality, anxiety and depression questionnaires were evaluated. Both exercised groups showed improvements in cardiovascular autonomic modulation, biochemical markers, and exercise tolerance after the exercise training program. The exercised kidney-transplanted patients group showed better improvements in cardiovascular autonomic modulation, biochemical markers, and exercise tolerance when compared to the exercised hemodialysis patients group. Both groups showed improvements in sleep quality, anxiety, and depression. The group of kidney-transplanted patients show better results in the cardiovascular autonomic modulation than subjects undergoing hemodialysis. However, the patients undergoing hemodialysis showed improvements in blood pressure, HDL, hemoglobin and phosphorus, changes not observed in the kidney-transplanted group. Exercise is beneficial for both hemodialysis and kidney-transplanted patients groups. However, exercise programs should be focused mainly in improving cardiovascular risk factors in the HD patients.

Effect of exercise training in heart rate variability, anxiety, depression, and sleep quality in kidney recipients: A preliminary study.

The aim of this study was to compare the sleep quality, depression, anxiety, and autonomic function of a group of kidney-transplanted recipients who joined a combined exercise program (KTRt) or remained sedentary (KTRs). A total of 20 kidney-transplanted recipients, split into two groups (10 KTRt and 10 KTRs), joined the study. Heart rate variability, cardiorespiratory capacity, depression, and sleep questionnaires were evaluated. KTRt presented lower Pittsburgh Sleep Quality Index and greater entropy, and increased parasympathetic and decreased sympathetic modulation than KTRs. Anxiety level was minimal and depression was absent in both groups. KTRt group presented better sleep quality and better autonomic modulation than KTRs.