• Hung-Yuan Chen, Chih-Kang Chiang, Hsi-Hao Wang, Kuan-Yu Hung, Yue-Joe Lee, Yu-Sen Peng, Kwan-Dun Wu, and Tun-Jun Tsai.
• Department of Internal Medicine, Division of Nephrology, Far Eastern Memorial Hospital, Taipei, Taiwan.
• Am. J. Kidney Dis. 2008 Aug 1; 52 (2): 314-23.

BackgroundGreater than 50% of dialysis patients experience sleep disturbances. Cognitive-behavioral therapy (CBT) is effective for treating chronic insomnia, but its effectiveness has never been reported in peritoneal dialysis (PD) patients and its association with cytokines is unknown. We investigated the effectiveness of CBT in PD patients by assessing changes in sleep quality and inflammatory cytokines.Study DesignRandomized control study with parallel-group design.Setting & Participants24 PD patients with insomnia in a tertiary medical center without active medical and psychiatric illness were enrolled.InterventionThe intervention group (N = 13) received CBT from a psychiatrist for 4 weeks and sleep hygiene education, whereas the control group (N = 11) received only sleep hygiene education.Outcomes & MeasurementsPrimary outcomes were changes in the Pittsburgh Sleep Quality Index and Fatigue Severity Scale scores, and secondary outcomes were changes in serum interleukin 6 (IL-6), IL-1beta, IL-18, and tumor necrosis factor alpha levels during the 4-week trial.ResultsMedian percentages of change in global Pittsburgh Sleep Quality Index scores were -14.3 (interquartile range, -35.7 to - 6.3) and -1.7 (interquartile range, -7.6 to 7.8) in the intervention and control groups, respectively (P = 0.3). Median percentages of change in global Fatigue Severity Scale scores were -12.1 (interquartile range, -59.8 to -1.5) and -10.5 (interquartile range, -14.3 to 30.4) in the intervention and control groups, respectively (P = 0.04). Serum IL-1beta level decreased in the intervention group, but increased in the control group (P = 0.04). There were no significant differences in changes in other cytokines.LimitationsThis study had a small number of participants and short observation period, and some participants concurrently used hypnotics.ConclusionsCBT may be effective for improving the quality of sleep and decreasing fatigue and inflammatory cytokine levels. CBT can be an effective nonpharmacological therapy for PD patients with sleep disturbances.

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