Cognitive-Behavioral Therapy for Sleep Disturbance in Patients Undergoing Peritoneal Dialysis: A Pilot Randomized Controlled Trial

Background: Greater 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 Design: Randomized control study with parallel-group design. Setting & Participants: 24 PD patients with insomnia in a tertiary medical center without active medical and psychiatric illness were enrolled. Intervention: The 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 & Measurements: Primary 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-1β, IL-18, and tumor necrosis factor α levels during the 4-week trial. Results: Median 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-1β 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. Limitations: This study had a small number of participants and short observation period, and some participants concurrently used hypnotics. Conclusions: CBT 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.