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Ecological momentary assessment of fatigue, sleepiness, and exhaustion in ESKD.

Abdel-Kader K, Jhamb M, Mandich LA, Yabes J, Keene RM, Beach S, Buysse DJ, Unruh ML - BMC Nephrol (2014)

Bottom Line: In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 - 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 - 0.41].Observed associations were minimally affected by adjustment for demographics and common confounders.Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate significant daily and diurnal variation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN S-3223, Nashville, TN 37232-2372, USA. khaled.abdel-kader@vanderbilt.edu.

ABSTRACT

Background: Many patients on maintenance dialysis experience significant sleepiness and fatigue. However, the influence of the hemodialysis (HD) day and circadian rhythms on patients' symptoms have not been well characterized. We sought to use ecological momentary assessment to evaluate day-to-day and diurnal variability of fatigue, sleepiness, exhaustion and related symptoms in thrice-weekly maintenance HD patients.

Methods: Subjects used a modified cellular phone to access an interactive voice response system that administered the Daytime Insomnia Symptom Scale (DISS). The DISS assessed subjective vitality, mood, and alertness through 19 questions using 7- point Likert scales. Subjects completed the DISS 4 times daily for 7 consecutive days. Factor analysis was conducted and a mean composite score of fatigue-sleepiness-exhaustion was created. Linear mixed regression models (LMM) were used to examine the association of time of day, dialysis day and fatigue, sleepiness, and exhaustion composite scores.

Results: The 55 participants completed 1,252 of 1,540 (81%) possible assessments over the 7 day period. Multiple symptoms related to mood (e.g., feeling sad, feeling tense), cognition (e.g., difficulty concentrating), and fatigue (e.g., exhaustion, feeling sleepy) demonstrated significant daily and diurnal variation, with higher overall symptom scores noted on hemodialysis days and later in the day. In factor analysis, 4 factors explained the majority of the observed variance for DISS symptoms. Fatigue, sleepiness, and exhaustion loaded onto the same factor and were highly intercorrelated. In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 - 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 - 0.41]. Observed associations were minimally affected by adjustment for demographics and common confounders.

Conclusions: Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate significant daily and diurnal variation. The variability in symptoms may contribute to poor symptom awareness by providers and greater misclassification bias of fatigue related symptoms in clinical studies.

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Mean FSE composite scores. FSE fatigue/sleepiness/exhaustion.
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Figure 2: Mean FSE composite scores. FSE fatigue/sleepiness/exhaustion.

Mentions: The mean FSE composite scores revealed that FSE scores increased later in the day and FSE scores were modestly higher on dialysis days (Figure 2). In LMM, mean composite FSE score was associated with time of day and dialysis day (Table 4). While controlling for dialysis day, each increase in time of day (e.g., from wake-up to noon or noon to 6 pm) increased FSE composite score by 0.33 (95% confidence interval [CI] 0.25-.41). While adjusting for time of day, dialysis day was associated with a 0.21 (95% CI 0.02-0.39) point increase in FSE composite score. Inclusion of a quadratic term to model a curvilinear relationship for time of day improved model performance but did not qualitatively change model interpretation (Additional file 1: Table S3). There was no modification of the effect of time of day by dialysis day.


Ecological momentary assessment of fatigue, sleepiness, and exhaustion in ESKD.

Abdel-Kader K, Jhamb M, Mandich LA, Yabes J, Keene RM, Beach S, Buysse DJ, Unruh ML - BMC Nephrol (2014)

Mean FSE composite scores. FSE fatigue/sleepiness/exhaustion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3927224&req=5

Figure 2: Mean FSE composite scores. FSE fatigue/sleepiness/exhaustion.
Mentions: The mean FSE composite scores revealed that FSE scores increased later in the day and FSE scores were modestly higher on dialysis days (Figure 2). In LMM, mean composite FSE score was associated with time of day and dialysis day (Table 4). While controlling for dialysis day, each increase in time of day (e.g., from wake-up to noon or noon to 6 pm) increased FSE composite score by 0.33 (95% confidence interval [CI] 0.25-.41). While adjusting for time of day, dialysis day was associated with a 0.21 (95% CI 0.02-0.39) point increase in FSE composite score. Inclusion of a quadratic term to model a curvilinear relationship for time of day improved model performance but did not qualitatively change model interpretation (Additional file 1: Table S3). There was no modification of the effect of time of day by dialysis day.

Bottom Line: In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 - 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 - 0.41].Observed associations were minimally affected by adjustment for demographics and common confounders.Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate significant daily and diurnal variation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue South, MCN S-3223, Nashville, TN 37232-2372, USA. khaled.abdel-kader@vanderbilt.edu.

ABSTRACT

Background: Many patients on maintenance dialysis experience significant sleepiness and fatigue. However, the influence of the hemodialysis (HD) day and circadian rhythms on patients' symptoms have not been well characterized. We sought to use ecological momentary assessment to evaluate day-to-day and diurnal variability of fatigue, sleepiness, exhaustion and related symptoms in thrice-weekly maintenance HD patients.

Methods: Subjects used a modified cellular phone to access an interactive voice response system that administered the Daytime Insomnia Symptom Scale (DISS). The DISS assessed subjective vitality, mood, and alertness through 19 questions using 7- point Likert scales. Subjects completed the DISS 4 times daily for 7 consecutive days. Factor analysis was conducted and a mean composite score of fatigue-sleepiness-exhaustion was created. Linear mixed regression models (LMM) were used to examine the association of time of day, dialysis day and fatigue, sleepiness, and exhaustion composite scores.

Results: The 55 participants completed 1,252 of 1,540 (81%) possible assessments over the 7 day period. Multiple symptoms related to mood (e.g., feeling sad, feeling tense), cognition (e.g., difficulty concentrating), and fatigue (e.g., exhaustion, feeling sleepy) demonstrated significant daily and diurnal variation, with higher overall symptom scores noted on hemodialysis days and later in the day. In factor analysis, 4 factors explained the majority of the observed variance for DISS symptoms. Fatigue, sleepiness, and exhaustion loaded onto the same factor and were highly intercorrelated. In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 - 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 - 0.41]. Observed associations were minimally affected by adjustment for demographics and common confounders.

Conclusions: Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate significant daily and diurnal variation. The variability in symptoms may contribute to poor symptom awareness by providers and greater misclassification bias of fatigue related symptoms in clinical studies.

Show MeSH
Related in: MedlinePlus