Sabbatini Massimo, Minale Bruno, Crispo Anna, Pisani Antonio, Ragosta Annalisa, Esposito Raffaela, Cesaro Antonio, Cianciaruso Bruno, Andreucci Vittorio E
Department of Nephrology, University Federico II, Naples, Italy.
Nephrol Dial Transplant. 2002 May;17(5):852-6. doi: 10.1093/ndt/17.5.852.
Studies in the last 15 years have shown a high prevalence of sleep disorders in maintenance haemodialysis (HD) patients.
To investigate whether the new technical and therapeutic advances of the last decade have had a positive impact on sleep disturbances in HD patients: 694 patients (384 males, 310 females) were surveyed using a specific questionnaire; their clinical, lifestyle and dialysis data were also recorded.
Forty-five per cent of patients (n=311; 156 males, 155 females) complained of insomnia, defined either by delayed sleep onset and/or night-time waking, and were included in the insomnia group; the remainder were used as controls (control group). There was a significantly higher risk of insomnia in patients with >12 months on dialysis, in patients dialysed in the morning (P<0.003), and in patients with higher parathyroid hormone (PTH) levels (P<0.05). Body mass index, body weight gain and blood pressure did not differ between the groups, and neither did the dialysis parameters. Creatinine and urea plasma levels were higher in the control group vs the insomnia group (P<0.001), but there was no difference in haemoglobin concentrations or use of erythropoietin, calcitriol and antihypertensive drugs. Cigarette smoking, caffeine or alcohol intake were comparable in the two groups. The most frequently recorded sleep disorders were night-time waking (92%), trouble falling asleep (67%) and early morning waking (62%). Restless leg symptoms were described in 52% of patients with insomnia.
The prevalence of insomnia in HD patients is still very high; elderly patients, and those with longer time on dialysis and high levels of PTH are at major risk of insomnia, whereas type of dialysis, haemoglobin levels and behavioural factors do not seem to play a critical role in determining this sleep disorder.
过去15年的研究表明，维持性血液透析（HD）患者睡眠障碍的患病率很高。
为了调查过去十年的新技术和治疗进展是否对HD患者的睡眠障碍产生了积极影响：使用特定问卷对694名患者（384名男性，310名女性）进行了调查；还记录了他们的临床、生活方式和透析数据。
45%的患者（n = 311；156名男性，155名女性）抱怨失眠，定义为入睡延迟和/或夜间醒来，并被纳入失眠组；其余患者作为对照组（对照组）。透析时间超过12个月的患者、上午进行透析的患者（P < 0.003）以及甲状旁腺激素（PTH）水平较高的患者（P < 0.05）患失眠的风险显著更高。两组之间的体重指数、体重增加和血压没有差异，透析参数也没有差异。对照组的血浆肌酐和尿素水平高于失眠组（P < 0.001），但血红蛋白浓度或促红细胞生成素、骨化三醇和抗高血压药物的使用没有差异。两组的吸烟、咖啡因或酒精摄入量相当。最常记录的睡眠障碍是夜间醒来（92%）、入睡困难（67%）和早醒（62%）。52%的失眠患者描述有不安腿症状。
HD患者失眠的患病率仍然很高；老年患者、透析时间较长和PTH水平较高的患者患失眠的风险较大，而透析类型、血红蛋白水平和行为因素似乎在确定这种睡眠障碍方面不起关键作用。
