糖尿病血液透析患者的失眠。一项多中心研究的患病率及危险因素

Insomnia in diabetic hemodialysis patients. Prevalence and risk factors by a multicenter study.

作者信息

Han Sang-Youb, Yoon Jong-Woo, Jo Sang-Kyung, Shin Jin-Ho, Shin Chol, Lee Jung-Bok, Cha Dae-Ryong, Cho Won-Yong, Pyo Heui-Jung, Kim Hyoung-Kyu, Lee Kyu-Bec, Kim Hyang, Kim Kyung-Wook, Kim Yong-Seop, Lee Jeong-Ho, Park Sang-Eun, Kim Chang-Soo, Wea Kyeong-So, Oh Kyung-Shik, Chung Tae-See, Suh Sang-Yeol

机构信息

Department of Internal Medicine, Korea University, Seong-Buk Gu, Seoul, South Korea.

出版信息

Nephron. 2002 Sep;92(1):127-32. doi: 10.1159/000064460.

DOI:10.1159/000064460

PMID:12187095

Abstract

BACKGROUND

Insomnia is one of the most common problems in dialysis patients, and likely to contribute impairment in quality of life, which has a positive correlation with patients' survival. In diabetic patients, morbidity and mortality are substantially higher than in the nondiabetic counterparts, and also the incidence of sleep disturbances. However, there is no means to predict sleep disturbance in the dialysis patients especially in diabetics. To define the prevalence and risk factors for insomnia in diabetic patients on hemodialysis, we undertook a cross-sectional multicenter study.

METHODS

Eighty-two diabetic patients (50 men/32 women, aged 58.7 +/- 9.23 years) on maintenance hemodialysis for more than 6 months from 12 different hospitals were enrolled. The demographic data, subjective symptoms, depression scale, and insomnia were assessed by questionnaires, and lean body mass, BMI, Kt/V, subjective global assessment, nursing assessment score (NAS), and biochemical parameters were examined.

RESULTS

The number of patients with and without insomnia were 56 and 26, respectively, which amounted to 68.2% for insomnia. NAS (28.1 +/- 3.81 vs. 30.8 +/- 2.88, p = 0.002), serum albumin concentration (3.82 +/- 0.44 vs. 4.09 +/- 0.36 g/dl, p = 0.008), and depression scale (25.2 +/- 12.1 vs. 18.9 +/- 10.3, p = 0.025) were significantly different between them. Patients with insomnia were older (60.5 +/- 9.0 vs. 56. 1 +/- 9.60 years, p = 0.053) and felt pain (38.5 vs. 15.3%, p = 0.06) more frequently than those without insomnia. The scale of depression was correlated with NAS (r = -0.455, p < 0.001) and the serum albumin concentration was correlated with NAS (r = 0.337, p = 0.002). NAS, age, and serum albumin concentration were the major risk factors for insomnia in logistic regression analysis.

CONCLUSION

The prevalence of insomnia in diabetic hemodialysis patients was 68.2%. Age, nutritional status, and depression were the major risk factors for sleep disturbance in diabetic patients.

摘要

背景

失眠是透析患者最常见的问题之一，可能会导致生活质量下降，而生活质量与患者的生存率呈正相关。在糖尿病患者中，发病率和死亡率显著高于非糖尿病患者，睡眠障碍的发生率也是如此。然而，尚无方法预测透析患者尤其是糖尿病患者的睡眠障碍。为了确定糖尿病血液透析患者失眠的患病率和危险因素，我们开展了一项横断面多中心研究。

方法

招募了来自12家不同医院的82例维持性血液透析超过6个月的糖尿病患者（50例男性/32例女性，年龄58.7±9.23岁）。通过问卷调查评估人口统计学数据、主观症状、抑郁量表和失眠情况，并检查瘦体重、体重指数、Kt/V、主观全面评定、护理评估评分（NAS）和生化参数。

结果

有失眠和无失眠的患者人数分别为56例和26例，失眠患病率为68.2%。两者之间NAS（28.1±3.81对30.8±2.88，p=0.002）、血清白蛋白浓度（3.82±0.44对4.09±0.36g/dl，p=0.008）和抑郁量表（25.2±12.1对18.9±10.3，p=0.025）存在显著差异。有失眠的患者比无失眠的患者年龄更大（60.5±9.0对56.1±9.60岁，p=0.053），且更频繁地感到疼痛（38.5%对15.3%，p=0.06）。抑郁量表与NAS相关（r=-0.455，p<0.001），血清白蛋白浓度与NAS相关（r=0.337，p=0.002）。在逻辑回归分析中，NAS、年龄和血清白蛋白浓度是失眠的主要危险因素。