FO025INTERVENTIONS TO IMPROVE SLEEP QUALITY IN PEOPLE WITH CHRONIC KIDNEY DISEASE: A COCHRANE SYSTEMATIC REVIEW

Abstract

Introduction: Sleep duration and quality is commonly decreased in people with chronic kidney disease (CKD) and sleep disorders are often presented even in the early stages of CKD. The prevalence rate of any sleep disorder in CKD ranges from 45% to 80% in adults with end-stage kidney disease (ESKD) and affects approximately half of patients with earlier stages of CKD. People with CKD have identified the importance of research focused on better treatments to reduce symptoms of CKD. This Cochrane systematic review evaluates the benefits and harms of interventions to improve sleep quality for adults or children with CKD. Method(s): We searched the Cochrane Kidney and Transplant specialized register for randomized trials reporting effects of treatment on sleep quality for people with CKD through to April 2018. Two authors independently screened citations for eligibility, extracted data, and assessed risk of bias using the Cochrane tool. Evidence certainty was evaluated using GRADE. Result(s): Sixty-seven studies (3427 participants) were eligible. Sixty-one studies (3201 participants) enrolled dialysis patients, three studies involved 104 transplant recipients, one study involved 63 transplant candidates, and one study (45 participants) enrolled patients with CKD. Median trial duration was 5 weeks. Mean age was 54.3 years. Interventions included acupressure, benzodiazepine therapy, cognitive-behavioral therapy, dopaminergic agonists, education, exercise, light therapy, melatonin, peritoneal dialysis technique, reflexology, relaxation techniques, telephone support, music, aromatherapy, and massage. Methodological reporting was incomplete for most studies. Relaxation techniques had very uncertain effect on sleep quality (mean difference [MD] -1.62, 95% confidence interval [CI] -5.03, 1.79; very low certainty), sleep latency (1 study), total sleep time (1 study), or sleep disturbance (1 study). Exercise had very uncertain effects on sleep quality (standardized MD -1.10, 95% CI -2.26, 0.05; very low certainty), or sleep disturbance (1 study). Acupressure compared to no treatment may improve sleep quality (MD -1.27, 95% CI -2.13, -0.40; very low certainty), sleep latency (MD -0.59, 95% CI -0.92, -0.27; moderate certainty) and sleep time (MD -0.60, 95% CI -1.12, -0.09), but had uncertain effects on sleep disturbance, sleep interruption, or sleep efficiency. However, compared with sham acupressure, acupressure had uncertain effects on sleep quality, latency, interruption, sleep time, or sleep disturbance. Effects of other interventions on sleep quality were very uncertain. Evidence in children was absent. Conclusion(s): Evidence supporting interventions to improve sleep quality for people with chronic kidney disease is very uncertain and not sufficient to inform clinical care.Copyright © 2019