Sleeping disorders are very common in patients with
chronic kidney disease on dialysis (CKD5D) and are an emerging risk factor able to predict mortality.
Parathyroid hormone (PTH) although considered a pivotal uremic toxin has rarely been associated with
sleep disorders in
uremia. In a study from our laboratory PTH concentrations failed to distinguish patients with
sleep disorders from those without. In a study performed by Chou et al a 97% prevalence of
insomnia was found in patients undergoing
hemodialysis requiring
parathyroidectomy. Surgery reduced PTH and increased sleeping hours within 3 months. The aim of this study was to study the effects of
parathyroidectomy on the
sleep disorders of insomniacs on maintenance
hemodialysis. The study was performed in 16 insomniac patients on maintenance
hemodialysis who successfully underwent surgery with
autotransplantation of autologous parathyroid tissue (40 mg) under the skin of the forearm. Patients (5 F and 11 M) were studied from 1 month before surgery to 1 year after.
Sleep disorders were assessed by means of a 27-item questionnaire--
Sleep Disorder questionnaire (SDQ)--that identified sleeping disorders according to Diagnostic and Statistical Manual of Mental Disorders - IV Edition (DSM-IV) criteria. The Charlson Comorbidity Index (CCI) was also measured along with systolic and diastolic blood pressure, Hb, PTH, Ca, P. A 95.5% prevalence of
sleep disorders was found pre operatively. Patients slept 4.90+/-1.2 hours, Ca averaged 10.09+/-0.54 mg/dL,
Phosphate 5.5+/-1.93, CCI 9.8+/-1.1, PTH 1498+/-498 ng/mL. After 1 year follow-up 2 out 16 patients had normal sleep, 6 out 16 patients had subclinical
sleep disorders and 8 remained insomniacs (p=0.008, Mc Nemar Test for paired data, insomniacs vs. no disturbance + subclinical disorders). Sleeping hours increased up to 6.0+/-1.24 (p<0.05), PTH was normalized, the Charlson Comorbidity Index was reduced (p<0.05) as were plasma
calcium and
phosphate (p<0.01). The study indicates that
insomnia in patients with severe
hyperparathyroidism on maintenance
hemodialysis is ameliorated by
parathyroidectomy.