Parker Kathy P, Kutner Nancy G, Bliwise Donald L, Bailey James L, Rye David B
Nell Hodgson Woodruff, School of Nursing, 1520 Clifton Road, USA.
Health Qual Life Outcomes. 2003 Nov 21;1:68. doi: 10.1186/1477-7525-1-68.
Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we studied a sample of stable HD patients to explore relationships between quality of life and both subjective and objective measures of nocturnal sleep and daytime sleepiness
The sample included forty-six HD patients, 24 men and 22 women, with a mean age of 51.6 (10.8) years. Subjects underwent one night of polysomnography followed the next morning by a Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Subjects also completed: 1) a brief nocturnal sleep questionnaire; 2) the Epworth Sleepiness Scale; and, 3) the Quality of Life Index (QLI, Dialysis Version) which provides an overall QLI score and four subscale scores for Health & Functioning (H&F), Social & Economic (S&E), Psychological & Spiritual (P&S), and Family (F). (The range of scores is 0 to 30 with higher scores indicating better quality of life.)
The mean (standard deviation; SD) of the overall QLI was 22.8 (4.0). The mean (SD) of the four subscales were as follows: H&F - 21.1 (4.7); S&E - 22.0 (4.8); P&S - 24.5 (4.4); and, F - 26.8 (3.5). H&F (rs = -0.326, p = 0.013) and F (rs = -0.248, p = 0.048) subscale scores were negatively correlated with periodic limb movement index but not other polysomnographic measures. The H&F subscale score were positively correlated with nocturnal sleep latency (rs = 0.248, p = 0.048) while the H&F (rs = 0.278, p = 0.030) and total QLI (rs = 0.263, p = 0.038) scores were positively associated with MSLT scores. Both of these latter findings indicate that higher life quality is associated with lower sleepiness levels. ESS scores were unrelated to overall QLI scores or the subscale scores. Subjective reports of difficulty falling asleep and waking up too early were significantly correlated with all four subscale scores and overall QLI. Feeling rested in the morning was positively associated with S&E, P&S, and Total QLI scores.
Selected measures of both poor nocturnal sleep and increased daytime sleepiness are associated with decreased quality of life in HD patients, underscoring the importance of recognizing and treating these patients' sleep problems.
尽管慢性肾脏病的治疗已取得显著进展，但对于接受血液透析（HD）的患者而言，生活质量受损仍是一个重大问题。然而，尽管该人群中睡眠障碍和睡眠投诉的发生率很高，但这些问题与生活质量之间的关系仍有待充分阐明。因此，我们对一组稳定的HD患者进行了研究，以探讨生活质量与夜间睡眠和白天嗜睡的主观及客观指标之间的关系。
样本包括46例HD患者，其中24例男性，22例女性，平均年龄51.6（10.8）岁。受试者接受了一晚的多导睡眠监测，次日早晨进行多次睡眠潜伏期试验（MSLT），这是一种白天嗜睡的客观测量方法。受试者还完成了：1）一份简短的夜间睡眠问卷；2）爱泼沃斯嗜睡量表；3）生活质量指数（QLI，透析版），该量表提供一个总体QLI评分以及健康与功能（H&F）、社会与经济（S&E）、心理与精神（P&S）和家庭（F）四个子量表评分。（评分范围为0至30分，分数越高表明生活质量越好。）
总体QLI的平均值（标准差；SD）为22.8（4.0）。四个子量表的平均值（SD）如下：H&F - 21.1（4.7）；S&E - 22.0（4.8）；P&S - 24.5（4.4）；F - 26.8（3.5）。H&F（rs = -0.326，p = 0.013）和F（rs = -0.248，p = 0.048）子量表评分与周期性肢体运动指数呈负相关，但与其他多导睡眠图测量指标无关。H&F子量表评分与夜间睡眠潜伏期呈正相关（rs = 0.248，p = 0.048），而H&F（rs = 0.278，p = 0.030）和总体QLI（rs = 0.263，p = 0.038）评分与MSLT评分呈正相关。后两个发现均表明，较高的生活质量与较低的嗜睡水平相关。ESS评分与总体QLI评分或子量表评分无关。入睡困难和过早醒来的主观报告与所有四个子量表评分及总体QLI均显著相关。早晨感觉休息良好与S&E、P&S和总体QLI评分呈正相关。
夜间睡眠不佳和白天嗜睡增加的特定指标与HD患者生活质量下降相关，这凸显了识别和治疗这些患者睡眠问题的重要性。
