- Title
- Sleep-disordered breathing in haemodialysis
- Creator
- Chu, Ginger
- Resource Type
- thesis
- Date
- 2020
- Description
- Professional Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Patients with End Stage Kidney Disease (ESKD) often suffer from high symptom burdens that affect physical and mental health and lead to reduced quality of life. Sleep disturbance is one of the most common symptoms reported by patients with ESKD. Literature suggests up to 80% of patients with ESKD self-report sleep difficulty, and consequences of untreated sleep disturbance, particularly sleep apnoea which is strongly associated with cardiovascular diseases, depression and increased mortality. Despite this, sleep apnoea and sleep disturbance are under-recognised and under treated in the routine practice of dialysis units. Consequently, patients with ESKD continue to report/experience a high burden of sleep disturbance. There is a need for research that identifies effective ways to assess sleep apnoea and explore methods to improve sleep quality in the dialysis population. Methods: The broad aims of this thesis were to identify a practical and effective way to assess sleep apnoea and manage sleep disturbance in the dialysis population. This has been addressed in three separate but inter-related studies in this thesis. Results: The finding of the cross-sectional study (study 1) indicated that the prevalence of sleep apnoea in patients receiving haemodialysis was high; up to 70% of local patients receiving haemodialysis had an abnormal oxygen desaturation index. A large neck circumference and anaemia were the independent risk factors, and nocturnal oximetry was an adequate tool to screen for sleep apnoea in the dialysis population. The second study which employed mixed methods revealed that ESKD patients with co-existing sleep apnoea had poor sleep quality despite a weak correlation between the severity of sleep apnoea and objective sleep quality and daytime symptoms. Many patients reported broken sleep and feeling unrefreshed upon wakening and described that these symptoms had a significant impact on their physical and mental health, ability to self-manage their illness and overall health-related quality of life. This study highlighted the need to assess sleep disturbance routinely to improve health –related quality of life of patients with ESKD. The final study (a randomised cross-over trial) showed that there was no statistically difference in AHI between OL-HDF and HD. However, when sleep apnoea was stratified into obstructive and central apnoeas, patients had less obstructive episodes after treated by OL-HDF; a sensitivity analysis was performed excluding outliers, and the treatment effect for obstructive episodes was found to be statistically significant. Patient-reported outcomes and inflammatory biomarkers were not statistically different between OL-HDF and HD in this study. Conclusion: Sleep apnoea is prevalent and the impact of sleep disturbance in quality of life of ESKD patients is profound. This thesis provides new evidence into the characteristics of sleep apnoea, the effective way of screening sleep apnoea in ESKD patients. It also demonstrated the potential role of OL-HDF in sleep apnoea symptoms. Given that sleep apnoea is common in patients receiving dialysis, the findings of this thesis will have clinical implications on the management of sleep apnoea in patients with kidney disease.
- Subject
- haemodialysis; sleep; sleep-disordered breathing; sleep apnoea; chronic kidney disease; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1438220
- Identifier
- uon:40561
- Rights
- Copyright 2020 Ginger Chu
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 10 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 755 KB | Adobe Acrobat PDF | View Details Download |