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. 2013 Jan;17(1):50-8.
doi: 10.1111/j.1542-4758.2012.00726.x. Epub 2012 Jul 20.

Physical activity and self-reported symptoms of insomnia, restless legs syndrome, and depression: the comprehensive dialysis study

Shuchi Anand  1 , Kirsten L Johansen, Barbara Grimes, George A Kaysen, Lorien S Dalrymple, Nancy G Kutner, Glenn M Chertow
Affiliations

Physical activity and self-reported symptoms of insomnia, restless legs syndrome, and depression: the comprehensive dialysis study

Shuchi Anand et al. Hemodial Int. 2013 Jan.

Abstract

Symptoms of sleep and mood disturbances are common among patients on dialysis and are associated with significant decrements in survival and health-related quality of life. We used data from the Comprehensive Dialysis Study (CDS) to examine the association of self-reported physical activity with self-reported symptoms of insomnia, restless legs syndrome (RLS), and depression in patients new to dialysis. The CDS collected data on physical activity, functional status, and health-related quality of life from 1678 patients on either peritoneal (n = 169) or hemodialysis (n = 1509). The Human Activity Profile was used to measure self-reported physical activity. Symptoms were elicited in the following manner: insomnia using three questions designed to capture difficulty in initiating or maintaining sleep, RLS using three questions based on the National Institutes of Health workshop, and depression using the two-item Patient Health Questionnaire. We obtained data on symptoms of insomnia and depression for 1636, and on symptoms of RLS for 1622 (>98%) patients. Of these, 863 (53%) reported one of three insomnia symptoms as occurring at a persistent frequency. Symptoms of RLS and depression occurred in 477 (29%) and 451 (28%) of patients, respectively. The Adjusted Activity Score of the Human Activity Profile was inversely correlated with all three conditions in models adjusting for demographics, comorbid conditions, and laboratory variables. Sleep and mood disturbances were commonly reported in our large, diverse cohort of patients new to dialysis. Patients who reported lower levels of physical activity were more likely to report symptoms of insomnia, RLS, and depression.

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Figures

Figure 1
Figure 1. Frequency of Insomnia symptoms in the CDS
Data were available for 1636 (>99%) of the participants. Abbreviations: CDS-Comprehensive Dialysis Study.
Figure 2
Figure 2. Overlap of symptoms of insomnia, RLS and depression in the CDS
Insomnia (defined here as at least one of the insomnia symptoms reported as occurring “all or most of the time”) was most common in the analytic cohort. Nine percent of the cohort reported all three symptoms. Participants reporting insomnia reported RLS, depression, or both symptoms concurrently 19%, 22% and 16% of the time, respectively. Abbreviations: CDS-Comprehensive Dialysis Study, RLS-Restless legs syndrome.
Figure 3a
Figure 3a. The associations among symptoms of insomnia and Adjusted Activity Score from the Human Activity Profile
Median Adjusted Activity Scores are lowest for participants who reported insomnia symptoms to be occurring all or more the time.
Figure 3b
Figure 3b. The association between RLS and Adjusted Activity Score, and depression and Adjusted Activity Score
Median Adjusted Activity Scores are lower for participants who reported RLS or depression, compared with participants who did not report these symptoms. Abbreviations: RLS-Restless legs syndrome. PHQ-2: Patient Health Questionnaire-2.
See this image and copyright information in PMC

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