There are scanty data available on alexithymia in patients with
end-stage renal disease, which point to an independent association with depression and social support. This study was devised to investigate the prevalence of alexithymia and
sleep disorders in patients maintenance
hemodialysis with insuppressible
secondary hyperparathyroidism, who need
parathyroidectomy (PTX), because previous data from our laboratories as well as those of others showed that this patient-group are the worst sleepers among
hemodialysis patients with
end-stage renal disease. A total of 40 patients needing PTX were enrolled and studied before the surgery. As for the control group, 80 patients on maintenance
hemodialysis not needing PTX were enrolled. We measured alexithymia with the Toronto Alexithymia Score (TAS-20),
sleep disorders with the Pittsburgh Sleep Quality Index (PSQI), and depression with Beck Depression Inventory (BDI), intact
parathyroid hormone (iPTH),
calcium, phosphate, use of
antihypertensives, systolic and diastolic blood pressure,
hemoglobin concentration, and
albumin concentration. Patients needing PTX in comparison with those not needing PTX had significantly higher iPTH,
calcium, and
phosphate; they also had significantly higher systolic and diastolic blood pressure. They were more significantly alexithymic (P < .001), had more severe
sleep disorders (P < .001), and were more depressed (P < .043). In multivariate analysis, BDI correlated significantly with iPTH concentration (r = 0.505, P < .001). A reduction of TAS-20 occurred after PTX which correlated with the number of patients on
antihypertensive drugs, PSQI, BDI,
hemoglobin concentration in the univariate and multivariate analysis. When TAS-20 and PSQI were adjusted for BDI (using analysis of variance) there was still a significant difference of TAS-20 and PSQI between patients needing PTX and not needing PTX (P < .001). This study confirms the high prevalence of
sleep disorders in patients with unsuppressed
secondary hyperparathyroidism and discloses a high prevalence of Alexithymia which is ameliorated by PTX. However, the correlation of Alexithymia with
sleep disorders does not depend on depression.