Cognitive-Behavioral Therapy for Sleep Disturbance in Patients Undergoing Peritoneal Dialysis: A Pilot Randomized Controlled Trial
Abstract
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-1beta, IL-18, and tumor necrosis factor alpha 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-1beta 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.
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Other human studies failed to detect a reduction in total leukocyte count with sleep compared with sleep deprivation or restriction.
“Other studies failed to detect this reduction (3, 103, 122, 224, 234, 254, 469, 580).”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [103]
Blood was assessed only once per day in the bedtime extension study, which may have reduced the chance of detecting transient changes in cell numbers.
“Of note, blood was assessed only once per day, which may have reduced the chance of detecting transient changes in cell numbers.”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [103]
The amount of SWS, which may play a critical role in leukocyte subset changes, was not changed by the bedtime extension condition.
“Furthermore, the amount of SWS, which may play a critical role in leukocyte subset changes (49), was not changed by the bedtime extension condition.”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [103]
In healthy young men, increasing bedtime by 1.5 h over 6 consecutive days produced a PSG-derived total sleep time difference of ~100 min on average between extended and habitual bedtime conditions, mainly due to increases of sleep stages 1, 2, and REM sleep.
“A recent study in healthy young men increased bedtime by 1.5 h over 6 consecutive days (103). PSG-derived total sleep time between the extended bedtime condition (9 PM–7 AM) and habitual bedtime condition (10:30 PM–7 AM) differed by ~100 min on average, mainly due to increases of sleep stages 1, 2, and REM sleep in the extended bedtime condition.”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [103]
No differences were observed in lymphocyte, monocyte, or neutrophil numbers in the blood after the bedtime extension.
“However, no differences were observed in lymphocyte, monocyte, or neutrophil numbers in the blood (103).”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [103]
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- Authors
- Chen, H.-Y., Chiang, C.-K., Wang, H.-H., Hung, K.-Y., Lee, Y.-J., Peng, Y.-S., Wu, K.-D., & Tsai, T.-J.
- Affiliations
- National Taiwan University (TW)
- E-Da Hospital (TW)
- Corresponding author
- Tsai, Tun-Jun
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 52
- Issue
- 2
- Pages
- 314-323
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W2076858653
- Cited by
- 111
- References
- 30
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 8 · 2021: 3 · 2020: 7 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 8 · 2015: 6 · 2014: 6 · 2013: 3 · 2012: 5
- FWCI
- 9.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- cognitive behavioral therapy, sleep disorders, peritoneal dialysis, insomnia, sleep quality, fatigue, inflammatory cytokines, interleukin-6, IL-1β, TNF-α, sleep hygiene education, non-pharmacological treatment
- MeSH terms
- Enzyme-Linked Immunosorbent Assay, Female, Follow-Up Studies, Humans, Kidney Failure, Chronic, Male, Middle Aged, Peritoneal Dialysis, Pilot Projects, Prospective Studies, Sleep, Sleep Wake Disorders, Time Factors, Cognitive Behavioral Therapy, Cytokines, Treatment Outcome
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