**15. Summary**


additional factors play an important role in the expression of day time sleepiness in this

Benz etal reported the effects of hematocrit normalization with recombinant erythropoietin on the sleep of 10 HD patients (44). All subjects underwent an initial nocturnal polysomnogram, with seven completing a 40 minutes MWT the next day. Tests were repeated after normalization of hematocrit. Treatment resulted in a significant reduction of

SAS, RLS and PLMD are prevalent in patients with advanced kidney disease and could explain EDS, but some studies suggested that other factors related to renal disease or its

Mild elevations of BUN and creatinine in renal failure patients have been associated with increased slow wave activity in the waking EEG and abnormalities in cognitive function, which may explain the susceptibility of patients with advanced renal disease to sleepiness (54). Elevation of parathyroid hormone has been associated with increased waking EEG slow wave activity in uremic animals and stable dialysis patient (55). The metabolites of creatinine may inhibit GABA responses (in mouse neurons) and may interfere with neurotransmissions necessary for sleep to occur. These changes may destabilize the wakeful state by increasing day time sleepiness propensity and decreasing nocturnal

Treatment with dialysis may also predispose patients to sleepiness. Abnormal production of interleukin-1, TNF-alpha, factor S can increase somnolence (57, 58). Rapid removal of these sleep inducing substances has also been postulated as the cause for fragmented nocturnal sleep and resulting day time sleepiness and fatigue in one study on patients on CAPD (59). Dialysis also results in rapid change in electrolytes, acid base balance and serum osmolarity which may decrease arousal and alertness (60). Treatment with dialysis may also disrupt the circadian pattern sleepiness due to inappropriately timed elevation of serum melatonin in response to the hemoconcentration (61) or from change in rhythm of body temperature (62). Medications such as antihypertensive and antidepressants may also contribute to the EDS in

 Sleep complaints and disorders are common in patients with CKD whether on dialysis or not and are characterized by difficulty in initiating and maintaining sleep,

 Polysomnographic studies have demonstrated that dialysis patients have overall decreased quantity and quality of sleep, suggesting that behavioral interventions such

SAS has been effectively treated with CPAP in patients with chronic kidney disease and

 RLS and PLMD are also very common and are associated increased mortality in patients on dialysis. Treatments include correcting anemia, iron deficiency and

as sleep hygiene and the appropriate use of medications may be helpful. Most common sleep disorders in CKD patients include SAS, RLS, and PLMD.

restless/jerking legs, and daytime sleepiness.

ESRD. Switching from CHD to NHD may also be useful.

nocturnal periodic limb movements and improvement on the MWT.

treatment may contribute to EDS (52, 53).

group (65).

sleep (56).

CKD patients.

**15. Summary** 

dopamine agonists.

