Cognitive-Behavioral Therapy for Sleep Disturbance in Patients Undergoing Peritoneal Dialysis: A Pilot Randomized Controlled Trial

Chen, Hung-Yuan; Chiang, Chih-Kang; Wang, Hsi-Hao; Hung, Kuan-Yu; Lee, Yue-Joe; Peng, Yu-Sen; Wu, Kwan-Dun; Tsai, Tun-Jun

doi:10.1053/j.ajkd.2008.03.012

« Previous Next »American Journal of Kidney Diseases
Volume 52, Issue 2 , Pages 314-323, August 2008

Cognitive-Behavioral Therapy for Sleep Disturbance in Patients Undergoing Peritoneal Dialysis: A Pilot Randomized Controlled Trial

Hung-Yuan Chen, MD
- Department of Internal Medicine, Division of Nephrology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Chih-Kang Chiang, MD, PhD
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Hsi-Hao Wang, MD
- Department of Internal Medicine, Division of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
Kuan-Yu Hung, MD, PhD
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Yue-Joe Lee, MD
- Department of Psychiatry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Yu-Sen Peng, MD
- Department of Internal Medicine, Division of Nephrology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Kwan-Dun Wu, MD, PhD
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Tun-Jun Tsai, MD, PhD
- Department of Internal Medicine, Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Address correspondence to Tun-Jun Tsai, MD, PhD, Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan.

Received 10 October 2007; accepted 10 March 2008. published online 30 May 2008.

Background

Greater than 50% of dialysis patients experience sleep disturbances. Cognitive-behavioral therapy (CBT) is effective for treating chronic insomnia, but its effectiveness has never been reported in peritoneal dialysis (PD) patients and its association with cytokines is unknown. We investigated the effectiveness of CBT in PD patients by assessing changes in sleep quality and inflammatory cytokines.

Study Design

Randomized control study with parallel-group design.

Setting & Participants

24 PD patients with insomnia in a tertiary medical center without active medical and psychiatric illness were enrolled.

Intervention

The intervention group (N = 13) received CBT from a psychiatrist for 4 weeks and sleep hygiene education, whereas the control group (N = 11) received only sleep hygiene education.

Outcomes & Measurements

Primary outcomes were changes in the Pittsburgh Sleep Quality Index and Fatigue Severity Scale scores, and secondary outcomes were changes in serum interleukin 6 (IL-6), IL-1β, IL-18, and tumor necrosis factor α levels during the 4-week trial.

Results

Median percentages of change in global Pittsburgh Sleep Quality Index scores were −14.3 (interquartile range, −35.7 to − 6.3) and −1.7 (interquartile range, −7.6 to 7.8) in the intervention and control groups, respectively (P = 0.3). Median percentages of change in global Fatigue Severity Scale scores were −12.1 (interquartile range, −59.8 to −1.5) and −10.5 (interquartile range, −14.3 to 30.4) in the intervention and control groups, respectively (P = 0.04). Serum IL-1β level decreased in the intervention group, but increased in the control group (P = 0.04). There were no significant differences in changes in other cytokines.

Limitations

This study had a small number of participants and short observation period, and some participants concurrently used hypnotics.

Conclusions

CBT may be effective for improving the quality of sleep and decreasing fatigue and inflammatory cytokine levels. CBT can be an effective nonpharmacological therapy for PD patients with sleep disturbances.

Index Words: Cognitive-behavioral therapy, insomnia, interleukin 1β, interleukin 18, tumor necrosis factor α