Parker Kathy P, Bliwise Donald L, Bailey James L, Rye David B
Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322-4207, USA.
Nephrol Dial Transplant. 2005 Jul;20(7):1422-8. doi: 10.1093/ndt/gfh816. Epub 2005 Apr 19.
Numerous factors probably contribute to the high prevalence of sleep problems in haemodialysis (HD) patients including metabolic changes and treatment-related factors. In contrast, the sleep problems of patients with chronic kidney disease (CKD) may be more related to psychological factors rather than the metabolic changes associated with renal disease. Thus, the objective of this study was to compare polysomnographic measures of nocturnal sleep in a group of stable patients on chronic, intermittent daytime HD and an age- and gender-matched, metabolically comparable group with CKD, and evaluate the role that quality of life (including psychological factors) and the effects of treatment may play in sleep outcomes.
The sample included 16 patients on HD and eight patients with CKD all of whom were free from other significant physical and psychological morbidity. To assess for psychological, functional, family and economic responses to the disease and treatment, all subjects took the Ferrans and Powers Quality of Life Index. HD subjects received treatment three times a week and were adequately dialysed [Kt/V >1.2, equivalent to a weekly glomerular filtration rate (GFR) of 10-15 ml/min]; CKD subjects had an estimated GFR of 14.5 (+/-7.2; range 5.4-28.8) ml/min. All subjects underwent one night of laboratory-based polysomnography. Appropriate statistical procedures were used to explore group differences in sleep variables and their relationship to quality of life dimensions and the effect of treatment.
The CKD patients reported significantly poorer functional and psychological quality of life; both groups had reduced total sleep time and sleep efficiency in comparison with normative data. However, HD subjects had less rapid eye movement sleep (P = 0.032). They also had a higher brief arousal index (P = 0.000), an independent predictor of which was treatment with HD, and respiratory disturbance index (P = 0.061). Less total sleep time, increased wake after sleep onset, lower sleep efficiency, higher periodic limb movement index, and longer latencies to sleep onset and rapid eye movement sleep were also noted in the HD group. Quality of life scores did not predict sleep variables in this small sample.
The results suggest that the sleep problems of patients with CKD and those receiving chronic, intermittent daytime HD may have different aetiologies; functional and psychological factors may play a more prominent role in the former group, while intrinsic sleep disruption (arousals, apnoeas and limb movements) secondary to the effects of chronic, intermittent daytime HD may play a more significant role in the latter. The findings suggest that further exploration is warranted and that population-specific sleep-promoting interventions may be indicated.
众多因素可能导致血液透析（HD）患者睡眠问题的高发生率，包括代谢变化和与治疗相关的因素。相比之下，慢性肾脏病（CKD）患者的睡眠问题可能更多地与心理因素有关，而非与肾脏疾病相关的代谢变化。因此，本研究的目的是比较一组接受慢性间歇性日间HD治疗的稳定患者与一组年龄和性别匹配、代谢情况相当的CKD患者夜间睡眠的多导睡眠图测量结果，并评估生活质量（包括心理因素）和治疗效果在睡眠结果中可能发挥的作用。
样本包括16例HD患者和8例CKD患者，所有患者均无其他严重的身体和心理疾病。为评估疾病和治疗对心理、功能、家庭和经济方面的影响，所有受试者均采用费兰斯和鲍尔斯生活质量指数。HD组患者每周接受3次治疗，且透析充分[Kt/V>1.2，相当于每周肾小球滤过率（GFR）为10 - 15 ml/min]；CKD组患者的估计GFR为14.5（±7.2；范围5.4 - 28.8）ml/min。所有受试者均接受一晚基于实验室的多导睡眠图检查。采用适当的统计方法探讨睡眠变量的组间差异及其与生活质量维度和治疗效果的关系。
CKD患者报告的功能和心理生活质量明显较差；与正常数据相比，两组的总睡眠时间和睡眠效率均降低。然而，HD组患者的快速眼动睡眠较少（P = 0.032）。他们还具有较高的短暂觉醒指数（P = 0.000），HD治疗是其独立预测因素，以及呼吸紊乱指数（P = 0.061）。HD组还存在总睡眠时间减少、睡眠开始后觉醒增加、睡眠效率降低、周期性肢体运动指数升高以及睡眠开始和快速眼动睡眠的潜伏期延长等情况。在这个小样本中，生活质量评分并未预测睡眠变量。
结果表明，CKD患者和接受慢性间歇性日间HD治疗的患者的睡眠问题可能有不同的病因；功能和心理因素在前一组中可能发挥更突出的作用，而慢性间歇性日间HD治疗的影响导致的内在睡眠中断（觉醒、呼吸暂停和肢体运动）在后一组中可能发挥更重要的作用。研究结果表明有必要进一步探索，并且可能需要针对特定人群的促进睡眠干预措施。
