The Effect of Dialysis Shift on Depression and Sleep Disturbances in Patients on Chronic Hemodialysis

Individuals dialyze during the morning, afternoon, and evening shifts at dialysis units based on the unit’s and individual’s availability. Studies suggest that the dialysis shift impacts sleep disorders, depressive symptoms, quality of life, and mortality. One of the most common psychological problems in the dialysis population is depression that affects hospitalizations, mortality, and adherence to medications, treatments, and fluid restriction. In addition, sleep disturbances are common among end-stage renal disease (ESRD) patients that further impair quality of life and increase mortality rates. Studies examining depression and sleep disturbances in relation to dialysis shifts are lacking. Therefore, the purpose of this study was to compare the effects of hemodialysis (HD) shifts (morning, afternoon, and evening) on outcome variables of depression and sleep disturbance. Quantitative data was collected with the following surveys: Demographic Data Survey, Patient Health Questionnaire (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI). The overall level of depression (M = 4.25, SD = 2.52) and sleep disturbance (M = 8.31, SD = 3.96) were both considered mild. Patients who dialyzed on the first shift had the least amount of depressive symptoms (M = 4.25) and those on the third shift had the most depressive symptoms (M = 11.67). Patients who dialyzed on the third shift had significantly higher levels of depression (p = .002). In addition, patients who dialyzed on the third shift had the poorest sleep quality (M = 14.50), compared to those who dialyzed on the first shift who had the best sleep quality scores (M = 8.31) (p = .013). A significant positive correlation was found between depression and sleep quality scores (r = .72, p = .008). These results indicate the dialysis shift can play a significant role in sleep disturbances and depression in patients on HD. Further studies need to be conducted to validate these findings. Furthermore, this study could be the basis for future studies investigating effective health promotion interventions such as sleep hygiene in order to mitigate depression and sleep disturbances.