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Ecological momentary assessment of fatigue, sleepiness, and exhaustion in ESKD

Abdel-Kader, K and Jhamb, M and Mandich, LA and Yabes, J and Keene, RM and Beach, S and Buysse, DJ and Unruh, ML (2014) Ecological momentary assessment of fatigue, sleepiness, and exhaustion in ESKD. BMC Nephrology, 15 (1).

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Background: Many patients on maintenance dialysis experience significant sleepiness and fatigue. However, the influence of the hemodialysis (HD) day and circadian rhythms on patients' symptoms have not been well characterized. We sought to use ecological momentary assessment to evaluate day-to-day and diurnal variability of fatigue, sleepiness, exhaustion and related symptoms in thrice-weekly maintenance HD patients. Methods. Subjects used a modified cellular phone to access an interactive voice response system that administered the Daytime Insomnia Symptom Scale (DISS). The DISS assessed subjective vitality, mood, and alertness through 19 questions using 7- point Likert scales. Subjects completed the DISS 4 times daily for 7 consecutive days. Factor analysis was conducted and a mean composite score of fatigue-sleepiness- exhaustion was created. Linear mixed regression models (LMM) were used to examine the association of time of day, dialysis day and fatigue, sleepiness, and exhaustion composite scores. Results: The 55 participants completed 1,252 of 1,540 (81%) possible assessments over the 7 day period. Multiple symptoms related to mood (e.g., feeling sad, feeling tense), cognition (e.g., difficulty concentrating), and fatigue (e.g., exhaustion, feeling sleepy) demonstrated significant daily and diurnal variation, with higher overall symptom scores noted on hemodialysis days and later in the day. In factor analysis, 4 factors explained the majority of the observed variance for DISS symptoms. Fatigue, sleepiness, and exhaustion loaded onto the same factor and were highly intercorrelated. In LMM, mean composite fatigue-sleepiness-exhaustion scores were associated with dialysis day (coefficient and 95% confidence interval [CI] 0.21 [0.02 - 0.39]) and time of day (coefficient and 95% CI 0.33 [0.25 - 0.41]. Observed associations were minimally affected by adjustment for demographics and common confounders. Conclusions: Maintenance HD patients experience fatigue-sleepiness-exhaustion symptoms that demonstrate significant daily and diurnal variation. The variability in symptoms may contribute to poor symptom awareness by providers and greater misclassification bias of fatigue related symptoms in clinical studies. © 2014 Abdel-Kader et al.; licensee BioMed Central Ltd.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Abdel-Kader, K
Jhamb, Mjhambm@pitt.eduJHAMBM
Mandich, LA
Yabes, J
Keene, RMrkeene@pitt.eduRKEENE0000-0002-5952-3338
Beach, Sscottb@pitt.eduSCOTTB
Buysse, DJbuysse@pitt.eduBUYSSE
Unruh, ML
Centers: University Centers > University Center for Social and Urban Research
Date: 6 February 2014
Date Type: Publication
Journal or Publication Title: BMC Nephrology
Volume: 15
Number: 1
DOI or Unique Handle: 10.1186/1471-2369-15-29
Schools and Programs: School of Medicine > Medicine
School of Medicine > Psychiatry
Refereed: Yes
Date Deposited: 02 Dec 2016 20:33
Last Modified: 04 Feb 2019 16:55


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