Sleep Quality After Intradialytic Oral Nutrition: A New Benefit of This Anabolic Strategy? A Pilot Study

Ailema González-Ortiz; Samuel Ramos-Acevedo; Victoria Santiago-Ayala; Gabriela Gaytan; Matilde Valencia-Flores; Ricardo Correa-Rotter; Juan Jesus Carrero; Hong Xu; Ángeles Espinosa-Cuevas

doi:10.3389/fnut.2022.882367

Sleep Quality After Intradialytic Oral Nutrition: A New Benefit of This Anabolic Strategy? A Pilot Study

Front Nutr. 2022 Jul 22:9:882367. doi: 10.3389/fnut.2022.882367. eCollection 2022.

Authors

Affiliations

¹ Translational Research Center, Instituto Nacional de Pediatría, Mexico City, Mexico.
² Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
³ Neurology Department, Sleep Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁴ School of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico.
⁵ Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁶ Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
⁷ Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico.

Abstract

Background: Since disturbances of appetite and sleep are closely related and both affect metabolic disorders, it would be expected that a renal specific oral nutritional supplement (RS-ONS) that covers the energy the patient does not consume on the HD day, could contribute to improve the nutritional status and body composition, as well as sleep quality. There is still scarce information related to this topic.

Aim: To evaluate the effect of the use of intra-dialytic RS-ONS vs. RS-ONS at home on sleep quality, nutritional status, and body composition in patients on HD.

Methods: Adult patients < 65 years, with ≥3 months on HD were invited to participate in an open randomized pilot study (ISRCTN 33897). Patients were randomized to a dialysis-specific high-protein supplement provided during the HD session (Intradialytic oral nutrition [ION]) or at home (control), during non-HD days (thrice weekly, for both) 12 weeks. The primary outcome was sleep quality defined by the Pittsburgh Sleep Quality Index (PSQI) score. Nutritional assessment included Malnutrition Inflammation Score (MIS), bioelectrical impedance analysis, anthropometry, 3-day food records, and routine blood chemistries.

Results: A total of 23 patients completed the study. Age was median 35 (range 24-48 years), 42% were women. At baseline, the PSQI score was median 4 (range 2-7), and MIS showed a median of 6 (range 5-8); there were no baseline differences between groups. After intervention, both groups improved their MIS scores and similarly when we analyzed the whole cohort (pre- vs. post-intervention P < 0.01). Patients in the ION group improved the overall PSQI score to median 3 (2-5), and assessment of sleep duration and sleep disturbances (pre- vs. post-intervention P < 0.05), with a trend toward an effect difference compared to patients consuming the supplement at home (P for treatment-effect across arms 0.07 for PSQI score and 0.05 for sleep latency).

Conclusion: Oral supplementation improved nutritional status in the whole cohort, but only ION improved the PSQI score. More studies are needed to explore the nutritional strategies that influence the relationship between sleep and nutritional status in HD patients.

Keywords: anabolic; hemodialysis; intradialytic oral supplementation; nutrition; sleep quality.