BACKGROUND: Current research regarding the impact aging has on characteristics of sleep suggest that over the course of one’s lifespan, the quantity and quality of sleep declines. Sleep quality is a measure of the extent to which sleep is consolidated- the less number of brief awakenings one experiences during a period of sleep, the better. The extent to which degradation of sleep quality may impact overall health and increase susceptibility to age-related diseases is currently unknown, nor is the mechanism that mediates sleep fragmentation and consolidation understood. OBJECTIVE: The purpose of this study was to ascertain if the increased sleep fragmentation experienced with age is due to a decreased arousal threshold towards external stimuli. A decreased ability to inhibit sensory processes during sleep could potentially trigger a greater number of brief awakenings and negatively impact sleep quality. METHODS: Various age groups of inbred wild-type genotypes of Drosophila melanogaster had arousal threshold tested during the night using mechanical stimuli to see if the older flies were more likely to be woken up. Sleep characteristics at baseline and after the arousal assay were compared to observe any impacts aging has on the ability to recover from a mild sleep deprivation as such. RESULTS: I observed an increase in arousal threshold with age; older flies were less likely to be aroused by the presentation of the mechanical stimulus. Arousal threshold findings were consistent between sexes but not between genotypes. It was noted that the degree to which aging impacted arousal threshold was affected by the expected lifespan of a genotype. In terms of sleep characteristics measured outside of the arousal assay, I noticed an increase in quantity of sleep and decrease in activity as flies aged, including a greater reliance on day sleep. This was further reflected by a decrease in rebound sleep after the arousal assay was performed. More specific sleep architecture characteristics such as bout number and bout length were greatly impacted by both sex and genotype. CONCLUSION: Our results were greatly unexpected in comparison to previous studies, especially in regards to older flies having an increased arousal threshold and an increased quantity of sleep. This is not conclusive, however, as previous studies have shown that the saliency of the stimulus presented may prove important, especially when considering the internal state of the fly. Instead of solely focusing on if older flies are more or less easy to wake up with the application of an external stimulus, it may instead be beneficial to also consider their ability to discriminate between salient stimuli while quiescent.

Miego sutrikimai yra vienas labiausiai paplitusių nūdienos medicininių nusiskundimų. Paskutiniu metu miego medicina domimasi vis labiau, keičiasi gydytojų ir visuomenės supratimas apie miegą, jo sutrikimus, ligas ir negalavimus, susijusius su miegu. Vienas iš svarbesnių ir labai varginančių sutrikimų yra miegas be poilsio jausmo. Mokslininkai iki šiol diskutuoja, kas lemia poilsio jausmą po miego. Pastaruoju metu nemažai dėmesio skiriama miego vientisumo ir suskaldymo reikšmės poilsio jausmui tyrimams. Manoma, kad miego fragmentacija – miego suskaidymas dažnais trumpais nubudimais – mažina jo atstatomąją vertę, ypač smegenims. Pagrindinis darbo tikslas buvo išnagrinėti miego struktūrą ir kokybę per miego ciklus, fazes ir stadijas bei įvertinti miego struktūros ryšį su poilsio jausmu po miego nepriklausomai nuo nemigos tipo. Buvo nagrinėjami trijų tipų – elgesiniai, vegetaciniai ir žieviniai mikro – nubudimai ir jų dinamika nakties metu, skirtinguose miego cikluose ir stadijose. Subjektyviai vertinama miego kokybė buvo analizuojama pasitelkus Pitsburgo miego kokybės indeksą. Darbo rezultatai parodė, kad miego stabilumas nakties pradžioje turi didesnę įtaką subjektyviam miego kokybės jausmui negu miegas nakties pabaigoje. Nubudimų indekso dydžiui reikšmingos įtakos turi miego stadija ir nubudimo tipas, nepriklausomai nuo miego ciklo, o didžiausią įtaką poilsio jausmui turi visų tipų nubudimų, ypač žievinių mikronubudimų, indeksų padidėjimas antroje lėtojo miego stadijoje. / Sleep disorders are one of the most common medical complaints today. There is a growing interest in sleep medicine, attitude of doctors and society is changing and knowledge about sleep and its disorders is increasing. One of the most tedious and understudied sleep problems is non-restorative sleep. Researchers are still debating about what determines persons rest sense after the sleep. A lot of attention recently is paid for sleep integrity and a role of sleep fragmentation for the rest sense. It is thought that sleep fragmentation with short arousals could have effect on the sleeps restorative function. The aim of our study was to analyze sleep structure and sleep quality through sleep cycles, phases and stages and to evaluate structure’s relationship with subjective sense of rest after the sleep without paying attention to the type of insomnia. We have analysed three types of arousals (behavioural, vegetative and microarousals) and their dynamics during the night, in different sleep cycles and stages. Subjective sleep quality was evaluated using the Pittsburgh sleep quality index. Work results showed that for the subjective sense of rest after the sleep it is more important the stability of sleep in the initial than in the last sleep cycles. Sleep stage and arousal type regardless of sleep cycle are significant factors for the arousal index values and that increase of all arousal indices in NREM 2 stage (especially increase of microarousal index) has strongest impact for... [to full text]

Sleep disorders are one of the most common medical complaints today. There is a growing interest in sleep medicine, attitude of doctors and society is changing and knowledge about sleep and its disorders is increasing. One of the most tedious and understudied sleep problems is non-restorative sleep. Researchers are still debating about what determines persons rest sense after the sleep. A lot of attention recently is paid for sleep integrity and a role of sleep fragmentation for the rest sense. It is thought that sleep fragmentation with short arousals could have effect on the sleeps restorative function. The aim of our study was to analyze sleep structure and sleep quality through sleep cycles, phases and stages and to evaluate structure’s relationship with subjective sense of rest after the sleep without paying attention to the type of insomnia. We have analysed three types of arousals (behavioural, vegetative and microarousals) and their dynamics during the night, in different sleep cycles and stages. Subjective sleep quality was evaluated using the Pittsburgh sleep quality index. Work results showed that for the subjective sense of rest after the sleep it is more important the stability of sleep in the initial than in the last sleep cycles. Sleep stage and arousal type regardless of sleep cycle are significant factors for the arousal index values and that increase of all arousal indices in NREM 2 stage (especially increase of microarousal index) has strongest impact for... [to full text] / Miego sutrikimai yra vienas labiausiai paplitusių nūdienos medicininių nusiskundimų. Paskutiniu metu miego medicina domimasi vis labiau, keičiasi gydytojų ir visuomenės supratimas apie miegą, jo sutrikimus, ligas ir negalavimus, susijusius su miegu. Vienas iš svarbesnių ir labai varginančių sutrikimų yra miegas be poilsio jausmo. Mokslininkai iki šiol diskutuoja, kas lemia poilsio jausmą po miego. Pastaruoju metu nemažai dėmesio skiriama miego vientisumo ir suskaldymo reikšmės poilsio jausmui tyrimams. Manoma, kad miego fragmentacija – miego suskaidymas dažnais trumpais nubudimais – mažina jo atstatomąją vertę, ypač smegenims. Pagrindinis darbo tikslas buvo išnagrinėti miego struktūrą ir kokybę per miego ciklus, fazes ir stadijas bei įvertinti miego struktūros ryšį su poilsio jausmu po miego nepriklausomai nuo nemigos tipo. Buvo nagrinėjami trijų tipų – elgesiniai, vegetaciniai ir žieviniai mikro – nubudimai ir jų dinamika nakties metu, skirtinguose miego cikluose ir stadijose. Subjektyviai vertinama miego kokybė buvo analizuojama pasitelkus Pitsburgo miego kokybės indeksą. Darbo rezultatai parodė, kad miego stabilumas nakties pradžioje turi didesnę įtaką subjektyviam miego kokybės jausmui negu miegas nakties pabaigoje. Nubudimų indekso dydžiui reikšmingos įtakos turi miego stadija ir nubudimo tipas, nepriklausomai nuo miego ciklo, o didžiausią įtaką poilsio jausmui turi visų tipų nubudimų, ypač žievinių mikronubudimų, indeksų padidėjimas antroje lėtojo miego stadijoje.

Nowadays, frequency of so called civilization diseases is raising and current life style of an industrial society brings increased number of sleep disorders. Various non-physiological and pathological phenomena, for which humans do not have and cannot have any adaptation mechanisms created, can be seen in our culture and society. The purpose of this thesis is to examine sleep habits of two groups of healthy adult persons (young adults and seniors) and determine factors having an influence on sleep quality. Three hypotheses were stated (Hypothesis No. 1: Sleep length and quality are changing throughout the life. Hypothesis No. 2: Sleep length has an influence on BMI. Hypothesis No. 3: Sleep length is dependent on a life style). Validity of these hypotheses was verified. The sample consisted of a group of young adults (76 women, 51 men) and of a group of active seniors (50 women, 40 men). Sleep behavior was investigated by a questionnaire form. Every person answered to 50 questions. Their answers were statistically processed. Basic somatic characteristics as body height, body weight and Body Mass Index were measured during the contact with respondents. Statistically significant difference (p < 0,05) in sleep behavior of young adults and seniors in weekdays and weekend was found out. Young adults were...

Plusieurs études ont montré que la prévalence des troubles du sommeil dans la population âgée de 65 ans et plus se situait entre 25 et 50%. Les benzodiazépines sont les médicaments les plus souvent prescrits pour traiter les problèmes de sommeil. La prévalence de la consommation de benzodiazépines chez les personnes âgées se situe à près de 25%. Le Collège des Médecins du Québec préconise une utilisation de benzodiazépines pour une durée maximale de trois mois.Plusieurs études rapportent toutefois que la durée moyenne de consommation de benzodiazépines est bien supérieure à la période recommandée et on possède peu d'information sur l'efficacité populationnelle à long terme de ces médicaments pour réduire les troubles du sommeil. Le but de ce mémoire était d'étudier le lien entre la consommation de benzodiazépines et la qualité de sommeil chez les personnes âgées de plus de 65 ans vivant à domicile au Québec. Pour atteindre cet objectif, deux études ont été réalisées et les résultats sont présentés sous forme d'articles. La première étude visait à documenter le lien entre la consommation de benzodiazépines et la qualité globale du sommeil ainsi que ses différentes composantes. La deuxième avait pour but d'étudier le lien entre la consommation de benzodiazépines et l'évolution de la qualité du sommeil sur une période de 12 mois. Pour répondre à ces objectifs, les données utilisées provenaient de l'Enquête sur la Santé des Aînés (ESA). L'ESA utilise un devis longitudinal avec entrevue à deux temps de mesures à un an d'intervalle auprès de 2798 sujets. Dans le cadre de la première étude, nous avons utilisé le premier temps de mesure de l'ESA et la consommation médicamenteuse était auto-rapportée par l'ensemble des participants. Pour la deuxième étude, nous avons étudié un sous-échantillon de 892 personnes participant aux deux temps de mesure de l'ESA et pour lesquelles les données sur la délivrance de benzodiazépines étaient disponibles via le registre sur la consommation médicamenteuse de la régie de l'assurance maladie du Québec. La qualité du sommeil était auto-rapportée à l'aide du questionnaire Pittsburgh Sleep Quality Index (PSQI). Des analyses de modélisation d'équations structurales ont été effectuées à l'aide du logiciel Lisrel 8,8. Le premier article montre que les facteurs les plus fortement associés à une mauvaise qualité de sommeil chez les personnes âgées sont la consommation de benzodiazépines et le sexe féminin. D'autre part, la consommation de benzodiazépines était associée de façon similaire à chacune des six composantes de la qualité du sommeil mesurées à l'aide du PSQI exception faite de la composante liée aux dysfonctionnements diurnes. Le deuxième article montre que la fréquence de consommation de benzodiazépines durant les 12 mois suivant le temps 1 de l'enquête ESA est associée à une diminution de la qualité de sommeil chez les gens qui ne souffraient pas de troubles du sommeil initialement. Chez les personnes âgées qui souf fraient d'une mauvaise qualité de sommeil au départ, le sommeil est de meilleure qualité après un an. Cette amélioration de la qualité du sommeil est toutefois moins importante chez les consommateurs de benzodiazépines que chez les personnes âgées ne consommant pas ces médicaments. Cette étude suggère donc un effet néfast de la consommation de benzodiazépines sur la qualité de sommeil des personnes âgées. Nous proposons que d'autres études soient réalisées auprès de sujets nouvellement exposés aux benzodiazépines (cas incidents) afin de vérifier la relation délétère suggérée par nos travaux entre la consommation de benzodiazépines à long terme et la qualité de sommeil chez les personnes âgées.

Background: Epidemiologic evidence supports the association between shiftwork and the development of cardiovascular disease. Sleep disturbances are associated with a variety of adverse cardiometabolic outcomes and they may lie on the causal pathway between the exposure to shiftwork and cardiovascular disease. Objectives: 1) To describe sleep quality in a group of shift-working and day-working female hospital employees; 2) To determine the association between shiftwork status and sleep disturbances in this group and to determine the effect of lifetime exposure to shiftwork on current sleep disturbances; and 3) To explore whether sleep disturbances mediate the relationship between shiftwork and cardiometabolic risk. Methods: A cross-sectional study was conducted among female hospital employees: participants were 132 women working only during the day, and 98 women who worked a shift schedule of two 12-hour days, followed by two 12-hour nights and five days off. Sleep quality was assessed with the Pittsburgh Sleep Quality Index questionnaire. The primary outcome of interest was the metabolic syndrome defined in accordance with the 2009 Joint Interim Studies consensus statement. Results: Shiftwork was associated with poor sleep latency (odds ratio (OR)= 2.08 95% CI: 1.11-3.92), poor sleep efficiency (OR=2.35 95% CI: 1.21- 4.54), and poor global sleep quality (OR=1.88 95% CI: 1.02-3.49), while the impact of past shiftwork history was inconclusive. The OR for the association of shiftwork with the metabolic syndrome was 2.00 (95% CI: 0.89-4.51), and there was no evidence of mediation by sleep disturbances in the relationship of shiftwork and the metabolic syndrome. Conclusion: In this study, a rapid forward rotating 2-shift system is associated with self-reported poor sleep quality, while the long-term effects of sleep disturbances on cardiometabolic risk requires further study. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-09-24 21:16:38.768

Background: Compression garments are elastic, body-tight pieces of clothing with different pressure gradients used as a recovery method after exercise, such as strength training. Compression garments have increased in popularity within recreational and elite athletes as it is believed that they promote a reduction of muscle soreness and inflammation, which in turn may enhance performance. However, the exact physiological, psychological and performance enhancing effects of compression garments after recovery still remain unknown. Aim: To investigate whether female and male recreational athletes wearing full leg customised compression garments for at least 15 hours following a personalised strength training workout leads to an improvement in anaerobic sprint cycling performance as well as a reduction of perceived muscle soreness. Additionally a sleep quality assessment was conducted to assess the effects of the garments during sleep. Methods: Thirteen male and female subjects took part of a cross-over, randomised, controlled study. Subjects performed the first set of tests including Wingate anaerobic sprint test followed by their personalised strength training workout, after which they recovered with Compression Garments (CGS) or without compression garments (CON). They then returned 24hrs later to perform the second set of tests. Ten days later the same procedure was conducted however the other recovery method was used. Results: No significantdifferences were found between CGS and CON for the Wingate anaerobic test performance. Perceived muscle soreness was lower when subjects wore the garments and they felt better recovered 24hrs post-intervention compared to the CON condition. Some aspects of sleep were affected by wearing the compression garments during sleep however it was unclear whether this had an impact on performance. Conclusion: Recovering with customised full leg compression garments did not promote an improvement of physiological power performance 24 hours after a personalised strength training workout session. However perceived muscle soreness was reduced and the perception of recovery improved. The compression garments caused some sleep disturbances as subjects rated that they were too warm, suggesting a possible drawback of recovering with garments if worn during sleep.

Introduction: Fibromyalgia (FMS) is a chronic pain syndrome characterized by non-restorative sleep, and fatigue. Over 75% of individuals with FMS complain of poor sleep quality and fatigue. These have been ranked by patients with FMS as having great impact on quality of life. A literature review suggested that poor sleep quality may be a predictor of increased stress and FMS symptom onset in those affected. However, no experimental studies have demonstrated a causal relationship between poor sleep and stress in people with FMS. Methods: Using a single stage cross-sectional design, the primary study aim was to compare 25 women with FMS and 25 women without FMS, on the following variables: autonomic nervous system activity; perceived stress; sleep quality; immune function (cytokines); and fatigue. The secondary aim was to explore the relationships among the above variables within each group. A third aim was to assess the validity of the Autonomic Symptoms Profile by comparing it to measures of heart rate variability and selected sleep indices. Significant Results: The FMS group had worse sleep quality, more autonomic symptoms, and greater fatigue than the non-FMS group; they also had higher TNF-α levels. The non-FMS group was more likely to have OSA. Non-FMS participants who had OSA also had higher IL-1β values than the FMS group. Study variables that correlated with each other in the FMS group differed from those seen in the non-FMS group, with the exception of the positive correlation of total arousals with AHI in both groups. In the FMS group, fatigue was positively correlated with perceived stress, autonomic symptoms, and TNF-α; stress was positively correlated with autonomic symptoms; and AHI was negatively correlated with IL-1β levels as well as the above noted correlation with total arousals. In the non-FMS group, sleep quality was positively correlated with fatigue, and sleep quality and fatigue were positively correlated with IL-1β. IL-1β also positively correlated with TNF-α. Total arousals were negatively correlated with mean RR interval. SDNN was correlated with RR interval and negatively correlated with AHI. The hypothesis tests related to construct validity of the ASP indicated no significant supportive correlations.

Os objetivos desse estudo foram verificar as associações entre atividade física (AF) organizada fora da escola, aptidão cardiorrespiratória (APCR) e qualidade do sono com os indicadores de saúde mental em crianças e verificar se a AF organizada fora da escola ou a APCR eram moderadores da relação entre a qualidade do sono com os indicadores de saúde mental. É um estudo de corte transversal, desenvolvido em 232 crianças (118 meninos e 114 meninas) de uma escola de ensino fundamental da rede estadual da cidade de Porto Alegre - RS, selecionada por conveniência. A saúde mental foi avaliada através do Strengths and Difficulties Questionnaire, respondido pelos pais. A AF organizada fora da escola e qualidade do sono também foram reportados pelos pais, através de perguntas de uma anamnese. A APCR foi avaliada através do teste de corrida e caminhada de 6 minutos. Como covariáveis, o nível socioeconômico (NSE) foi verificado através de uma adaptação do questionário da ABEP, além do sexo e idade (indicados pelos pais). Para análise de dados utilizou-se estatística descritiva, regressão linear generalizada, correlação e análises de moderação. Os resultados indicaram que, nos meninos, a AF organizada fora da escola apresentou associação com o total de dificuldades (β= 2,691; p= 0,03) e sintomas emocionais (β= 1,528; p< 0,001). A APCR relacionou-se com o total de dificuldades (β= -0,013; p< 0,001), hiperatividade/déficit de atenção (β= -0,006; p< 0,001) e problemas de relacionamento com colegas (β= -0,002; p< 0,001). Nas meninas, houveram associações entre o NSE com o total de dificuldades (β= 2,783; p= 0,03) e hiperatividade/déficit de atenção (β= 1,245; p= 0,01), além da idade com os problemas de conduta (β= -0,136; p< 0,001). A qualidade do sono apresentou associação com total de dificuldades (r= -0,45; p< 0,001), sintomas emocionais (r= - 0,31; p= 0,001), problemas de conduta (r= -0,29; p= 0,001), hiperatividade/déficit de atenção (r= -0,43; p< 0,001), e os problemas de relacionamento com colegas (r= - 0,25; p< 0,001), nos meninos. Já nas meninas a qualidade do sono associou-se com o total de dificuldades (r= -0,27; p< 0,001), sintomas emocionais (r= -0,18; p= 0,05), e problemas de conduta (r= -0,25; p= 0,01). A AF organizada fora da escola e APCR não foram moderadoras da relação entre a qualidade do sono e os indicadores de saúde mental. Diante das associações, conclui-se que crianças que mantém hábitos saudáveis como dormir bem, praticar AF organizada fora da escola e ter bons níveis de APCR, apresentam melhores níveis de saúde mental. / The aims of the present study were to verify the associations between organized physical activity (PA) outside school, cardiorespiratory fitness (CRF) and sleep quality as indicators of mental health in children, and to verify if organized PA outside school or CRF were moderators of the relationship between sleep quality with mental health indicators. It is a cross-sectional study, developed with 232 children (118 boys and 114 girls) of a public from Porto Alegre - RS, selected by convenience. Mental health was assessed through the Strengths and Difficulties questionnaire, answered by the parents. Also, the parents, through an anamnesis, reported organized PA and sleep quality. CRF was evaluated through the running and walking test of 6 minutes. As covariates, socioeconomic status was obtained by an adaptation of the ABEP questionnaire, in addition to gender and age. To data analysis were used descriptive statistics, generalized linear regression, correlation and moderation analyzes. The results indicated that, in boys, organized PA outside school showed association with total difficulties (β= 2.691; p= 0.03) and emotional symptoms (β= 1.528; p< 0.001). CRF was related with total difficulties (β= -0.013; p<0.001), hyperactivity/attention deficit (β= -0.006; p<0.001) and relationship problems with colleagues (β= -0.002; p< 0.001). In girls, there was an association between socioeconomic status with total difficulties ((β= 2.783; p= 0.03) and hyperactivity/attention deficit (β= 1.245; p= 0.01), besides age with conduct problems (β= -0.136; p<0.001). Sleep quality was associated with total difficulty (r= -0.45; p<0.001), emotional symptoms (r= -0.31; p=0.001), behavioral problems (r= -0.29; p=0.001), hyperactivity/attention deficit (r= - 0.43; p<0.001) and relationship problems with colleagues (r= -0.25; p<0.001), in boy. Already in girls, sleep quality was associated with total difficulties (r= -0.27; p<0.001), emotional symptoms (r= -0.18; p= 0.05) and behavioral problems (r= -0.25; p=0.01). Organized PA outside school and CRF were not moderators of the relationship between sleep quality and mental health indicators. Considering the associations, it is concluded that children who maintain healthy habits, such as sleeping well, practicing organized PA outside of school and having good levels of CRF, present better levels of mental health.

Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%–83.1%). Poor sleep quality was associated with depressive symptoms (PR = 1.28; 95%CI: 1.17-1.39), anemia (PR = 1.18; 95%CI: 1.04-1.34) and uremia (PR = 1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients. / brucepemar@gmail.com / Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer los potenciales factores asociados a ella. Materiales y métodos Estudio transversal analítico que enroló a pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluada mediante la escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés, reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57,5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79,3% (IC 95%: 75,6-83,1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP = 1,28; IC 95%: 1,17-1,39), anemia (RP = 1,18; IC 95%: 1,04-1,34) y compromiso urémico (RP = 1,26; IC 95%: 1,17-1,36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes. / Revisión por pares