Do Brief Mindfulness Interventions (BMI) and Health Enhancement Programs (HEP) Improve Sleep in Patients in Hemodialysis with Depression and Anxiety?

Paola Lavin,Ahsan Alam,Istvan Mucsi,Elizaveta Solomonova,Elena Dikaios,Outi Linnaranta,Rita S Suri,Helen Noble,Rim Nazar,Soham Rej,Zoe Thomas,Clare Mc Veigh,Angela Potes,Marta Novak,Marouane Nassim,Mark Lipman,Susana Torres-Platas,Emilie Trinh

doi:10.3390/healthcare9111410

Abstract

(1) Objective: to determine if a brief mindfulness intervention (BMI) and a health education program (HEP) could improve measures of insomnia in patients undergoing hemodialysis. (2) Methods: this was a planned secondary analysis of a randomized controlled trial of BMI vs. HEP for hemodialysis patients with depression and/or anxiety symptoms. The primary outcome for the analysis was the Athens Insomnia Scale (AIS). The secondary outcome was consolidation of daily inactivity (ConDI), an actigraphy measure that describes sleep continuity and is based on a sleep detection algorithm validated by polysomnography. We also explored whether changes in AIS and ConDI were associated with changes in depression, anxiety, and quality of life scores over 8-week follow-up. (3) Results: BMI and HEP groups did not differ significantly from one another. Exposure to BMI or HEP improved sleep quality (baseline AIS 9.9 (±5.0) vs. 8-week follow-up 6.4 (±3.9), (V = 155.5, p = 0.015)), but not ConDI. Improvements in AIS were associated with lower depression scores (Rho = 0.57, p = 0.01) and higher quality-of-life scores (Rho = 0.46, p = 0.04). (4) Conclusions: mindfulness and HEP may be helpful interventions to improve self-reported sleep quality in patients undergoing hemodialysis. Decreases in insomnia scores were associated with decreased depression symptoms and increased quality of life scores.

Highlights

Sleep disorders are common in dialysis patients with a mean prevalence of 60% [1], while the prevalence observed in the general population is 4% to 29% [2]
A metaanalysis on mindfulness-based treatments for insomnia reported a reduction of symptoms and higher sleep quality compared to psychological placebos and waitlist controls [14]
We explored whether change in Athens Insomnia Scale (AIS) and change in consolidation of daily inactivity (ConDI) were associated with changes in depression (PHQ-9), anxiety (GAD-7) and quality of life at 8-week followup

Summary

Introduction

Sleep disorders are common in dialysis patients with a mean prevalence of 60% [1], while the prevalence observed in the general population is 4% to 29% [2]. Sleep problems are often attributed to a large body mass index, inflammatory status, low nutritional indices, comorbid anxiety or depression, inadequate dialysis, and overnight rostral fluid shift [5]. Pharmaceutical treatments such as sedative antidepressants and anxiolytics remain common interventions; concerns exist about habituation and complications such as drowsiness, sedation, confusion, and increased risk of falls [6,7]. Previous mindfulness-based interventions for patients receiving hemodialysis have used large group trainings, long individual sessions or a combination of these, which poses a limitation for everyday implementation.

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Discussion

Conclusion