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SLEEP-PROMOTING MATERIAL EXTRACTED FROM PERITONEAL DIALYSATE OF PATIENTS WITH END-STAGE RENAL DISEASE AND INSOMNIA

From the Departments of Psychiatry and Medicine, Toronto Western Hospital, University of Toronto, Canada. The Department of Physiology and Biophysics, The Chicago Medical School, North Chicago, Illinois, and the Department of Medicine, Tufts University School of Medicine, Boston Massachusetts.

We studied four patients with end stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD) who complained of chronic insomnia and fatigue. Overnight polysomnography showed a disorder of sleep maintenance that was associated with nocturnal myoclonus. Sleeppromoting substance(s), Factor S-like material, that was extracted from the patient's dialysate effluent, was somnogenic and pyrogenic in a rabbit bioassay. Another proposed sleep substance, lnterleukin -I, isolated by gel filtration, also was present in the dialysate effluents of all patients. Altered metabolism and/or loss of these substances from the effluent may contribute to the chronic insomnia and fatigue of CAPD patients.

KEY WORDS: Peritoneal dialysis; Sleep; Nocturnal myoclonus; Factor S; Interleukin-l.

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