Content area
Full text
Keywords. hemodialysis, sleep disorders, clonazepam, zolpidem
Introduction. Poor sleep quality is very common among maintenance hemodialysis patients and has negative impacts on patients' quality of life. Benzodiazepines have traditionally been used in this population; however, they may induce physical dependence and sleep apnea. Nonbenzodiazepine hypnotic medications with less side effects are introduced as alternatives. This study was designed to compare the effect of zolpidem and clonazepam on sleep quality of hemodialysis patients.
Materials and Methods. In a randomized crossover study on 23 hemodialysis patients, sleep quality was assessed using the Pittsburgh Sleep Quality Index at baseline, at the initiation of a 1-week washout period after a 2-week treatment with zolpidem (1 mg) and clonazepam (5 mg to 10 mg), and after the second 2 weeks of treatment. Patients who suffer from any concurrent situations that may affect sleep quality or psychiatric disorders and those on medications affecting sleep quality were excluded.
Results. The prevalence of poor sleep quality was 87.8% of the 88 hemodialysis patients who were initially approached. There was a significant negative correlation between iron deficiency and poor sleep quality. Both clonazepam and zolpidem significantly improved sleep quality; however, clonazepam was more effective in decreasing the Pittsburgh Sleep Quality Index scores (P = .03). Zolpidem was better tolerated in the hemodialysis patients.
Conclusions. Clonazepam was more effective than zolpidem in the improvement of sleep quality of hemodialysis patients, while zolpidem was better tolerated in these patients.
IJKD 2011;5:404-9
www.ijkd.org
INTRODUCTION
Sleep disorders, in particular poor sleep quality, are widespread problems in maintenance hemodialysis patients.1,2 The prevalence of poor sleep quality in hemodialysis patients was estimated to be 41% to 83%.3-7 Poor sleep quality has negative impacts on patients' quality of life. After a while, these sleep disturbances may lead to "day-night reversal," ie, insomnia at night and sleepiness during the day; headache; depression; and declined functional capacity. Moreover, it has recently been shown that poor-quality sleep caused by periodic limb movements and their related arousals is an important predictor of mortality in patients with end-stage renal disease.8
Different strategies have been applied to improve patients' sleep quality, among which physical activity in the form of intradialytic aerobic training showed to have a positive influence on the sleep disorder of hemodialysis patients.9...