Original communicationSleep disturbances before and after parathyroidectomy for secondary hyperparathyroidism
Section snippets
Subjects and methods
From February 2003 to September 2003, 31 patients who had undergone a successful total parathyroidectomy and autotransplantation for symptomatic secondary hyperparathyroidism were enrolled in this study. Their ages ranged from 28 to 61 years, with an average of 49.8 ± 11.9 years (mean ± SD). The participants comprised 25 men and 6 women. The etiologies of renal failure were chronic nephritis in 8 patients, nephrotoxic drugs in 5, diabetes mellitus in 1, and unknown causes in 17. The indications
Results
The main symptoms of secondary hyperparathyroidism before surgery were bone pain in 28 patients, skin itching in 22, general weakness in 20, and sleep disturbances in 30. Significant improvements of the above symptoms were noted 3 months after surgery, and only 7 patients complained of sleep disturbances at that time (P < .001; Table I).
Before surgery, serum levels of calcium, phosphorus, Alk-ptase, and iPTH were 10.88 ± 0.92 mg/dL, 6.06 ± 1.66 mg/dL, 295 ± 287 u/L, and 1542 ± 1083 pg/mL,
Discussion
Sleep disturbances are common in patients with end-stage renal disease on dialysis. More recently, a high prevalence of subjective sleep complaints has been documented, with problems reported by more than 50% to 80% of patients surveyed.2, 7, 8, 9 However, in the literature, the situation of sleep disturbances has not been reported in symptomatic secondary hyperparathyroidism either before or after parathyroidectomy. In this study, we found that almost all patients with symptomatic secondary
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Cited by (25)
Association between clinical variables and mortality after parathyroidectomy in maintenance hemodialysis patients
2017, American Journal of SurgeryCitation Excerpt :Furthermore, we found that PTX patients had higher levels of Hb and nutritional markers, including blood BUN, Cr, and albumin levels, as well as lower blood Ca levels, compared with those who did not undergo PTX. In our previous studies, we found that PTX in HD patients was associated with an improvement in several symptoms such as anemia, pruritus, bone pain, and cognition, as well as overall quality of life.10–12 The findings of the present study provide further evidence for the benefits of PTX in HD patients.
Parathyroidectomy improves symptomatology and quality of life in patients with secondary hyperparathyroidism
2014, Surgery (United States)Neurologic disorders of mineral metabolism and parathyroid disease
2014, Handbook of Clinical NeurologyCitation Excerpt :The response to parathyroidectomy is often dramatic. Improvement in frequently seen sleep disturbances and reduction in use of sleeping pills has been observed after parathyroid removal (Chou et al., 2005). The mechanism for this is not clear, but the improvement has been attributed, at least in part, to relief of troublesome symptoms which could impair sleep, such as skin itching and bone pain.
The high prevalence of alexithymia in hemodialyzed patients with secondary hyperparathyroidism unsuppressed by medical therapy is cured by parathyroidectomy
2010, Journal of Renal NutritionCitation Excerpt :The difficulty in expressing feelings in patients on maintenance hemodialysis with sHPT needing PTX is a novelty. Present findings on PSQI scores are in good keeping with studies of Chou et al.17 who reported a 97% prevalence of insomnia in hemodialyzed patients waiting for PTX, as well as with previous data from this laboratory18,19 where sleep disorders were studied with another questionnaire and supported the hypothesis that the disordered sleep might represent a PTH-related dysfunction.17–19 The prevalence of depression is the highest measured with BDI in end-stage renal disease.
Cognitive changes after parathyroidectomy in patients with secondary hyperparathyroidism
2008, SurgeryCitation Excerpt :Parathyroidectomy with autotransplantation of parathyroid tissue is an easy, inexpensive, and simple way to treat symptomatic secondary hyperparathyroidism. After parathyroidectomy, serum levels of calcium, phosphorus, Alk-ptase, iPTH, and aluminum decreased, as did the symptoms of pruritus, bone pain, insomnia, and general weakness in our study and our previous studies45-47; similarly, MMSE scores increased and global CDR scales, especially memory scales, decreased significantly. Our study shows improvements of cognitive impairment after parathyroidectomy for symptomatic secondary hyperparathyroidism.
High Prevalence of Sleep Disorders in Hemodialyzed Patients Requiring Parathyroidectomy
2008, Journal of Renal NutritionCitation Excerpt :In our laboratory, in a study of 228 hemodialyzed patients, 82% complained of sleep disorders, and 37.28% manifested insomniac,2,4,10 a finding in accordance with other studies in Italy.11,12 Our study indicates that patients with severe hyperparathyroidism requiring parathyroidectomy have the worst sleep, thus confirming recent data by Chou et al.,1 who found a 97% prevalence of sleep disturbances in patients with symptomatic secondary hyperparathyroidism before parathyroidectomy. Although considered a pivotal uremic toxin,13 PTH has rarely been investigated in studies focusing on sleep disorders in patients with end-stage kidney disease.