Novak Marta, Mendelssohn David, Shapiro Colin M, Mucsi Istvan
Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Semin Dial. 2006 May-Jun;19(3):210-6. doi: 10.1111/j.1525-139X.2006.00157.x.
Sleep complaints are very common in patients with end-stage renal disease (ESRD) and contribute to their impaired quality of life. Both obstructive and central sleep apnea syndromes are reported more often in patients on dialysis than in the general population. Impaired daytime functioning, sleepiness, and fatigue, as well as cognitive problems, are well known in patients with sleep apnea. Increasing evidence supports the pathophysiological role of sleep apnea in cardiovascular disorders, which are the leading cause of death in ESRD patients. Uremic factors may be involved in the pathogenesis of sleep apnea in this patient population and optimal dialysis may reduce disease severity. Furthermore, treatment with continuous positive airway pressure may improve quality of life and may help to manage hypertension in these patients. Secondary restless legs syndrome is highly prevalent in patients on maintenance dialysis. The pathophysiology of the disorder may also involve uremia-related factors, iron deficiency, and anemia, but genetic and lifestyle factors might also play a role. The treatment of restless legs syndrome involves various pharmacologic approaches and might be challenging in severe cases. In this article we review the diagnosis and treatment of sleep apnea and restless legs syndrome, with a focus on dialysis patients. We also briefly review current data regarding sleep problems after transplantation, since these studies may indirectly shed light on the possible pathophysiological role of uremia or dialysis in the etiology of sleep disorders. Considering the importance of sleep disorders, more awareness among professionals involved in the care of patients on dialysis is necessary. Appropriate management of sleep disorders could improve the quality of life and possibly even impact upon survival of renal patients.
睡眠问题在终末期肾病（ESRD）患者中非常常见，会导致他们的生活质量受损。据报道，透析患者中阻塞性和中枢性睡眠呼吸暂停综合征的发生率高于普通人群。睡眠呼吸暂停患者存在日间功能障碍、嗜睡、疲劳以及认知问题，这是众所周知的。越来越多的证据支持睡眠呼吸暂停在心血管疾病发病机制中的作用，而心血管疾病是ESRD患者的主要死因。尿毒症因素可能参与了该患者群体睡眠呼吸暂停的发病机制，优化透析可能会降低疾病严重程度。此外，持续气道正压通气治疗可能会改善这些患者的生活质量，并有助于控制高血压。继发性不安腿综合征在维持性透析患者中非常普遍。该疾病的病理生理学可能还涉及与尿毒症相关的因素、缺铁和贫血，但遗传和生活方式因素也可能起作用。不安腿综合征的治疗涉及多种药物治疗方法，在严重病例中可能具有挑战性。在本文中，我们回顾了睡眠呼吸暂停和不安腿综合征的诊断和治疗，重点是透析患者。我们还简要回顾了目前关于移植后睡眠问题的数据，因为这些研究可能间接揭示尿毒症或透析在睡眠障碍病因中可能的病理生理作用。考虑到睡眠障碍的重要性，参与透析患者护理的专业人员需要提高更多认识。对睡眠障碍进行适当管理可以改善生活质量，甚至可能影响肾病患者的生存。
