Sleep Quality and Compliance to Medical Therapy Among Hemodialysis Patients With Moderate-to-Severe Depression: A Cross-Sectional Study.

Abstract

BackgroundDepression is a fairly common finding among end-stage renal disease (ESRD) patients and is an independent risk factor for morbidity and mortality. The psychiatric manifestations of the disease may affect their compliance to medications and alter sleep quality that is often overlooked. This translates into poor quality of life and poorer disease prognosis. Our study aims to assess the prevalence of depression and its association with compliance to medical therapy and sleep quality among ESRD patients on hemodialysis.MethodologyIn this cross-sectional study, a total of 288 hemodialysis patients with a confirmed diagnosis of ESRD were evaluated for depression using Patient Health Questionnaire-9 (PHQ-9) scale. Only patients with moderate-to-severe depressive symptoms on PHQ-9 were further evaluated for sleep quality and compliance to medications using Pittsburgh Sleep Quality Index (PSQI) and Drug Attitude Inventory-10 (DAI-10), respectively. The characteristics of ESRD patients with depression were also assessed. Median PHQ-9, DAI-10, and PSQI scores were calculated, and the correlation between study variables was assessed using Spearman’s correlation.ResultsOf the 288 included participants, 188 (65.27%) had depression as evaluated via PHQ-9. Of these 188 patients, 114 were males while 74 were females. A total of 113 (60.01%) of depressed patients had poor compliance to medication while 137 (72.87%) patients had poor sleep quality. Higher PHQ-9 scores were positively correlated with disease duration, dialysis years, and time between diagnosis and therapy (r = 0.41, 0.39, and 0.43, respectively) and negatively with marital and employment status (r = -0.32 and -0.49, respectively). Spearman’s correlation showed a significant negative correlation of PHQ-9 scores with DAI-10 scores but a significant positive correlation with PSQI scores. The correlation between DAI-10 and PSQI was a significant negative correlation.ConclusionsThis study indicated a high prevalence of moderate-to-severe depression among ESRD patients on hemodialysis. Poor sleep quality and non-adherence to medications are frequent among ESRD patients with depression. These psychiatric components must be considered to optimize medical treatment and improve the quality of life in this subset of patients. More studies should be conducted to assess the risk factors of depression in patients with ESRD.