Investigating Interventions to Improve Sleep Quality in Hemodialysis Patients: A Meta-Analysis Study

Uremic syndrome, because of chronic renal failure, causes a wide range of problems in patients. One of the most important diseases which can be mentioned is considered to be sleep disorder. The prevalence of sleep disorder has been reported to be 40-85% that can cause a decline in various systems in the body, including cardiovascular and the immune systems and can eventually lead to a decrease in life quality and may also increase the morbidity and mortality rate in these patients. Therefore, finding effective interventions in order to manage sleep disorder of these patients should be part of the comprehensive care plan of patients undergoing maintenance hemodialysis. The present study was conducted to investigate the effectiveness of interventions to improve sleep quality in hemodialysis patients.

A literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, EMBASE, ProQuest, Science Direct and Cochrane Library databases for publications up to May 2022 in order to find all studies that examined the effects of interventions (pharmacological and non-pharmacological) on sleep outcomes in hemodialysis patients. By performing meta-analysis, Standardized Mean Differences (SMD) and Confidence Intervals (CIs) of 95% were calculated for continuous outcomes using a random-effects model. The heterogeneity among studies was assessed using I2 statistic.

Totally, 15 studies with 997 participants were included in the meta-analysis. Findings reveal a positive effect of interventions on sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) score, (SMD = -1.93, 95% CI = -2.63 to -1.22, P<0.001) with a significant heterogeneity among studies (I2 = 94.9%, P<0.001).

Based on the findings of the present meta-analysis, interventions such as acupressure, relaxation techniques, pharmaceutical interventions and muscle relaxation have a positive effect on the quantity and quality of sleep of patients undergoing hemodialysis. However, due to diversity in methodological quality and the heterogeneity of the studies included in this study, it is difficult to draw definitive conclusions about the effectiveness of different intervention. As a result, the interpretation of the results should be done cautiously.