SLEEP DISTURBANCE AND LONGER DIALYSIS VINTAGE WORSEN ANTIBODY RESPONSE TO VACCINATION IN DIALYSIS PATIENTS

Abstract

Objectives: This study aimed to assess whether sleep disturbance is associated with immune response and could predict magnitude of antibody response to the novel antigen of hepatitis B in vaccinated dialysis patients. Materials and methods: We prospectively studied the evolution of HBsAg antibody (HBsAb) after primary vaccination (three doses; Engerix B, 40 pg i.m. at 0, one and 6 months) in 91 seronegative dialysis patients in three years period. The mean age of patients was 57.65±12.94; dialysis vintage 47.23±54.63 months; 54% were men. We also assessed dialysis adequacy (Kt/V), pre-dialysis albumin and CRP before vaccination and the anti-HBs titer one month after completed vaccination. Results: Twenty-one (23%) patients were non-responders (HBsAb<10IU/L); 26 (28%) were weak responders (10-100 IU/L) and 44 (48%) showed good antibody response (>100 IU/L). HBsAb titer showed no association with age, serum albumin Kt/V and CRP (p > 0.05). The regression analysis showed that dialysis vintage and presence of sleep disturbance were strongly and inversely associated with immune response (β = - 0.309, p=0.01; β= - 0.252, p=0.008, respectively). In the multivariate model the presence of sleep disturbance and longer vintage predicted lower antibody level, explaining 16% of the population. Conclusion: Dialysis patients should be vaccinated against hepatitis B as soon as possible at start, or in pre-dialysis period of the disease. Sleep disturbance negatively affects immune response.