Nocturnal sleep, daytime sleepiness, and quality of life in stable patients on hemodialysis

BACKGROUND: Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we studied a sample of stable HD patients to explore relationships between quality of life and both subjective and objective measures of nocturnal sleep and daytime sleepiness METHODS: The sample included forty-six HD patients, 24 men and 22 women, with a mean age of 51.6 (10.8) years. Subjects underwent one night of polysomnography followed the next morning by a Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Subjects also completed: 1) a brief nocturnal sleep questionnaire; 2) the Epworth Sleepiness Scale; and, 3) the Quality of Life Index (QLI, Dialysis Version) which provides an overall QLI score and four subscale scores for Health & Functioning (H&F), Social & Economic (S&E), Psychological & Spiritual (P&S), and Family (F). (The range of scores is 0 to 30 with higher scores indicating better quality of life.) RESULTS: The mean (standard deviation; SD) of the overall QLI was 22.8 (4.0). The mean (SD) of the four subscales were as follows: H&F – 21.1 (4.7); S&E – 22.0 (4.8); P&S – 24.5 (4.4); and, F – 26.8 (3.5). H&F (r(s )= -0.326, p = 0.013) and F (r(s )= -0.248, p = 0.048) subscale scores were negatively correlated with periodic limb movement index but not other polysomnographic measures. The H&F subscale score were positively correlated with nocturnal sleep latency (r(s )= 0.248, p = 0.048) while the H&F (r(s )= 0.278, p = 0.030) and total QLI (r(s )= 0.263, p = 0.038) scores were positively associated with MSLT scores. Both of these latter findings indicate that higher life quality is associated with lower sleepiness levels. ESS scores were unrelated to overall QLI scores or the subscale scores. Subjective reports of difficulty falling asleep and waking up too early were significantly correlated with all four subscale scores and overall QLI. Feeling rested in the morning was positively associated with S&E, P&S, and Total QLI scores. CONCLUSION: Selected measures of both poor nocturnal sleep and increased daytime sleepiness are associated with decreased quality of life in HD patients, underscoring the importance of recognizing and treating these patients' sleep problems

Moderators and Mediators of Exercise-Induced Objective Sleep Improvements in Midlife and Older Adults With Sleep Complaints

Objective: Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints. Methods: Participants (N ϭ 66, 67% women, 55-79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, selfreported global sleep quality, and physical activity levels. Putative mediators were changes in BMI, depressive symptoms, and physical function at 6 months. Initially less active individuals with higher initial physical function and poorer sleep quality improved the most. Affective, functional, and metabolic mediators specific to sleep architecture parameters were suggested. These results indicate strategies to more efficiently treat poor sleep through exercise in older adults

Measuring Circadian Advantage in Major League Baseball: A 10-Year Retrospective Study

Purpose: The effect of travel on athletic performance has been investigated in previous studies. The purpose of this study was to investigate this effect on game outcome over 10 Major League Baseball (MLB) seasons. Methods: Using the convention that for every time zone crossed, synchronization requires 1 d, teams were assigned a daily number indicating the number of days away from circadian resynchronization. With these values, wins and losses for all games could be analyzed based on circadian values. Results: 19,079 of the 24,121 games (79.1%) were played between teams at an equal circadian time. The remaining 5,042 games consisted of teams playing at different circadian times. The team with the circadian advantage won 2,620 games (52.0%, P = .005), a winning percentage that exceeded chance but was a smaller effect than home field advantage (53.7%, P < .0001). When teams held a 1-h circadian advantage, winning percentage was 51.7% (1,903-1,781). Winning percentage with a 2-h advantage was 51.8% (620-578) but increased to 60.6% (97-63) with a 3-h advantage (3-h advantage > 2-hadvantage = 1-h advantage, P = .036). Direction of advantage showed teams traveling from Western time zones to Eastern time zones were more likely to win (winning percentage = .530) than teams traveling from Eastern time zones to Western time zones (winning percentage = .509) with a winning odds 1.14 (P = .027). Conclusion: These results suggest that in the same way home field advantage influences likelihood of success, so too does the magnitude and direction of circadian advantage. Teams with greater circadian advantage were more likely to win