by Megan Rauscher

Last Updated: 2008-08-29 8:30:15 -0400 (Reuters Health)

NEW YORK (Reuters Health) – In peritoneal dialysis patients with sleep problems, cognitive-behavioral therapy (CBT) may reduce insomnia and fatigue, improve sleep quality, and decrease inflammatory cytokines, results of a pilot study suggest.

"Sleep disturbance in patients undergoing peritoneal dialysis is a puzzling and prevalent complaint (and) correlates with systemic inflammatory process," Dr. Hung-Yuan Chen from National Taiwan University Hospital, Taipei, noted in comments to Reuters Health. "However, only hypnotics are available for clinicians to solve this problem at present."

Dr. Chen’s team investigated the effect of CBT on sleep disturbance and inflammatory cytokine levels in 24 patients with insomnia undergoing maintenance peritoneal dialysis for longer than 90 days.

All patients received sleep hygiene education before the 4-week study, and 13 of them were randomized to an intervention group that also received four 1-hour-weekly psychiatrist-led CBT treatment sessions. Participants who were on low-dose hypnotics long-term before entering the study were maintained at the same dose during the study.

After 4 weeks, there was an "impressive" trend toward improvement in global scores on the Pittsburgh Sleep Quality Index with CBT, although the results were not statistically significant, the authors report in the August issue of the American Journal of Kidney Diseases.

Nearly 80% of patients in the CBT group experienced favorable changes in PSQI scores, the team notes. The median change was a decrease of 14.3% in the intervention group compared with a decrease of 1.7% in the control group.

Median changes in Fatigue Severity Scale scores were also larger with CBT than without (-12.1% vs -10.5%).

Serum interleukin-1-beta levels decreased in the CBT group but increased in the control group (p = 0.04). There were no significant differences in changes in other cytokines.

CBT has been proven effective for chronic insomnia in the elderly and in patients with cancer or chronic pain. Dr. Chen and colleagues conclude that the current study provides "novel evidence that treating peritoneal dialysis patients with insomnia with CBT, in addition to an extreme low fixed dose of hypnotics, may not only improve sleep quality and daytime fatigue, but also alter levels of circulating biomarkers of inflammation in this population."

Am J Kidney Dis 2008;52:314-323.