The Study Overview
This two-week study on the link between the patients undergoing hemodialysis and sleep disorders evaluated twelve patients in a medical facility in New York. The research involved the patients putting on Fitbit device every evening. They also had to have smartphones. They then downloaded the information and synced it with cell phones every morning. The data in the Fitbit devices then showed the time of the night the subject was sleeping soundly and the time was awake.
The author of this study (Daniel Shasha) has a Ph.D. in hematology. He has a teaching, practice and research experience spanning over thirty years. He authored more than 50 medical journals and articles most of which have been cited more than a hundred times.
Many patients undergoing dialysis more especially the end-stage renal disease (ESRD) suffer from sleep disorders. This study, therefore, aims at investing in the relationship between hemodialysis and sleep disorders. The study will use ten subjects in a medical facility in New York. They will wear a FitBit machine and remove it in the morning and then download the data obtained for analysis.
Title Appropriate to Study
The title of the study is relevant because it tries to find out the existing direct link between hemodialysis and sleep disorders
Good sleep quality is subjectively defined as the perception of one falling asleep quickly and getting enough time to rest to rise feeling rested. The rest will make one get through the day without any experience of sleepiness during the day. The rate of prevalence of abnormalities in sleep is high among those with end-stage renal diseases (ESRD) about the population in general. (1)The poor quality of sleep is the major contributor to the quality of life amongst the patients under hemodialysis. (1) The sleep disorders are prevalent amongst the ESRD patients, and it is one of the most typical symptoms having a prevalence of 44 %.( 3) Sleep disorders have tremendous effects on the African Americans more than the Caucasians. (4) More than 70 sleep disorders have been described, and they are managed effectively provided a proper diagnosis is made (5) (Hamzi, 2017). The most common sleep disorders are Obstructive sleep apnea and insomnia. The estimations of the World Health Organization show that (WHO) one in every four women and one in every five men who are aged between the ages of 64 and 74 suffer CKD (Chronic kidney diseases. With the ESRD increasing burden, extra attention should be given to all the aspects of the patients for their well-being.
Problem Statement/Justification/ Statement of Purpose(s)
To improve their quality of life in these patients the quality of sleep, as well as the treatment of the disorders, should be given priority. Since there has been an increase of the number of patients undergoing hemodialysis which has increased the number of patients experiencing sleep disorders this study will endeavor to get accurate quantitative data on the severity of sleep disorders on patients undergoing hemodialysis.
The examination of 1023 subjects done by Carroll, Irwin, Merkin, and(2015) found out that patients who either had long or short sleep were at risk tissue multisystem regulation. They, therefore, recommended that a thorough assessment of the quantity and quality of sleep should be integral in the evaluation of the lifestyle factors which are associated with sickness. The current estimate on rest is predominantly carried out in the sleep labs for the patients who have sleep apnea. According to the Hamzi, (2017) show that the lab assessments include the use of electroencephalogram, the movement of the eyes, respiration, behaviors changes, heart rate, and legs and the chin.
Outside the laboratory setting, the assessments are also done using studies like the (PSQI) the Pittsburg Sleep Quality Index in the hospital setting (O'Brien, 2014).In responding to the concerns raised on the effects of sleep disorder the(CDC) Center for Disease Control and Prevention in the United States under the leadership of Giles began a project on the national health awareness in 2013 with the aim of improving the sleep surveillance using new techniques and metrics. The focus created the attention of the media which has increased the awareness and made the health providers come up with effective methods of assessing sleep. According to Painter (2013), the sleep medicine division director at Harvard University recommends that the best way is to track sleep even by using imperfect devices so that more people can realize the importance of a shut-eye.
Pedruzzi et al., (2015) posits that some of the contributing factors which make the patients receiving hemodialysis suffer from sleep abnormalities include the overload of fluids in the upper airway which leads to occlusion and edema together with the muscle relaxation due to neuropathy and uremia. Some other evidence from studies implicates the carbon dioxide in the dialysis as one of the causes of hypocarbia, uremic toxins and metabolic acidosis which leads to apnea in the patients undergoing hemodialysis(Pedruzzi et al., 2015).An earlier study conducted by Pedruzzi, StocklerPinto,
Wu, (2018) posits that the role of cytokines (the molecules that help in communication between the cells in response to immunes) was discussed as one of the causes of obstructive sleep apnea. The other factors that studies have shown cause insomnia in hemodialysis patients include obesity, gender, advanced age, the length of time on dialysis, anemia. The changes in the circadian patterns due to the temperature of the body, the elevation of the parathyroid hormone and the intake of stimulants. The other factors include the changes in the melatonin levels, use of alcohol and the rise in orexin levels (Perlis, Corbitt, & Kloss, 2014). The literature is relevant to nursing because the healthcare workers more especially the nurses have been grappling with the link between sleep disorders and patients undergoing hemodialysis as well as how to manage them.
The solving of sleep issues in patients undergoing hemodialysis earlier would reduce hospitalization and therefore the reduced utilization of the healthcare services. Patients undergoing hemodialysis have been associated with a sleep disorder. Since there has been an increase of the number of patients undergoing hemodialysis which has increased the number of patients experiencing sleep disorders this study will endeavor to get accurate quantitative data on the severity of sleep disorders on patients undergoing hemodialysis (Kosmadakis & Medcalf, 2008). The study will try to answer the following questions:
- What is the link between the patients undergoing hemodialysis and sleep disorders?
- What is the percentage of patients who undergo dialysis get sleep disorders?
- What are the factors that contribute to sleep disorders in hemodialysis patients?
Ethical Considerations and Concerns Present
Since the study was involving human participants, it was conducted in a way that respected the safety rights and the dignity of the subjects. The principle of that is accepted clinically, epidemiologically and ethically accepted and which meets the international and World Health Organization (WHO) were met (In Elswick,2017). There were no ethical issues raised during the study.
To quantify sleep disorders, ten patients receiving hemodialysis will be assessed after getting the approval from the medical director of that facility. Approval will also be sought from the Academic institutional view Board. The choice of the case study method was because it is cost effective in providing a first look that will assist in quantifying the sleep issues In (Elswick, 2017). There will be an examination of the medical records though it will be restricted to verification that the subjects have received hemodialysis for at least one year.
The setting of the study will be an inpatient and outpatient hospital in New York with a dialysis center with a capacity of twelve patients. The hospital has a patient population which is racially and ethnically diverse as well as old, and that was a contributing factor in its choice.
The inclusion criteria entail one having received hemodialysis for at least one year and should not have any documentation of sleep disorders. He subjects should also agree to put on the Fitbit device tracker and be in possession of a smartphone and make and acknowledge downloading and syncing data with the cell phone. An additional inclusion was the evening dialysis because there were fewer variables that would alter the sleep of the patient after completing the hemodialysis ( In Elswick, 2017). The choice of ten subjects was due to the constraint of time as well as the availability of funds for the purchase of Fitbit machines.
The collection of data was done within two weeks. The subjects had to complete the VAS every morning wear a Fitbit every evening. The data from the Fitbit was then uploaded and then synced to iPhones and personal computers using the Bluetooth TM. The information was then displayed in the form of graphs and charts which then would be analyzed online. The tables indicated the efficiency of the subject's sleep in percentages (Flamm & Luisi,2013. The time they sleep and the time they were awake were indicated in hours as well as in minutes.
The report on the Subject's Fitbit showed the time the subject woke up between 2:00 and 4:00 pm. The data showed that the subjects were sleeping soundly between 4:00 and 5:00 am (Flamm & Luisi,2013). When the subjects underwent hemodialysis the wake-up time was more pronounced which resulted in a mere 6.5 hours of sleep which translates to 64% sleep.
The study shows that there is a direct link between patients undergoing hemodialysis and their sleep patterns. The results are in sync with previous studies which showed the same connection with a percentage of 70. The study published in the World Journal of Nephrology in 2016 shows the same results though their percentage was 70. The European Respiratory Journal 2015, evaluated 90 subjects and found the percentage of sleep disorder at 45%. Further studies with a global dimension are required to find out the exact percentage link. The current findings, however, will be helpful to health care practitioners so that they can come up with methods of mitigating the problem.
Carroll, J.E., Irwin, M.R., Merkin, S.S., & Seeman, T.E. (2015). Sleep and multisystembiological risk: A population-based study. PLoS ONE, 10(2), 1-1
Flamm, J., & Luisi, T. (2013). Reliability Data Collection and Analysis. Dordrecht: Springer Netherlands.
Hamzi, M., Hassani, K., Asseraji, M., & El Kabbaj, D. (2017). Insomnia in hemodialysis patients: A multicenter study from Morocco. Saudi Journal of Kidney Diseases and Transplantation, 28(5), 1112. doi:10.4103/1319-2442.215152
In Elswick, S. E. (2017). Data collection: Methods, ethical issues, and future directions.
Kosmadakis, G.C., & Medcalf, J.F. (2008). Sleep disorders in dialysis patients. International Journal of Artificial Organs, 31(11), 919-927.
O'Brien, D. (2014). Industry news: Taking sleep public. Sleep Review. Retrieved from http://www. sleepreviewmag.com/2014/08/ taking-sleep-public-CDC-Wayne-Giles
Painter, K. (2013). Sleep-tracking gadgets raise awareness - and skepticism. USA Today. Retrieved from http:// www.usatoday.com/story/news/ nation/2013/03/24/sleep-trackingdevices/2007085
Pedruzzi, L. M., Stockler-Pinto, M. B., Leite, M., & Mafra, D. (2012). Nrf2-keap1 system versus NF-kB: The good and the evil in chronic kidney dise...
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