Parker Kathy P, Bliwise Donald L, Bailey James L, Rye David B
Nell Hodgson Woodruff School of Nursing; Department of Neurology, Sleep Disorders Center; and the Renal Division, Emory University, Atlanta, GA, USA.
Am J Kidney Dis. 2003 Feb;41(2):394-402. doi: 10.1053/ajkd.2003.50049.
Patients frequently sleep during hemodialysis (HD), a behavior often attributed to treatment-related fatigue and/or simple boredom. The possibility that this behavior reflects a more pervasive underlying increase in daytime sleepiness has never been systematically examined. Thus, we studied a sample of HD patients on an off-dialysis day to establish the presence or absence of daytime sleepiness independent of effects of treatment, quantify its severity, and identify associated demographic, metabolic, and sleep-related variables.
Forty-six stable HD patients underwent polysomnography, followed the next day (a nondialysis day) by the Multiple Sleep Latency Test (MSLT; low score = greater sleepiness), a measure of physiological daytime sleepiness. Subjects also completed the Epworth Sleepiness Scale (ESS; high score = greater sleepiness), a measure of subjective daytime sleepiness.
One third (n = 15) of subjects had MSLT scores suggesting abnormal levels of physiological daytime sleepiness, and six subjects had scores consistent with severe, pathological sleepiness. Thirty percent (n = 14) had significant subjective daytime sleepiness as measured by the ESS. However, MSLT and ESS scores were unrelated. Higher indices of sleep apnea (r = -0.324; P = 0.028) and brief arousals (r = -0.370; P = 0.009) correlated significantly with increased physiological, but not subjective, sleepiness. Longer nocturnal sleep latencies (r = 0.350; P = 0.017) and greater percentage of rapid-eye-movement sleep (r = 0.302; P = 0.042) were associated with decreased physiological sleepiness. Other major demographic, metabolic, and sleep-related variables did not correlate with MSLT scores, and none of the variables examined were related to ESS scores.
Daytime sleepiness is common in HD patients and may be severe despite the absence of obvious clinical risk factors for the condition. Thus, research designed to identify cost-effective indicators of daytime sleepiness and evaluate the detrimental effects of sleepiness on clinical outcomes in HD patients is warranted.
患者在血液透析（HD）期间经常睡觉，这种行为通常归因于与治疗相关的疲劳和/或单纯的无聊。这种行为是否反映了白天嗜睡更为普遍的潜在增加，从未得到系统研究。因此，我们对一组HD患者在非透析日进行了研究，以确定是否存在独立于治疗影响的白天嗜睡情况，量化其严重程度，并识别相关的人口统计学、代谢和睡眠相关变量。
46名稳定的HD患者接受了多导睡眠图检查，次日（非透析日）进行多次睡眠潜伏期试验（MSLT；低分表示嗜睡程度更高），这是一种测量生理性白天嗜睡的方法。受试者还完成了爱泼华嗜睡量表（ESS；高分表示嗜睡程度更高），这是一种测量主观性白天嗜睡的方法。
三分之一（n = 15）的受试者MSLT评分表明生理性白天嗜睡水平异常，6名受试者的评分与严重的病理性嗜睡一致。30%（n = 14）的受试者根据ESS测量有明显的主观性白天嗜睡。然而，MSLT和ESS评分无关。睡眠呼吸暂停指数较高（r = -0.324；P = 0.028）和短暂觉醒指数较高（r = -0.370；P = 0.009）与生理性嗜睡增加显著相关，但与主观性嗜睡无关。夜间睡眠潜伏期较长（r = 0.350；P = 0.017）和快速眼动睡眠百分比更高（r = 0.302；P = 0.042）与生理性嗜睡减少有关。其他主要的人口统计学、代谢和睡眠相关变量与MSLT评分无关，所检查的变量均与ESS评分无关。
白天嗜睡在HD患者中很常见，即使没有明显的临床危险因素，也可能很严重。因此，有必要开展旨在识别具有成本效益的白天嗜睡指标并评估嗜睡对HD患者临床结局的有害影响的研究。
