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终末期肾病患者的睡眠障碍

Authors
Patrick J Hanly, MD, FRCPC, MRCPI, DABSM
Andreas Pierratos, MD, FRCPC
Istvan Mucsi, MD, PhD
Marta Novak, MD, PhD
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD
Translators
刘雪梅, 主任医师，教授

引言

睡眠障碍在终末期肾病(end-stage renal disease, ESRD)患者中较常见。一篇系统评价纳入了17项有关ESRD患者的研究，该系统评价表明，睡眠障碍是其最常见的症状之一，平均患病率为44%[1]。肾脏科医生往往会漏诊患者的睡眠障碍[2]。

本专题将总结ESRD患者的睡眠障碍，包括失眠、过度嗜睡、睡眠呼吸暂停、不安腿综合征(restless legs syndrome, RLS)和睡眠周期性肢动(periodic limb movement, PLM)障碍。一般人群的睡眠障碍将在别处讨论。 (参见“睡眠障碍的分类”和“失眠概述”和“白天睡眠过多患者的概述”)

失眠

据报道，采用常规血液透析或持续性不卧床腹膜透析(chronic ambulatory peritoneal dialysis, CAPD)治疗的ESRD患者，失眠的患病率为19%-71%[3-14]。失眠是一个重要的应激源[5,15]，并与ESRD患者的死亡率增加有关[14,16]。失眠增加ESRD患者死亡率的机制不清，但可能是通过全身炎症反应增加导致，而全身炎症反应增加已被证实与ESRD和ESRD患者的心血管结局较差均相关[17,18]。

发病机制 — 促使失眠的因素包括：RLS，PLM，睡眠呼吸暂停[19-21]，代谢因素(包括尿毒症、贫血、高钙血症[22,23]、骨痛和瘙痒)，焦虑和抑郁[24,25]，昼夜节律紊乱(如睡眠时相滞后综合征)[4,26]，应用防止睡眠的药物，以及睡眠卫生习惯不好(包括白天透析时频繁小睡)。

食欲素，一种促进觉醒的神经肽，其血浆水平升高[27]和全身炎症反应[17,18]，也可能促使ESRD患者睡眠质量差。ESRD患者的褪黑激素昼间节律是紊乱的，这也与慢性肾脏病(chronic kidney disease, CKD)患者的肾功能损伤程度有关[28]。一些研究已表明，透析的时间安排(dialysis shift)可改变失眠的严重程度，例如早上透析的患者的失眠更重[6,29]，但这并未在所有研究中得到证实[30]。

                       

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Literature review current through: 2017-06 . | This topic last updated: 2016-04-01.
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References
Top
  1. Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis 2007; 14:82.
  2. Weisbord SD, Fried LF, Mor MK, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol 2007; 2:960.
  3. Sabbatini M, Minale B, Crispo A, et al. Insomnia in maintenance haemodialysis patients. Nephrol Dial Transplant 2002; 17:852.
  4. Walker S, Fine A, Kryger MH. Sleep complaints are common in a dialysis unit. Am J Kidney Dis 1995; 26:751.
  5. Iliescu EA, Coo H, McMurray MH, et al. Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 2003; 18:126.
  6. Hsu CY, Lee CT, Lee YJ, et al. Better sleep quality and less daytime symptoms in patients on evening hemodialysis: a questionnaire-based study. Artif Organs 2008; 32:711.
  7. Mucsi I, Molnar MZ, Ambrus C, et al. Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transplant 2005; 20:571.
  8. Hui DS, Wong TY, Ko FW, et al. Prevalence of sleep disturbances in chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2000; 36:783.
  9. Lui SL, Ng F, Lo WK. Factors associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 2002; 22:677.
  10. Yngman-Uhlin P, Edéll-Gustafsson U. Self-reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home. Int J Nurs Pract 2006; 12:143.
  11. Holley JL, Nespor S, Rault R. A comparison of reported sleep disorders in patients on chronic hemodialysis and continuous peritoneal dialysis. Am J Kidney Dis 1992; 19:156.
  12. Eryavuz N, Yuksel S, Acarturk G, et al. Comparison of sleep quality between hemodialysis and peritoneal dialysis patients. Int Urol Nephrol 2008; 40:785.
  13. De Vecchi A, Finazzi S, Padalino R, et al. Sleep disorders in peritoneal and haemodialysis patients as assessed by a self-administered questionnaire. Int J Artif Organs 2000; 23:237.
  14. Unruh ML, Buysse DJ, Dew MA, et al. Sleep quality and its correlates in the first year of dialysis. Clin J Am Soc Nephrol 2006; 1:802.
  15. Parfrey PS, Vavasour HM, Henry S, et al. Clinical features and severity of nonspecific symptoms in dialysis patients. Nephron 1988; 50:121.
  16. Elder SJ, Pisoni RL, Akizawa T, et al. Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2008; 23:998.
  17. Chiu YL, Chuang YF, Fang KC, et al. Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transplant 2009; 24:247.
  18. Bornivelli C, Alivanis P, Giannikouris I, et al. Relation between insomnia mood disorders and clinical and biochemical parameters in patients undergoing chronic hemodialysis. J Nephrol 2008; 21 Suppl 13:S78.
  19. Novak M, Shapiro CM, Mendelssohn D, Mucsi I. Diagnosis and management of insomnia in dialysis patients. Semin Dial 2006; 19:25.
  20. Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001; 344:102.
  21. Loewen A, Siemens A, Hanly P. Sleep disruption in patients with sleep apnea and end-stage renal disease. J Clin Sleep Med 2009; 5:324.
  22. Virga G, Stanic L, Mastrosimone S, et al. Hypercalcemia and insomnia in hemodialysis patients. Nephron 2000; 85:94.
  23. Koch BC, Nagtegaal JE, Hagen EC, et al. Subjective sleep efficiency of hemodialysis patients. Clin Nephrol 2008; 70:411.
  24. Güney I, Biyik M, Yeksan M, et al. Sleep quality and depression in peritoneal dialysis patients. Ren Fail 2008; 30:1017.
  25. Yang JY, Huang JW, Peng YS, et al. Quality of sleep and psychosocial factors for patients undergoing peritoneal dialysis. Perit Dial Int 2007; 27:675.
  26. Pai MF, Hsu SP, Yang SY, et al. Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia. Ren Fail 2007; 29:673.
  27. Sugimoto T, Nagake Y, Sugimoto S, et al. Plasma orexin concentrations in patients on hemodialysis. Nephron 2002; 90:379.
  28. Koch BC, van der Putten K, Van Someren EJ, et al. Impairment of endogenous melatonin rhythm is related to the degree of chronic kidney disease (CREAM study). Nephrol Dial Transplant 2010; 25:513.
  29. Barmar B, Dang Q, Isquith D, et al. Comparison of sleep/wake behavior in CKD stages 4 to 5 and hemodialysis populations using wrist actigraphy. Am J Kidney Dis 2009; 53:665.
  30. Bastos JP, Sousa RB, Nepomuceno LA, et al. Sleep disturbances in patients on maintenance hemodialysis: role of dialysis shift. Rev Assoc Med Bras (1992) 2007; 53:492.
  31. Hanly PJ, Gabor JY, Chan C, Pierratos A. Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis 2003; 41:403.
  32. Parker KP, Bliwise DL, Bailey JL, Rye DB. Daytime sleepiness in stable hemodialysis patients. Am J Kidney Dis 2003; 41:394.
  33. Unruh ML, Sanders MH, Redline S, et al. Subjective and objective sleep quality in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the sleep heart health study. Am J Kidney Dis 2008; 52:305.
  34. Novak MJ, Sheth H, Bender FH, et al. Improvement in Pittsburgh Symptom Score index after initiation of peritoneal dialysis. Adv Perit Dial 2008; 24:46.
  35. Bro S, Bjorner JB, Tofte-Jensen P, et al. A prospective, randomized multicenter study comparing APD and CAPD treatment. Perit Dial Int 1999; 19:526.
  36. Eryilmaz MM, Ozdemir C, Yurtman F, et al. Quality of sleep and quality of life in renal transplantation patients. Transplant Proc 2005; 37:2072.
  37. Novak M, Molnar MZ, Ambrus C, et al. Chronic insomnia in kidney transplant recipients. Am J Kidney Dis 2006; 47:655.
  38. American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2005; 2nd ed.: Diagnostic and coding manual:
  39. Mucsi I, Molnar MZ, Rethelyi J, et al. Sleep disorders and illness intrusiveness in patients on chronic dialysis. Nephrol Dial Transplant 2004; 19:1815.
  40. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14:540.
  41. Carskadon MA, Dement WC, Mitler MM, et al. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep 1986; 9:519.
  42. Stepanski E, Faber M, Zorick F, et al. Sleep disorders in patients on continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 1995; 6:192.
  43. Parker KP, Bliwise DL, Rye DB, De A. Intradialytic subjective sleepiness and oral body temperature. Sleep 2000; 23:887.
  44. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22:667.
  45. Heslegrave R, Thomley K, Ouwendyk M, et al. Impact of nocturnal hemodialysis on sleep and daytime cognitive functioning in patients with chronic renal failure. Sleep 1998; 21:51.
  46. Kang EW, Abdel-Kader K, Yabes J, et al. Association of sleep-disordered breathing with cognitive dysfunction in CKD stages 4-5. Am J Kidney Dis 2012; 60:949.
  47. Nicholl DD, Ahmed SB, Loewen AH, et al. Declining kidney function increases the prevalence of sleep apnea and nocturnal hypoxia. Chest 2012; 141:1422.
  48. Bloembergen WE, Port FK, Mauger EA, Wolfe RA. A comparison of cause of death between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 1995; 6:184.
  49. Turek NF, Ricardo AC, Lash JP. Sleep disturbances as nontraditional risk factors for development and progression of CKD: review of the evidence. Am J Kidney Dis 2012; 60:823.
  50. Sakaguchi Y, Shoji T, Kawabata H, et al. High prevalence of obstructive sleep apnea and its association with renal function among nondialysis chronic kidney disease patients in Japan: a cross-sectional study. Clin J Am Soc Nephrol 2011; 6:995.
  51. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342:1378.
  52. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365:1046.
  53. Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010; 182:269.
  54. Mooe T, Franklin KA, Wiklund U, et al. Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease. Chest 2000; 117:1597.
  55. Molnar MZ, Lazar AS, Lindner A, et al. Sleep apnea is associated with cardiovascular risk factors among kidney transplant patients. Clin J Am Soc Nephrol 2010; 5:125.
  56. Lavie L. Obstructive sleep apnoea syndrome--an oxidative stress disorder. Sleep Med Rev 2003; 7:35.
  57. Larkin EK, Rosen CL, Kirchner HL, et al. Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation 2005; 111:1978.
  58. Lavie L. Sleep-disordered breathing and cerebrovascular disease: a mechanistic approach. Neurol Clin 2005; 23:1059.
  59. Fornadi K, Lindner A, Czira ME, et al. Lack of association between objectively assessed sleep disorders and inflammatory markers among kidney transplant recipients. Int Urol Nephrol 2012; 44:607.
  60. Zoccali C, Benedetto FA, Tripepi G, et al. Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients. Kidney Int 1998; 53:1078.
  61. Zoccali C, Mallamaci F, Tripepi G, Benedetto FA. Autonomic neuropathy is linked to nocturnal hypoxaemia and to concentric hypertrophy and remodelling in dialysis patients. Nephrol Dial Transplant 2001; 16:70.
  62. Zoccali C, Benedetto FA, Mallamaci F, et al. Left ventricular hypertrophy and nocturnal hypoxemia in hemodialysis patients. J Hypertens 2001; 19:287.
  63. Zoccali C, Mallamaci F, Tripepi G. Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients. J Am Soc Nephrol 2002; 13:729.
  64. Tang SC, Lam B, Yao TJ, et al. Sleep apnea is a novel risk predictor of cardiovascular morbidity and death in patients receiving peritoneal dialysis. Kidney Int 2010; 77:1031.
  65. Benz RL, Pressman MR, Hovick ET, Peterson DD. Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. Am J Kidney Dis 2000; 35:1052.
  66. Kimmel PL, Miller G, Mendelson WB. Sleep apnea syndrome in chronic renal disease. Am J Med 1989; 86:308.
  67. Wadhwa NK, Mendelson WB. A comparison of sleep-disordered respiration in ESRD patients receiving hemodialysis and peritoneal dialysis. Adv Perit Dial 1992; 8:195.
  68. Unruh ML, Sanders MH, Redline S, et al. Sleep apnea in patients on conventional thrice-weekly hemodialysis: comparison with matched controls from the Sleep Heart Health Study. J Am Soc Nephrol 2006; 17:3503.
  69. Mendelson WB, Wadhwa NK, Greenberg HE, et al. Effects of hemodialysis on sleep apnea syndrome in end-stage renal disease. Clin Nephrol 1990; 33:247.
  70. Beecroft JM, Pierratos A, Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with end-stage renal disease. J Clin Sleep Med 2009; 5:115.
  71. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004; 291:2013.
  72. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007; 132:325.
  73. de Oliveira Rodrigues CJ, Marson O, Tufic S, et al. Relationship among end-stage renal disease, hypertension, and sleep apnea in nondiabetic dialysis patients. Am J Hypertens 2005; 18:152.
  74. Jung HH, Han H, Lee JH. Sleep apnea, coronary artery disease, and antioxidant status in hemodialysis patients. Am J Kidney Dis 2005; 45:875.
  75. Tada T, Kusano KF, Ogawa A, et al. The predictors of central and obstructive sleep apnoea in haemodialysis patients. Nephrol Dial Transplant 2007; 22:1190.
  76. Elias RM, Castro MC, de Queiroz EL, et al. Obstructive sleep apnea in patients on conventional and short daily hemodialysis. Am J Nephrol 2009; 29:493.
  77. Beecroft J, Duffin J, Pierratos A, et al. Enhanced chemo-responsiveness in patients with sleep apnoea and end-stage renal disease. Eur Respir J 2006; 28:151.
  78. Beecroft JM, Zaltzman J, Prasad R, et al. Impact of kidney transplantation on sleep apnoea in patients with end-stage renal disease. Nephrol Dial Transplant 2007; 22:3028.
  79. Jean G, Piperno D, François B, Charra B. Sleep apnea incidence in maintenance hemodialysis patients: influence of dialysate buffer. Nephron 1995; 71:138.
  80. Pressman MR, Benz RL, Schleifer CR, Peterson DD. Sleep disordered breathing in ESRD: acute beneficial effects of treatment with nasal continuous positive airway pressure. Kidney Int 1993; 43:1134.
  81. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med 2005; 172:1363.
  82. Younes M, Ostrowski M, Thompson W, et al. Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2001; 163:1181.
  83. Beecroft JM, Duffin J, Pierratos A, et al. Decreased chemosensitivity and improvement of sleep apnea by nocturnal hemodialysis. Sleep Med 2009; 10:47.
  84. Anastassov GE, Trieger N. Edema in the upper airway in patients with obstructive sleep apnea syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86:644.
  85. Chiu KL, Ryan CM, Shiota S, et al. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med 2006; 174:1378.
  86. Shiota S, Ryan CM, Chiu KL, et al. Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax 2007; 62:868.
  87. Redolfi S, Yumino D, Ruttanaumpawan P, et al. Relationship between overnight rostral fluid shift and Obstructive Sleep Apnea in nonobese men. Am J Respir Crit Care Med 2009; 179:241.
  88. Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 2010; 121:1598.
  89. Beecroft JM, Hoffstein V, Pierratos A, et al. Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea. Eur Respir J 2007; 30:965.
  90. Beecroft JM, Hoffstein V, Pierratos A, et al. Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease. Nephrol Dial Transplant 2008; 23:673.
  91. Tang SC, Lam B, Ku PP, et al. Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 2006; 17:2607.
  92. Tang SC, Lam B, Lai AS, et al. Improvement in sleep apnea during nocturnal peritoneal dialysis is associated with reduced airway congestion and better uremic clearance. Clin J Am Soc Nephrol 2009; 4:410.
  93. Elias RM, Chan CT, Paul N, et al. Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure. Nephrol Dial Transplant 2013; 28:937.
  94. Elias RM, Bradley TD, Kasai T, et al. Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea. Nephrol Dial Transplant 2012; 27:1569.
  95. Kimoff RJ, Sforza E, Champagne V, et al. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med 2001; 164:250.
  96. Boyd JH, Petrof BJ, Hamid Q, et al. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med 2004; 170:541.
  97. Auckley DH, Schmidt-Nowara W, Brown LK. Reversal of sleep apnea hypopnea syndrome in end-stage renal disease after kidney transplantation. Am J Kidney Dis 1999; 34:739.
  98. Langevin B, Fouque D, Léger P, Robert D. Sleep apnea syndrome and end-stage renal disease. Cure after renal transplantation. Chest 1993; 103:1330.
  99. Lee JJ, Kim GS, Kim JA, et al. Improvement of sleep-related breathing disorder in patients with end-stage renal disease after kidney transplantation. Clin Transplant 2011; 25:126.
  100. Mallamaci F, Leonardis D, Tripepi R, et al. Sleep disordered breathing in renal transplant patients. Am J Transplant 2009; 9:1373.
  101. Szentkiralyi A, Czira ME, Molnar MZ, et al. High risk of obstructive sleep apnea is a risk factor of death censored graft loss in kidney transplant recipients: an observational cohort study. Sleep Med 2011; 12:267.
  102. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003; 4:101.
  103. Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis 1996; 28:372.
  104. Kawauchi A, Inoue Y, Hashimoto T, et al. Restless legs syndrome in hemodialysis patients: health-related quality of life and laboratory data analysis. Clin Nephrol 2006; 66:440.
  105. Molnar MZ, Novak M, Ambrus C, et al. Restless Legs Syndrome in patients after renal transplantation. Am J Kidney Dis 2005; 45:388.
  106. Gigli GL, Adorati M, Dolso P, et al. Restless legs syndrome in end-stage renal disease. Sleep Med 2004; 5:309.
  107. Enomoto M, Inoue Y, Namba K, et al. Clinical characteristics of restless legs syndrome in end-stage renal failure and idiopathic RLS patients. Mov Disord 2008; 23:811.
  108. Unruh ML, Levey AS, D'Ambrosio C, et al. Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival. Am J Kidney Dis 2004; 43:900.
  109. Szentkiralyi A, Molnar MZ, Czira ME, et al. Association between restless legs syndrome and depression in patients with chronic kidney disease. J Psychosom Res 2009; 67:173.
  110. Jung HH, Lee JH, Baek HJ, et al. Nocturnal hypoxemia and periodic limb movement predict mortality in patients on maintenance hemodialysis. Clin J Am Soc Nephrol 2010; 5:1607.
  111. Molnar MZ, Szentkiralyi A, Lindner A, et al. Restless legs syndrome and mortality in kidney transplant recipients. Am J Kidney Dis 2007; 50:813.
  112. Lindner A, Fornadi K, Lazar AS, et al. Periodic limb movements in sleep are associated with stroke and cardiovascular risk factors in patients with renal failure. J Sleep Res 2012; 21:297.
  113. Ali NJ, Davies RJ, Fleetham JA, Stradling JR. Periodic movements of the legs during sleep associated with rises in systemic blood pressure. Sleep 1991; 14:163.
  114. Walters AS, Rye DB. Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep 2009; 32:589.
  115. Walters AS, Rye DB. Evidence continues to mount on the relationship of restless legs syndrome/ periodic limb movements in sleep to hypertension, cardiovascular disease, and stroke. Sleep 2010; 33:287.
  116. Jaber BL, Schiller B, Burkart JM, et al. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol 2011; 6:1049.
  117. Beecroft JM, Zaltzman J, Prasad GV, et al. Improvement of periodic limb movements following kidney transplantation. Nephron Clin Pract 2008; 109:c133.
  118. Yasuda T, Nishimura A, Katsuki Y, Tsuji Y. Restless legs syndrome treated successfully by kidney transplantation--a case report. Clin Transpl 1986; :138.
  119. Winkelmann J, Stautner A, Samtleben W, Trenkwalder C. Long-term course of restless legs syndrome in dialysis patients after kidney transplantation. Mov Disord 2002; 17:1072.
  120. Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003; 4:121.
  121. Sloand JA, Shelly MA, Feigin A, et al. A double-blind, placebo-controlled trial of intravenous iron dextran therapy in patients with ESRD and restless legs syndrome. Am J Kidney Dis 2004; 43:663.
  122. Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant 2013; 28:2834.