Abstract

BACKGROUND: Chronic Kidney Disease is one of the leading global health problems affecting millions of persons, with a prevalence of 13.4% and an estimated 697.5million people living with the condition. Patients on maintenance haemodialysis have been shown to have a higher prevalence of sleep disorders compared to the general population. Studies done in Cameroon have shown high prevalence of insomnia among maintenance hemodialysis patients as high as 76.1%.

OBJECTIVE: Our objective was to determine the burden of sleep disorders in maintenance hemodialysis patients, determine the prevalence of the specific sleep disorders and compare them in the case and control groups, and find out the factors associated with these sleep disorders in patients on maintenance hemodialysis.

METHODS: 136 participants were recruited from the dialysis center and general population. All patients completed a structed questionnaire for diagnosis of sleep disorders. 71 maintenance dialysis patients (cases) were then compared with 65 non-dialysis patients (controls).

RESULTS: Overall prevalence of sleep disorders was 91.5% in the case group and 52.3% in the control group. For the case group, we had the following prevalence findings; insomnia (70.4%), EDS (50.7%), Risk of OSA (63.4%) and RLS (36.6%). Among the control population, the prevalence was as follows; insomnia (32.3%), EDS (26.2%), Risk of OSA (12.5%), and RLS (13.8%). Anxiety, depression and marital status were significantly associated with insomnia. BMI, anxiety and a Risk of OSA were significantly associated with EDS. Age was found to be associated with RLS.

Age, gender and marital status were also significantly associated with a risk of OSA.

CONCLUSION: the burden of sleep disorders is high in hemodialysis patients. The most common sleep disorder in the two groups of patients was insomnia. Attention should be paid to modifiable risk factors for these sleep disorders such as anxiety and depression, which are also common in hemodialysis patients.

CHAPTER ONE

INTRODUCTION

1.1 Background

Chronic Kidney Disease (CKD) is a global health problem affecting millions of persons, with increasing prevalence worldwide [1,3]. The global prevalence of CKD is estimated at 13.4% (11.7-15.1) and patients with end-stage renal disease (ESRD) needing renal replacement therapy are estimated to be between 4.902 and 7.083 million[1].

It is estimated that the number of patients diagnosed with the disease continues to increase at a rate of 5-7% per year[2]. Persons living with CKD generally have a higher risk of substantial complications, including progression to End-Stage Renal Disease (ESRD), cardiovascular disease, neuropathic disease, stroke and seizures (with severe uraemia), and complex symptoms such as fatigue, impotence and insomnia [3,4]. CKD causes millions of deaths worldwide, accounting for approximately 1.2 million deaths yearly [5].

Despite significant care, morbidity and mortality in patients on maintenance haemodialysis (MHD) is still high, with cardiovascular disease accounting for 44% of overall mortality in these patients[6]. Management of ESRD is via renal replacement therapy (RRT), with the most common modality used being haemodialysis.

The burden of CKD in Sub-Saharan Africa is rising, with the main modality of RRT for end-stage kidney disease being haemodialysis. It has been shown globally that sleep disorders are a common occurnence in end stage renal disease patients who are on maintenance hemodialysis. Very little data is available about sleep disorders in CKD patients in Sub-Saharan Africa and Cameroon as a whole. In a study conducted at the Douala General Hospital, 76.1% of hemodialyzed CKD patients reported poor sleep quality[7,8]. This study, therefore, seeks to provide data on the burden of sleep disorders amongst patients undergoing haemodialysis at the BRH.

1.2 Problem Statement

Global prevalence of CKD is on the rise, with Cameroon not left out. It is estimated that 1 in 10 adults in Cameroon have chronic kidney disease (diagnosed or undiagnosed) [9]. It has been shown that sleep disorders are more common in CKD patients, hence reducing their quality of life [10]. It is therefore important that we assess the degree to which sleep disorders are a burden to CKD patients, which might help in developing better management plans for these patients.

1.3 Justification

In Cameroon, there exist very limited studies that describe the burden and prevalence of sleep disorders in CKD patients undergoing haemodialysis. In carrying out this study, the prevalence of sleep disorders will be determined, and related factors will be identified. It will also provide baseline data that could be used by healthcare providers and policymakers in making better management plans for these patients.

1.4 Research Questions

1. What is the overall burden of sleep disorders?
2. What is the prevalence of sleep disorders amongst patients on maintenance HD at the Buea Regional Hospital Hemodialysis Center and patients who are not on maintenance hemodialysis?
3. Is there a significant difference between the prevalence in these two groups of patients?
4. What are the factors associated with sleep disorders in patients on maintenance HD at the Buea Regional Hospital Hemodialysis Center?

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