Chapter 4

Presentation, Analysis and Interpretation of Data

This chapter presents, analyze and interprets the data gathered from the

respondents to answer the research question in a form of tables as a result of

statistical treatment. Each table is introduced by research question from the

statement of the problem.

Problem 1: What is the demographic profile of the respondents?

Table 1 shows the distribution of the Demographic and Hemodialysis Profile of

the respondents in terms of age, gender, civil status, occupation, stage of CKD,

frequency of hemodialysis treatment, coffee intake, tea intake, and cigarette

smoking were further presented.

Table 1.1. Age of the Respondents in the Morning and other shifts of

Hemodialysis.

Morning-shift Other shifts

Age Frequenc Percentag Frequenc Percentag

y e y e

18-35 years
1 10% 2 20%
old
36-45 years
3 30% 2 20%
old
 46-65 years
6 60% 5 50%
old
65 years old
0 0% 1 10%
and above
Total 10 100% 10 100%

Table 1.1 above shows that the age of the respondents both in the

morning-shift and other shifts of hemodialysis is mostly between 46-65 years

old. Six out of 10 respondents in the morning-shift HD are between the ages of

46-65 years old, which comprises 60% of the total respondents. Another 3

(30%) respondents are between the ages of 36-45. While only 1 out of 10

(10%) of the respondents is in between 18-35 years old.

Fifty percent of the respondents in the other- shift HD are also between

the ages 46-65 years old. Two of respondents (20%) are between the ages 18-

35 and another 2 out of 10 (20%) are between the ages 36-45. While only 1 out

of 10 (10%) of the respondents is over the age of 65 years old.

Table 1.2. Gender of the Respondents in the Morning and other shifts of

Hemodialysis.

Morning-shift Other shifts

Gender Frequenc Percentag Frequenc Percentag

y e y e

Male 8 80% 8 80%

Female 2 20% 2 20%

Total 10 100% 10 100%

Table 1.2 above presents the gender of the respondents both in the

morning-shift and other shifts of hemodialysis. Majority of the respondents in the

morning-shift HD are male, which is 80% of the total respondents. While the

remaining 20% of the respondents are females. The other shifts of HD comprise

of 8 males (80%) and 2 females (20%).

Table 1.3. Civil Status of the Respondents in the Morning and other shifts

of Hemodialysis.

Morning-shift Other shifts

Civil Status Frequenc Percentag Frequenc Percentag

y e y e

Single 4 80% 2 80%

Married 5 20% 8 20%

Widow/ed 1 10% 0 0%
Divorced/
0 0% 0 0%
Annulled
Total 10 100% 10 100%

Table 1.3 above presents the frequency and percentage of Civil Status

of the respondents both in the morning-shift and other shifts of hemodialysis.

Fifty percent (F=5) of the respondents in the morning-shift HD are married.

While 40% (F=4) of the respondents are single. And the remaining 10% (F=1)

of the respondents is widowed. Majority of the respondents (F=8) in the other-

shift HD are married with an 80%, while the remaining respondents (F=2) are

single with 20%.

Table 1.4. Occupation of the Respondents in the Morning and other shifts

of Hemodialysis.

Morning-shift Other shifts

Occupation Frequenc Percentag Frequenc Percentag

y e y e

None 5 50% 6 60%

Business 1 10% 0 0%

Clerical 0 0% 2 20%

Service 2 20% 1 10%

Professiona
2 20% 0 0%
l
Student 0 0% 1 10%

Total 10 100% 10 100%

Table 1.4 above presents the frequency and percentage of Occupation

of the respondents both in the morning-shift and other shifts of hemodialysis.

Fifty percent (F=5) of the respondents in the morning-shift HD are unemployed.

One of 10 (10%) respondents have self-owned business industry, 2

respondents (20%) work in the service industry and the remaining 2 (20%) are

Professional workers. Majority of the respondents (F=6, 60%) in the other-shifts

HD are unemployed. While 20% (F=2) work as clericals, 10% (F=1) work as

service providers, and 1 out of 10 respondents (10%) is a student.

Table 1.5. Stage of Chronic Kidney Disease of the Respondents in the

Morning and other shifts of Hemodialysis.

Morning-shift Other shifts

Occupation Frequenc Percentag Frequenc Percentag

y e y e

Stage 1 0 0% 0 0%

Stage 2 1 10% 2 20%

Stage 3 1 10% 0 0%

Stage 4 0 0% 0 0%

Stage 5 8 80% 8 80%

Total 10 100% 10 100%

Table 1.5 above presents the frequency and percentage of Stage of

CKD of the respondents both in the morning-shift and other shifts of

hemodialysis. Majority of the respondents (F=8) are in the fifth stage of CKD.

While 10% (F=1) of the respondent is in the second stage of CKD and the

remaining 10% (F=1) of respondent is in the third stage of CKD. Majority of the

respondents (F=6) in the other-shift HD are from the afternoon shift HD with a

60% and are scheduled HD twice a week. While the remaining respondents

(F=4) are from the night shift HD with a 40% and are schedule HD trice a week.

Majority of the respondents (F=8) are in the fifth stages of CKD. While 10%

(F=1) of the respondent is in the first stage of CKD and the remaining 10%

(F=1) is in the second stage of CKD.

Table 1.6. Frequency of Hemodialysis of the Respondents in the Morning

and other shifts of Hemodialysis.

Morning-shift Other shifts

Frequency
Frequenc Percentag Frequenc Percentag
(per week)
y e y e

1x 1 10% 0 0%

2x 1 10% 6 60%

3x 6 60% 4 40%

4x 1 10% 0 0%

5x 1 10% 0 0%

Total 10 100% 10 100%

Table 1.6 above presents the frequency of Hemodialysis of the

respondents both in the morning-shift and other shifts of hemodialysis. Sixty

percent (F=6) of the respondents have HD thrice a week. While 10% (F=1)

have HD once a week, 10% (F=1) have HD twice a week, 10% (F=1) have HD

four times a week and the remaining 10% (F=1) have HD five times a week.
Table 1.7.1. Coffee intake of the Respondents in the Morning and other

shifts of Hemodialysis.

Morning-shift Other shifts

Coffee Frequenc Percentag Frequenc Percentag

Intake
y e y e

Yes 6 60% 1 10%

No 4 40% 9 60%

Total 10 100% 10 100%

Table 1.7.2. Cups of Coffee intake of the Respondents in the Morning and

other shifts of Hemodialysis.

Morning-shift Other shifts

Coffee
Frequenc Percentag Frequenc Percentag
Intake
(cups/day)
y e y e

1-5 cups 6 60% 1 10%

6-10 cups 0 00% 0 0%

Total 6 100% 1 100%

Table 1.7 above presents the frequency and percentage of the coffee

intake of the respondents both in the morning-shift and other shifts of

hemodialysis. Majority of the respondents (n=6) in the morning-shift HD

consumes coffee with the range of 1-5 cups which is 60% of the respondents.

While the remaining respondents (n=4) do not consume coffee, which is 40% of
the respondents. Majority of the respondents (f=9, 90%) in the other-shift HD do

not consume coffee, while the remaining respondent one (10%) respondent

consumes a range of 1-5 cups of coffee/ caffeine.

Table 1.8. Tea intake of the Respondents in the Morning and other shifts

of Hemodialysis.

Morning-shift Other shifts

Frequenc Percentag Frequenc Percentag

Tea Intake
y e y e

Yes 0 0% 0 0%

No 10 100% 10 100%

Total 10 100% 10 100%

Table 1.8 above presents the frequency and percentage of Tea intake of

the respondents both in the morning-shift and other shifts of hemodialysis. The

table shows that no respondent in both morning and other shifts of hemodialysis

drinks tea. Which means that 10 out of 10 respondents (100%) in the morning

shift, and 10 out of 10 respondents (100%) in the other shifts of Hemodialysis do

not drink tea.

Table 1.9.1. Cigarette Smoking of the Respondents in the Morning and

other shifts of Hemodialysis.

Morning-shift Other shifts

Cigarette Frequenc Percentag Frequenc Percentag

Smoking
y e y e

Yes 2 20% 1 0%

No 8 80% 9 60%

Total 10 100% 10 100%

Table 1.9.2. Number of Cigarette sticks usually smoked by the

Respondents in the Morning and other shifts of Hemodialysis.

Morning-shift Other shifts

Cigarette
Smoked Frequenc Percentag Frequenc Percentag
(No. of
sticks) y e y e

1-10 sticks 1 10% 0 0%

11-20 sticks 1 10% 1 10%

Total 2 100% 1 100%

Table 1.9 above presents the frequency and percentage of cigarette

smoking of the respondents both in the morning-shift and other shifts of

hemodialysis. Majority of the respondents (n=8) in the morning-shift HD do not

smoke cigarettes. While the remaining respondents (F=2) smoke cigarettes. 50%

(F=1) of the respondent who do smoke cigarettes smoke a range of 1-10 sticks

of cigarettes a day and the remaining 50% (F=1) of respondent smoke more than
10 sticks of cigarettes a day. Majority of the respondents (F=9) in the other-shift

HD do not smoke cigarettes. While the remaining respondent (F=1) smokes a

range of 1-10 sticks a day.

Problem 2: What is the relationship of the age, gender, civil status,

occupation, Stage of CKD, frequency of hemodialysis treatment, coffee and

tea consumption and cigarette smoking to the sleep quality index of the

patients?

In Table 2, the relationship of the Demographic and Hemodialysis Profile which

are the age, gender, civil status, occupation, stage of CKD, frequency of

hemodialysis treatment, coffee intake, tea intake, and cigarette smoking to the

sleep quality index were further presented.

Table 2.1. Test of Relationship of the Demographic and Hemodialysis

Profile of respondents to the Sleep quality.

Variables p-value

Age 0.171b

Gender 0.494b

Civil Status 0.216b

Occupation 0.320b

Stage of 0.665b
Chronic Kidney
Disease
Frequency of 0.582b
hemodialysis
Coffee intake 0.035b

Cups of Coffee 0.036a

consumed a
day
Tea intake 0.761b
 Cigarette 0.125b
smoking
Sticks of 0.140a
cigarette
consumed a
day

a Statistical treatment used is Spearman Rhos

b Statistical treatment used is Chi-square test

The table above showed that there is a significant relationship (p=0.035)

between coffee intake and sleep quality of the respondents. These findings show

that majority of respondents who drinks coffee had a poor sleep quality and those

who dont had a good sleep quality.

Table 2.2. Test of Relationship of the Age of respondents and their Sleep

quality.

Variables p-value

Sleep Duration 0.510

Sleep 0.103
Disturbances
Sleep Latency 0.234

Day Dysfunction 0.233

Sleep Efficiency 0.077

Overall Sleep 0.133

Quality
Use of Sleep 0.164
Meds

Table 2.2 above shows the relationship of the age of the respondents and
their sleep quality. Pearson
Table 2.3. Test of Relationship of the Gender of respondents and their

Sleep quality.

Variables p-value

Sleep Duration 0.535

Sleep 0.820
Disturbances
Sleep Latency 0.161

Day Dysfunction 0.937

Sleep Efficiency 0.264

Overall Sleep 0.185

Quality
Use of Sleep 0.434
Meds

Table 2.3 above shows the relationship of the gender of the respondents and
their sleep quality. chi
Table 2.4. Test of Relationship of the Civil Status of respondents and their

Sleep quality.

Variables p-value

Sleep Duration 0.942

Sleep 0.371
Disturbances
Sleep Latency 0.374

Day 0.034
Dysfunction
Sleep Efficiency 0.260

Overall Sleep 0.176

Quality
Use of Sleep 0.683
Meds

Table 2.4 above shows the relationship of the civil status of the respondents and
their sleep quality.
Table 2.5. Test of Relationship of the Occupation of respondents and their

Sleep quality.

Variables p-value

Sleep Duration 0.003

Sleep 0.710
Disturbances
Sleep Latency 0.196

Day Dysfunction 0.292

Sleep Efficiency 0.346

Overall Sleep 0.606

Quality
Use of Sleep 0.633
Meds

Table 2.5 above shows the relationship of the occupation of the respondents and
their sleep quality.
Table 2.6. Test of Relationship of the Stage of Chronic Kidney Disease of

respondents and their Sleep quality.

Variables p-value

Sleep Duration 0.798

Sleep 0.405
Disturbances
Sleep Latency 0.547

Day Dysfunction 0.789

Sleep Efficiency 0.290

Overall Sleep 0.620

Quality
Use of Sleep 0.960
Meds

Table 2.6 above shows the relationship of the stage of Chronic Kidney Disease
of the respondents and their sleep quality.
Table 2.7. Test of Relationship of the Frequency of Hemodialysis

treatment of respondents and their Sleep quality.

Variables p-value

Sleep Duration 0.681

Sleep 0.472
Disturbances
Sleep Latency 0.673

Day Dysfunction 0.944

Sleep Efficiency 0.960

Overall Sleep 0.872

Quality
Use of Sleep 0.698
Meds

Table 2.7 above shows the relationship of the frequency of Hemodialysis

treatment of the respondents and their sleep quality.
Table 2.8. Test of Relationship of Coffee consumption of respondents and

their Sleep quality.

Variables p-value

Sleep Duration 0.260

Sleep 0.134
Disturbances
Sleep Latency 0.099

Day 0.020
Dysfunction
Sleep Efficiency 0.061

Overall Sleep 0.054

Quality
Use of Sleep 0.325
Meds

Table 2.8 above shows the relationship of coffee consumption of the respondents
and their sleep quality.
Table 2.9. Test of Relationship of Number cups of Coffee consumed by

respondents per day and their Sleep quality.

Variables p-value

Sleep Duration 0.186

Sleep 0.050
Disturbances
Sleep Latency 0.033

Day 0.022
Dysfunction
Sleep Efficiency 0.066

Overall Sleep 0.014

Quality
Use of Sleep 0.196
Meds

Table 2.8 above shows the relationship of cups of coffee consumed by the
respondents per day and their sleep quality.
Table 2.10. Test of Relationship of Cigarette smoking to the respondents

Sleep quality.

Variables p-value

Sleep Duration 0.376

Sleep 0.105
Disturbances
Sleep Latency 0.450

Day Dysfunction 0.284

Sleep Efficiency 0.374

Overall Sleep 0.158

Quality
Use of Sleep 0.957
Meds

Table 2.10 above shows the relationship of cigarette smoking to the respondents
sleep quality.
Table 2.11. Test of Relationship of sticks of Cigarette consumed by

respondents per day and their Sleep quality.

Variables p-value

Sleep Duration 0.584

Sleep 0.264
Disturbances
Sleep Latency 0.793

Day Dysfunction 0.493

Sleep Efficiency 0.514

Overall Sleep 0.405

Quality
Use of Sleep 0.954
Meds

Table 2.8 above shows the relationship of sticks of cigarette consumed by the
respondents per day and their sleep quality.
Problem 3a: What is the sleep quality measures of the patients undergoing

hemodialysis one month before and after the session in the Morning-shift

hemodialysis?

Table 3.1. Average Sleep quality measures of the patients in Morning-shift

during pretest and posttest.

Morning-shift
Sleep Quality
Interpretatio Post Interpretatio
Measures Pretest
n test n
Sleep Duration
(score) 0.1 Very Good 0.3 Very Good
(in hours) 8.3 hrs. 7.25
hrs.
Sleep Duration
(score) 1.5 Once or 1.7 Once or
twice a week twice a week
1.6 1.57
Wake up in the Once or Once or
middle of the twice a week twice a week
night or early 1.4 2.12
morning Less than Once or
once a week twice a week
Have to get up to
use the bathroom 1.9 1.4
Once or Once or
twice a week twice a week
Cannot breathe 0.9 1.8
comfortably
 Less than Less than
0.8 once a week 1.38 once a week
Cough or snore
loudly Less than Less than
once a week once a week
1.16 1.6
Once or
Feel too cold Less than twice a week
0.5 once a week
Less than
Not during 1.2 once a week
Feel too hot 1.21 the past
month Once or
1.5 twice a week
Less than
Have bad dreams 0.9 once a week Less than
once a week
Less than 0.9
once a week
Have pain

\
Other
reasons________
Sleep Latency
(score) 0.9 Good 1.4 Good

(in minutes) 19mins 32 mins

Less than Less than
(frequency) 1 Once a week 1.2 once a week
 Day Dysfunction
(score) 1.4 Good 2.2 Bad

Difficulty staying 1.15 Less than 1.9 Once or

awake while once a week twice a week
driving, eating
meals, or Less than Three or
engaging in social 0.91 once a week 2.3 more times a
activity week

Difficulty keeping
up enthusiasm to
get things done
Sleep Efficiency 0.1 Very Good 0.4 Very Good
Overall Sleep 1.5 Bad 1.9 Bad
Quality
Need Meds to 0.9 Less than 1.3 Less than
Sleep once a week once a week

Table 3.1 shows the average sleep quality measure scores of the

respondents from the morning-shift hemodialysis during pretest and posttest.

The interpretation of each values is also included in the table. During pretest in

the morning shift, respondents often experience some sleep disturbances which

includes being awake in the middle of the night or early morning and cannot

breathe comfortably that they experience mostly ones or twice a week. They

also have a bad overall sleep quality as rated by the respondents. Respondents

also have an average of 19 minutes sleep latency for less than once a week.

Seldom, respondents also experience a day dysfunction due to sleepiness which

includes difficulty staying awake while driving , eating meals or engaging in social

activity and difficulty keeping up enthusiasm to get things done. Respondents

also seldom take meds in order for them to sleep. And they have a very good

sleep efficiency and sleep duration with an average of 8.3 hours.

While during posttest in the morning shift, respondents also often

experience sleep disturbances which includes being awake in the middle of the

night or early morning, have to get up to use the bathroom, having cough and

snores loudly, feels too hot and experience pain. And just like in the pretest,

respondents also have a bad overall sleep quality as stated by the respondents.

Respondents also have an average of 32 minutes sleep latency for less than

once a week. And respondents often experience a day dysfunction due to

sleepiness which includes difficulty staying awake while driving, eating meals or

engaging in social activity which respondents experience it often and sometimes

they also experience difficulty keeping up enthusiasm to get things done. Just

like in pretest, the respondents also seldom take meds in order for them to sleep.

And they have a very good sleep efficiency and sleep duration with an average

of 7.25 hours.
Table 3.2. Frequency of Sleep quality index of the respondents in

Morning-shift hemodialysis during pretest and posttest.

Pretest Post test

(frequency/ (frequency/
percentage) percentage)

Good 3 (30%) 4 (40%)

Poor 7 (70%) 6 (60%)

Seventy percent of the respondents (F=7) had a poor sleep quality

during pretest and the remaining 30% (F=3) had a good sleep quality. While

during the post test, majority of the respondents (F=6) had a poor sleep quality

and the remaining 40% (F=4) had a good sleep quality.

Problem 3b: What is the sleep quality measures of the patients

undergoing hemodialysis one month before and after the session in the

other shifts of hemodialysis?

Table 3.3. Average Sleep quality measures of the patients in the other

shifts of Hemodialysis during pretest and posttest.

Other shifts
Sleep Quality Pretest Post test
Measures Score Interpretatio Score Interpretatio
(Mean) n (Mean) n
Sleep Duration
(score) 0.1 Very Good 0.3 Very Good
(in hours) 8.1 hrs. 7.8 hrs.
Sleep
Disturbance 1.8 Once or 1.3 Less than
(score) twice a week once a week
1.8 1.1
Once or Less than
Wake up in the twice a week once a week
middle of the 2 1.5
night or early Once or Less than
morning twice a week once a week

0.9 0.8
Have to get up to Less than Less than
use the bathroom once a week once a week
1.7 1
 Once or Less than
Cannot breathe twice a week once a week
comfortably 1 0.4
Less than Not during
once a week the past
Cough or snore month
loudly 1.5 0.4
Once or Not during
twice a week the past
month
Feel too cold 1.1 Less than 0.1
once a week Not during
the past
1.8 Once or 1.5 month
Feel too hot twice a week
Once or
Not during twice a week
0.6 the past 0.6
Have bad dreams month Not during
the past
month

Have pain

\
Other
reasons________
Sleep Latency
(score) 1.7 Bad 0.8 Good
 (in minutes) 30 mins 10.7
mins
(frequency) 1.9 Once or 1.1 Less than
twice a week once a week
Day Dysfunction
(score) 1.5 Bad 0.7 Good

Difficulty staying 1.4 Less than 0.8 Less than

awake while once a week once a week
driving, eating
meals, or Less than Not during
engaging in social 1.3 once a week 0.5 the past
activity month

Difficulty keeping
up enthusiasm to
get things done
Sleep Efficiency 0.4 Very Good 0 Very Good
Overall Sleep 2.2 Bad 0.9 Good
Quality
Need Meds to 0.9 Less than 0.8 Less than
Sleep once a week once a week

Table 3.2 shows the average sleep quality measure scores of the

respondents from the morning-shift hemodialysis during pretest and posttest.

The interpretation of each values is also included in the table. During the other-

shifts pretest, the respondents have a very good sleep duration, with an

average of 8.1 hours, and very good sleep efficiency. The respondents often

experience sleep disturbances associated with waking up in the middle of the

night or in the early morning, waking up to go to the bathroom, coughing or

snoring loudly, feeling hot, and pain, while having the seldom need medications

to sleep. The respondents have a bad sleep latency with an average time of 30

minutes experienced once or twice a week. The respondents often experience

day dysfunction associated with seldom experiences of difficulty staying awake

while driving, eating meals, or engaging in social activity and difficulty keeping

up with enthusiasm to get things done. Overall sleep quality of the respondents

pretest is bad.

While during the posttest, the respondents have a fairly good overall

sleep quality. The respondents sleep duration is very good with an average of

7.8 hours. Sleep disturbances are seldom experienced, but show an often

occurrence of having to wake up to use the bathroom and feelings of pain,

while seldom needing medications to sleep. Sleep latency is fairly good with an

average of 10.7 minutes experienced less than once a week. Day dysfunction

is very good with the seldom occurrence of difficulty staying awake while

driving, eating meals, or engaging in social activity and sleep. Sleep efficiency

is also very good.

It is noteworthy to mention that sleep duration is interpreted as Very

Good between pre- and posttest scores. The findings found between the pre-

and posttest scores in terms of Sleep Disturbances shows that there is a

significant difference from bad to good. And needs meds to sleep is interpreted

from bad to good. There is a significant change in pretest and posttest of sleep

efficiency and is interpreted as very good. While the sleep latency is interpreted
as good both pretest and posttest. It is noteworthy that the pretest and posttest

of day dysfunction due to sleepiness shows a result of bad to good.

Table 3.2. Frequency of Sleep quality index of the respondents in other

shifts of hemodialysis during pretest and posttest.

Sleep Quality Index Pretest Post test

(frequency/ (frequency/
percentage) percentage)

Good 2 (20%) 8 (80%)

Poor 8 (80%) 2 (20%)

Eighty percent of the respondents (F=8) had a poor sleep quality during

pretest and the remaining 20% (F=2) had a good sleep quality. While during the

post test, majority of the respondents (F=8) had a good sleep quality and the

remaining 20% (F=2) had a poor sleep quality. The findings indicate that after

hemodialysis, quality of sleep improved.

Problem 4a: Is there a significant difference in the sleep quality of the

patients undergoing hemodialysis one month before and after the session

in the Morning-shift hemodialysis?

Table 4.1. Test of Difference between Sleep quality measures of the

respondents during pretest and posttest in Morning-shift Hemodialysis.

Variables t-value df p-value Interpretation

Sleep Duration 0.612 9 0.555 Not significant

(VG-VG)
Sleep Disturbances 0.514 9 0.619 Not significant
(Bad-Bad)
Sleep Latency 1.861 9 0.096 Not significant
(G-G)
Day Dysfunction 1.562 9 0.153 Not significant
(G-B)
Sleep Efficiency 1.964 9 0.081 Not significant
(VG-VG)
Overall Sleep Quality 0.840 9 0.423 Not significant
(Bad-Bad)
Use of Sleep Meds 1.809 9 0.104 Not significant
(G-G)

Table 4.1 above shows the difference between Sleep quality measures of

the respondents during pretest and posttest in Morning-shift Hemodialysis. In

general, the results showed that there were no significant differences in the pretest

and posttest sleep quality measures of the respondents in the morning-shift

hemodialysis. Therefore, we cannot infer that the morning-shift hemodialysis

causes or had caused the improvement or decline in sleep quality measures.

There might have been other variables that caused the changes. These variables

can be the symptomsdry skin, itching, difficulty sleeping, feeling tired or lack of
energy, trouble falling asleep, decrease interest in sex, etc.associated with End-

Stage Renal Disease (ESRD), in which majority of our patients have. Poor sleep

quality can also be associated with changes in lifestyle and activities of daily living

due to disease limitations and treatments (Wang, et al., 2016). Mental health of

Chronic Kidney Disease patients affects the sleep quality measures especially the

sleep efficiency, subjective (overall) sleep quality, and use of sleep medications

(Edalat-Nejad & Qlich-Khani, 2013)

Table 4.2. Test of Difference between Sleep quality index of the

respondents during pretest and posttest in Morning-shift Hemodialysis.

Posttest
Pretest p-Value
Good Poor
Sleep
Good (n=3) 1 (33%) 2 (66%)
Quality 1.000
Poor (n=7) 3 (43%) 4 (57%)

Table 4.2 shows the McNemars results of Pretest and Posttest Sleep

quality index of Morning-shift hemodialysis respondents.

Three respondents had a positive change from Poor sleep quality to

Good sleep quality, four respondents remained having Poor sleep quality index

and only one respondents sleep quality remained Good. On the other hand, two

respondents had a negative change from Good sleep quality to Poor sleep
quality. McNemar's test determined that there was no significant difference in the

sleep quality index of the respondents pre- and post-intervention, p = 1.000.

Therefore, we cannot infer that the morning-shift hemodialysis caused

improvement or decline in sleep quality index. The same results were found by

Cheng et al. wherein no association was found with subjective sleep quality (PSQI

scores) and hemodialysis timing. He, however, found that age, gender and length

of dialysis treatment were significantly related with poor sleep quality. Trbojevi

also formulated the same conclusion when he found no significant relationship with

sleep quality and hemodialysis shifting. But he found out that age, female gender,

and depression level are the factors that causes significant changes in subjective

sleep quality results.

On the contrary, the study by Wang et al. showed that morning-shift

hemodialysis is related to significantly better sleep quality than other remaining

shifts. The same finding was utilized by Thompson in 2013, wherein she inferred

morning-shift hemodialysis is significantly related with better sleep quality and that

presence of anxiety, depression and tea drinking is associated with poorer sleep

quality.
Problem 4b: Is there a significant difference in the sleep quality measures

of the patients undergoing hemodialysis one month before and after the

session in the other shifts of hemodialysis?

Table 4.3. Test of Difference between Sleep quality measures of the

respondents during pretest and posttest in other shifts of Hemodialysis.

Variables t-value df p-value

Sleep Duration 1.000 9 0.343

Sleep Disturbances -1.861 9 0.096

Sleep Latency -2.586 9 0.029

Day Dysfunction -2.228 9 0.053

Sleep Efficiency -2.449 9 0.037

Overall Sleep -2.414 9 0.039

Quality

Use of Sleep Meds -0.429 9 0.678

Table 4.3 above shows the difference between Sleep quality measures of

the respondents during pretest and posttest in other shifts of Hemodialysis. It can

be seen that the Sleep latency (t(9)=-2.586, p=0.029), Sleep efficiency (t(9)=-

2.449, p=0.037), and Overall sleep quality (t(9)=-2.414, p=0.039) showed a

significant difference. In the other (afternoon and night) shifts of hemodialysis,

the respondents are dialyzed at their usual sleep time. This causes a decrease in

sleep (onset) latency, improving the sleep efficiency and therefore, enhancing
patients subjective sleep quality (Cengic, Resic, Spasovski, Avdic, &

Alajbegovic, 2012).

There is no significant difference found in the pre- and posttest scores in

terms of sleep duration, sleep disturbances, day dysfunction due to sleepiness,

and use of sleep-inducing medications. Because theres not enough significant

evidence to reject the null, therefore, we fail to reject the null. Thus, we wont be

able to conclude that the other shifts caused improvements or decline in the

following measures. There might also have been extraneous variables that

affected the sleep quality measures of the respondents, and were not assessed

by the tool, such as energy drinks in the morning that will prevent daytime

sleepiness by increasing the caffeine and sugar level in the blood, which is vital

for the Circadian clock to keep us awake (Science Answers, Why Do Energy

Drinks Make Me Tired?, 2017). The insignificant difference in the change of Day

Dysfunction score may have been because of the Very Good or long sleep

duration time that is already present in the respondents in pretest that continued

until posttest.

Table 4.4. Test of Difference between Sleep quality index of the

respondents during pretest and posttest in the other shifts of

Hemodialysis.

PSQI Scores
Sleep Quality (Posttest)
Index p-Value
(Pretest) Good Poor
 Good 2 0
0.031
Poor 6 2

Table 4.4 shows the McNemars results of Pretest and Posttest Sleep quality index

of other shifts of hemodialysis respondents. Six respondents had a positive change

from poor sleep quality to good sleep quality. While two respondents had a

constant Good sleep quality and the other two remained Poor. The table above

shows that there is a significant difference (p=0.031) in the Sleep Quality index

scores of pretest and posttest in the other-shift HD. This is related to the overall

improvement of the sleep quality measures of the respondents in the other shifts.

Koch et.al showed that hemodialysis increases body temperature, and this

increase in body temperature activates the cooling physiological process of an

individual, causing sleepiness at night. Furthermore, the sleep-inducing effect of

the hemodialysis treatment, corresponds with the usual time of sleep of individual,

preventing alterations in melatonin secretion and the sleep-wake cycle. This

causes improvement in sleep quality.

However, some studies show that afternoon and nighttime hemodialysis

worsened the patients quality of sleep. One reason is the distance of the dialysis

center to the house of the patient that may delay their sleep onset leading to

compromised sleep. One-third to half of these patients were also found to have

sleep apnea which that may have caused decrease in sleep quality (Bathla,

Ahmad, Gupta, & Ahmad, 2017).

Problem 5: Is there a significant difference in the sleep quality of the

respondents during the pre-and posttest in the Morning and other

hemodialysis shifts?

Table 5.1. Test of Difference between Sleep quality measures of the

respondents in the Morning-shift and other shifts of Hemodialysis during

pretest.

Variables t-value df p-value

Sleep Duration 0.001 18 1.000

Sleep Disturbances 0.818 18 0.424

Sleep Latency 1.656 14.014 0.120

Day Dysfunction 0.231 18 0.820

Sleep Efficiency 1.567 14.918 0.138

Overall Sleep Quality 1.413 18 0.175

Use of Sleep Meds .001 18 1.000

Table 5.1 shows the test of difference between Sleep quality measures of the

respondents in the Morning-shift and other shifts of Hemodialysis during pretest.

According to the result of the statistical test, no significant finding was noted. This

indicates that the null Ho will not be rejected. The sleep quality measures of the

respondents in the morning-shift and other shifts of Hemodialysis are equal and

are comparable.
Table 5.2. Test of Difference between Sleep quality index of the

respondents in the Morning-shift and other shifts of Hemodialysis during

pretest.

*Note: Review the results. Use Fishers Exact Sig for n<5.

Sleep
Quality Morning- Other p-
Total 2 df
Index shift shifts value
(Pretest)
Good 3 2 5

Poor 7 8 15 1 0.606
0.267
Total 10 10 20

Table 5.2 shows the test of difference between Sleep quality index of the

respondents in the Morning-shift and other shifts of Hemodialysis during pretest.

According to the result of the statistical test, no significant finding was noted. This

indicates that the null Ho will not be rejected. The sleep quality measures of the

respondents in the morning-shift and other shifts of Hemodialysis are equal and

are comparable.
Table 5.3. Test of Difference between Sleep quality measures of the

respondents in the Morning-shift and other shifts of Hemodialysis during

posttest.

Variables t-value df p-value

Sleep Duration 0.001 18 1.000

Sleep Disturbances -1.524 18 0.145

Sleep Latency -1.423 18 0.172

Day Dysfunction -3.382 18 0.003

Sleep Efficiency -2.449 9 0.025

Overall Sleep -2.132 18 0.047

Quality

Use of Sleep Meds 0.204 18 0.247

Table 5.3 shows the test of difference between Sleep quality measures of the

respondents in the Morning-shift and other shifts of Hemodialysis during posttest.

Table 5.4. Test of Difference between Sleep quality index of the

respondents in the Morning-shift and other shifts of Hemodialysis during

posttest.

Sleep
Quality Morning- Other p-
Total 2 df
Index shift shifts value
(Pretest)
Good 4 8 12

Poor 6 2 8 1 0.068
3.333
Total 10 10 20

Table 5.4 shows the test of difference between Sleep quality index of the

respondents in the Morning-shift and other shifts of Hemodialysis during posttest.