Fatigue and Depression and Sleep Problems among Hemodialysis Patients in a Tertiary Care Center

High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD) patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5) and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13) were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI) was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30) and severe (score >30). Fatigue Severity Scale was used to assess fatigue (score >= 36 indicates fatigue). The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 +/- 13.1 (range 19-65 years) years, with 89.3% being males. The majority (68.1%) of the MHD patients was poor sleepers, but only five (10.6%) patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3%) had depression (mild to moderate in 59.7% and severe in 12.6%). Fatigue scores were found to be significantly associated with lesser frequency of dialysis (P <0.05). There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 +/- 3.7) than who were unemployed (mean EPSS score 3.9 +/- 2.7). Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 +/- 11.8) as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 +/- 8.8). Fatigue positively correlated with that of daytime sleepiness (P = 0.02), poor nighttime sleep (P = 0.02) and depression (P=0.006). In the present study, there was no correlation (P <0.05) found between daytime and night time sleep and depression. We found a high prevalence of fatigue, depression and poor sleep quality in our MHD patients. These abnormalities are closely related to each other and to the socioeconomic and demographic profiles of the population.