Key words : Kidney transplantation, Nursing care, Sleep disorders

Introduction

Kidney transplant stands as the primary therapeutic option for patients with end-stage renal disease, offering notable advantages in terms of survival, healthcare costs, and quality of life.¹ Nevertheless, kidney transplant recipients face the potential risk of experiencing significant posttransplant side effects.² Both medical and surgical treatment modalities will bring distinct advantages, disadvantages, and varying impacts on the physical, psychological, and social well-being of patients.³ Among the range of potential disorders, anxiety and depression emerge as the most prevalent ones, capable of influencing the disease trajectory and graft survival in kidney transplant recipients.⁴

Too much or not enough sleep has been shown to increase mortality and morbidity when associated with chronic health conditions.⁵ Particularly in the context of a patient’s recovery process, obtaining restful sleep assumes great significance.⁶ Regrettably, sleep deprivation, often not regarded as a treatable health concern, is prevalent across various causes. Repercussions of sleep deprivation are strongly linked to severe medical conditions, such as diabetes mellitus, insulin resistance, hypertension, obesity, obstructive sleep apnea, depression, and anxiety.⁷ Optimal sleep quality, characterized by sufficient duration, emerges as an indispensable factor for overall health and well-being.⁸ Sleep disturbances are prevalent among people with chronic kidney disease and may persist even after kidney transplant.⁹ Patients in the solid-organ transplant journey often self-report experiencing poor-quality sleep, characterized by irregular timing, frequent awakenings, or shortened duration.⁸ The prevalence of poor sleep quality among kidney transplant recipients has been reported to range from 37.5% to 78%.⁸ Although transplantation may improve quality of sleep in close to half of the patients, it has been reported that a high number of patients still have sleep disturbances after kidney transplant.¹⁰

Materials and Methods

We conducted a comprehensive search by using the PubMed and Ulakbim databases, without imposing any restrictions on the publication dates. The primary objective of the search was to identify relevant studies involving the keywords “kidney transplantation,” “sleep disorders,” and “nursing care.”

Results and Discussion

Sleep disorders and fatigue are highly prevalent among patients with chronic kidney disease and end-stage renal disease, yet the impact of kidney transplant on these conditions remains limited in terms of available evidence.¹¹ In people with chronic kidney disease, the rate of various sleep disorders can be as high as 80%, with insomnia, daytime sleepiness, restless leg syndrome, frequent night waking, and nightmares being the most commonly reported complaints.¹² Importantly, sleep disorders persist even after kidney transplant in recipients.¹³ Fatigue, a common symptom, is correlated with factors such as inflammation, depressive symptoms, sleep disturbances, and obesity.¹⁴ Furthermore, nocturnal polyuria and poor sleep quality are frequently observed after kidney transplant, with excess body fat percentage independently associated with compromised sleep quality.¹⁵ Kidney transplant recipients constitute a distinct patient population, characterized by the use of immunosuppressive medications and the presence of various comorbidities, including obesity, a heightened risk of cardiovascular disease, malignancy, and concerns regarding allograft loss. These factors collectively contribute to an increased susceptibility to sleep disorders.¹⁶

The implementation of appropriate screening and management strategies to address sleep disorders is crucial, as sleep disorders can have detrimental effects on both the kidney allograft and the overall survival of the recipient. A longitudinal study reported that the utilization of sleep medication decreased in recipients after kidney transplant. This decrease could be attributed to apprehension regarding potential drug interactions or a lack of recognition of the significance of sleep disorders.¹⁰

In a study investigating sleep quality and associated psychosocial factors in kidney transplant recipients, the Pittsburgh Sleep Quality Index (PSQI) scores were significantly lower, indicating poorer sleep quality, with 29.2% of transplant recipients experiencing suboptimal sleep. A positive correlation was also observed between PSQI scores and scores on the Self-Rating Depression Scale, suggesting a relationship between sleep quality and depressive symptoms. Sleep quality in kidney transplant recipients was also lower compared with the general population.¹⁷ In a study examining the prevalence of sleep disorders among kidney transplant recipients, a prevalence of 19.3% was reported.¹³ In addition, in a study investigating the sleep quality of patients before and after kidney transplant, before surgery, 37.5% of patients experienced poor sleep.¹² This percentage remained the same at the 3-month follow-up after transplant but decreased to 20.0% after 6 months. Such findings suggest that kidney transplant has a positive effect on sleep quality, with an improvement observed 6 months posttransplant.¹²

Among patients with nocturia after kidney transplant, 34.9% exhibited poor sleep quality based on the PSQI.¹⁵ Kidney transplant recipients demonstrate substantial changes in sleep quality,⁸ as indicated by decreased rates of poor sleep quality, insomnia, sleep disturbance, and sleep dissatisfaction from pretransplant to posttransplant, with the percentage decreasing from 53.5% for patients waiting for transplant to 38.9% after transplant.⁸

To address the issue of persistent poor sleep quality, it is crucial to identify the factors or combination of factors that influence patient perceptions of their sleep quality. Understanding these factors and making progress require system-level improvements in the follow-up care of transplant recipients.¹⁸ Evaluations of physical conditions after transplant should consider the potential side effects of surgery and medications, as these factors can effect the sleep cycle.¹² Nurses are often expected to assess the sleep health of both patients and healthy individuals and to implement interventions to address sleep problems and enhance sleep health during the caregiving process.¹⁹

Conclusions

With the substantial effects of poor sleep quality on overall health outcomes, future studies should aim to adopt a longitudinal approach to assess sleep quality at various stages of the transplant process. Further research should also explore strategies for optimizing sleep in populations undergoing solid-organ transplant.⁸ It is crucial to emphasize the early identification and intervention of sleep disorders in transplant patients. These measures play a vital role in promoting optimal adherence to therapy and in preserving graft function.²⁰

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