Associations between sleep quality, excessive daytime sleepiness, and theta wave activity during resting-state electroencephalography in maintenance hemodialysis patients.

Objective: This study aimed to evaluate sleep quality, excessive daytime sleepiness, absolute theta power during resting stage, and its associations in maintenance hemodialysis patients.

Methods: A cross-sectional study was conducted from June 2023 to May 2024 on 119 patients undergoing maintenance hemodialysis and 114 healthy controls at the Department of Nephrology and Dialysis, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam. Sleep quality and excessive daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Resting-state absolute theta power was analyzed with eyes closed using electroencephalography.

Results: Patients undergoing maintenance hemodialysis showed significantly higher adjusted means for sleep latency, sleep duration, sleep efficiency, sleep disturbances, daytime dysfunction, and overall PSQI and ESS scores compared with controls (p < 0.01). Poor sleep quality (PSQI > 5) was observed in 41.2% of patients, while 11.5% exhibited excessive daytime sleepiness (ESS ≥ 10). Notably, 9.2% of patients demonstrated both conditions. Absolute theta power was signficantly increased in the left prefrontal, frontal, right prefrontal, and parietal regions of patients undergoing maintenance hemodialysis compared with controls (p < 0.01). Elevated theta power in the left prefrontal and frontal regions was significantly and possitively associated with increasing poor sleep quality (p < 0.05).

Conclusions: Poor sleep quality and excessive daytime sleepiness are prevalent in patients undergoing maintenance hemodialysis. Altered theta wave activity, particularly increased absolute power in the left prefrontal and frontal regions, may indicate a link between brain activity and sleep disturbances in maintenance hemodialysis patients.