Hanly P J, Pierratos A
Department of Medicine, St. Michael's Hospital, University of Toronto, ON, Canada.
N Engl J Med. 2001 Jan 11;344(2):102-7. doi: 10.1056/NEJM200101113440204.
Sleep apnea is common in patients with chronic renal failure and is not improved by either conventional hemodialysis or peritoneal dialysis. With nocturnal hemodialysis, patients undergo hemodialysis seven nights per week at home while sleeping. We hypothesized that nocturnal hemodialysis would correct sleep apnea in patients with chronic renal failure because of its greater effectiveness.
Fourteen patients who were undergoing conventional hemodialysis for four hours on each of three days per week underwent overnight polysomnography. The patients were then switched to nocturnal hemodialysis for eight hours during each of six or seven nights a week. They underwent polysomnography again 6 to 15 months later on one night when they were undergoing nocturnal hemodialysis and on another night when they were not.
The mean (+/-SD) serum creatinine concentration was significantly lower during the period when the patients were undergoing nocturnal hemodialysis than during the period when they were undergoing conventional hemodialysis (3.9+/-1.1 vs. 12.8+/-3.2 mg per deciliter [342+/-101 vs. 1131+/-287 micromol per liter], P<0.001). The conversion from conventional hemodialysis to nocturnal hemodialysis was associated with a reduction in the frequency of apnea and hypopnea from 25+/-25 to 8+/-8 episodes per hour of sleep (P=0.03). This reduction occurred predominantly in seven patients with sleep apnea, in whom the frequency of episodes fell from 46+/-19 to 9+/-9 per hour (P= 0.006), accompanied by increases in the minimal oxygen saturation (from 89.2+/-1.8 to 94.1+/-1.6 percent, P=0.005), transcutaneous partial pressure of carbon dioxide (from 38.5+/-4.3 to 48.3+/-4.9 mm Hg, P=0.006), and serum bicarbonate concentration (from 23.2+/-1.8 to 27.8+/-0.8 mmol per liter, P<0.001). During the period when these seven patients were undergoing nocturnal hemodialysis, the apnea-hypopnea index measured on nights when they were not undergoing nocturnal hemodialysis was greater than that on nights when they were undergoing nocturnal hemodialysis, but it still remained lower than it had been during the period when they were undergoing conventional hemodialysis (P=0.05).
Nocturnal hemodialysis corrects sleep apnea associated with chronic renal failure.
睡眠呼吸暂停在慢性肾衰竭患者中很常见，传统血液透析或腹膜透析均无法改善。夜间血液透析时，患者每周七个晚上在家睡眠期间进行血液透析。我们推测夜间血液透析因其更高的有效性可纠正慢性肾衰竭患者的睡眠呼吸暂停。
14例每周三天、每次4小时接受传统血液透析的患者接受整夜多导睡眠监测。然后这些患者改为每周六或七个晚上、每次8小时的夜间血液透析。6至15个月后，他们在进行夜间血液透析的一晚和未进行夜间血液透析的另一晚再次接受多导睡眠监测。
患者进行夜间血液透析期间的平均（±标准差）血清肌酐浓度显著低于进行传统血液透析期间（3.9±1.1比12.8±3.2mg/dl[342±101比1131±287μmol/L]，P<0.001）。从传统血液透析转换为夜间血液透析与呼吸暂停和呼吸浅慢频率从每小时睡眠25±25次降至8±8次相关（P=0.03）。这种降低主要发生在7例睡眠呼吸暂停患者中，其发作频率从每小时46±19次降至9±9次（P=0.006），同时最低氧饱和度增加（从89.2±1.8%增至94.1±1.6%，P=0.005），经皮二氧化碳分压增加（从38.5±4.3至48.3±4.9mmHg，P=0.006），血清碳酸氢盐浓度增加（从23.2±1.8至27.8±0.8mmol/L，P<0.001）。在这7例患者进行夜间血液透析期间，未进行夜间血液透析的夜晚测得的呼吸暂停-呼吸浅慢指数大于进行夜间血液透析的夜晚，但仍低于他们进行传统血液透析期间（P=0.05）。
夜间血液透析可纠正与慢性肾衰竭相关的睡眠呼吸暂停。
