Kuhlmann U, Becker H F, Birkhahn M, Peter J H, von Wichert P, Schütterle S, Lange H
Clinic of Nephrology, Centre of Internal Medicine, Philipps University, Marburg, Germany.
Clin Nephrol. 2000 Jun;53(6):460-6.
A high prevalence of sleep apnea syndrome (SAS) of 54%-80% has been reported in patients with end-stage renal disease (ESRD). However, these studies were either done in highly selected small patient groups or without objective data using questionnaires only.
We, therefore, studied the prevalence of SAS in a large, unselected group of patients with ESRD. During a 6-month period 77 out of 84 unselected patients with ESRD filled out the sleep apnea questionnaire of the University of Marburg and the Epworth Sleepiness Scale. In 55 of these patients, snoring sounds, heart rate, body position and transcapillary arterial oxygen saturation were recorded with an ambulatory device during the night after hemodialysis.
In the questionnaires, 70.3% of the patients reported of an excessive day-time sleepiness, 40.5% of unwillingly falling asleep during the daytime and 35.2% rated their ability to concentrate as decreased. 30.9% (40% male/15% female) of the patients showed evidence of sleep-disordered breathing with an apnea-hypopnea-index (AHI) equal or more than 5/hour. 16.4% (20% male/10% female) of the patients met the diagnostic criteria of SAS. Neither dialysis and biochemical data nor anamnestic parameters measured by the questionnaires correlated significantly with sleep-disordered breathing.
The prevalence of SAS in this large unselected patient group was not as high as previously reported, but it is still considerably higher than in the general population. Objective recordings are essential, as questionnaires overestimate the prevalence of SAS in patients with ESRD. As SAS promotes hypertension and impairs quality of life, ESRD patients might benefit from a treatment of concomitant SAS.
据报道，终末期肾病（ESRD）患者中睡眠呼吸暂停综合征（SAS）的患病率高达54% - 80%。然而，这些研究要么是在经过高度筛选的小患者群体中进行，要么仅使用问卷而没有客观数据。
因此，我们对一大组未经筛选的ESRD患者进行了SAS患病率研究。在6个月期间，84例未经筛选的ESRD患者中有77例填写了马尔堡大学的睡眠呼吸暂停问卷和爱泼华嗜睡量表。其中55例患者在血液透析后的夜间，使用动态监测设备记录了打鼾声、心率、体位和经皮动脉血氧饱和度。
在问卷中，70.3%的患者报告有日间过度嗜睡，40.5%的患者在白天会不自觉入睡，35.2%的患者认为自己的注意力集中能力下降。30.9%（男性40%/女性15%）的患者存在睡眠呼吸紊乱，呼吸暂停低通气指数（AHI）等于或超过5次/小时。16.4%（男性20%/女性10%）的患者符合SAS的诊断标准。透析和生化数据以及问卷所测量的既往参数与睡眠呼吸紊乱均无显著相关性。
在这个未经筛选的大患者群体中，SAS的患病率并不像之前报道的那么高，但仍显著高于普通人群。由于问卷会高估ESRD患者中SAS的患病率，因此客观记录至关重要。鉴于SAS会加重高血压并损害生活质量，ESRD患者可能会从合并SAS的治疗中获益。
