Análise dos problemas relacionados com o sono e sua associação com adesão de medicamentos: a importância do cuidado farmacêutico nos pacientes com doença renal crônica

Abstract

Chronic kidney disease (CKD) is considered a global public health problem, especially in low- and middle-income countries, as they are less prepared to deal with the prevention, treatment and progression of CKD. Early detection of CKD and therapeutic follow-up of patients with hypertension and diabetes are necessary to reduce morbidity and mortality. Stage 3 and advanced stages 4 and 5 of CKD were associated with 2.2 million deaths in the global population, more than half of which were from cardiovascular disease, while 0.96 million deaths were related to end-stage renal disease. Furthermore, risks increase when prescribed medications are not adhered to. Patients undergo hemodialysis three times a week, starting early in the morning, and there may be chronic changes in sleep schedules due to waking up early or sleeping late. In the literature, the prevalence of sleep disorders and poor medication adherence in patients with CKD are well evidenced, but there are few studies on whether sleeprelated problems are associated with poor medication adherence. In addition, until the time of the study, there were no reports in the literature on the identification of circadian chronotype and occurrence of social jetlag in hemodialysis patients. In view of this, the study aims to analyze the behavior of circadian preference and sleep-related problems if they are associated with therapeutic adherence in patients on hemodialysis. A crosssectional study was carried out with 108 patients with CKD undergoing hemodialysis treatment in three hospitals in Maceió from June to November 2022. Data collection was performed through interviews with the patient using the following validated questionnaires: Pittsburgh Sleep Quality – PSQI, EPWORTH Daytime Sleepiness Scale, Chalder Fatigue Scale, Morisky Therapeutic Adherence Scale (MMAS-8), Obstructive Sleep Apnea Risk Factor Questionnaire – STOP-Bang, Morningness Eveningness Questionnaire – MEQ and Munich Chronotype Questionnaire - MCQT. Questions about health conditions, life habits, sociodemographic data and continuous use medication were also addressed. The main results obtained, patients had a morning circadian preference (56.5%), among the concomitant diseases, hypertension was the most frequent (60.2%), patients used cell phones before going to sleep (61.1%) and 13% exceeded cell phone use for more than 2 hours. Short sleep duration was observed in patients, 62.9% had a sleep duration < 6 hours, poor sleep quality (81.5%), high-risk prevalence of obstructive sleep apnea syndrome (64.8%), low adherence to medication (72.2%) and occurrence of social jetlag in patients for more than 1 hour (56.5%). The associations were significant between daytime sleepiness (p=0.038), fatigue (p=0.046) and chronotype (p=0.014) with low therapeutic adherence. Therefore, the results indicate worrisome problems that can lead to complications in comorbidities and worsen the prognosis. Clinical trials reinforce the importance for future studies to determine the best method or combination of different methods to manage medication adherence and integrate pharmaceutical care into patients' daily routine.