Sakkas Giorgos K, Gourgoulianis Konstantinos I, Karatzaferi Christina, Liakopoulos Vassilios, Maridaki Maria D, Pastaka Chaido, Lavdas Eleftherios, Soher Brian J, Dovas Spiros, Fezoulidis Ioannis, Hadjigeorgiou Georgios M, Stefanidis Ioannis
Department of Nephrology, School of Medicine, University of Thessaly, Greece.
Nephrol Dial Transplant. 2008 Jan;23(1):336-44. doi: 10.1093/ndt/gfm559. Epub 2007 Sep 22.
Sleep apnoea frequently affects patients with end-stage renal disease. However, it is still unclear whether or to what extent sleep disorders may affect functional capacity and quality of life in haemodialysis patients. We tested the hypothesis that apneic dialysis patients due to the lack of restorative sleep will have a further reduced functional capacity and further compromised quality of life compared to their non-apneic counterparts.
Forty-three clinically stable haemodialysis patients (13 F, 56.6+/-19.4 years) were examined. After polysomnographic analysis, patients were divided in two groups according to their calculated apnoea hypopnoea index (AHI; cutoff 5). Primary outcomes were intergroup differences in the following: (1) physical capacity and muscle performance, assessed by functional tests, (2) quality of life, assessed by the SF-36, (3) body composition, measured by DEXA and (4) muscle composition and size, as well as (5) visceral (VAT) and subcutaneous (SAT) adipose tissue, calculated by computed tomography.
Twenty-two patients had AHI >5 (4 F, AHI=28.8+/-22.3). The adjusted analysis for age, BMI and years in dialysis therapy, showed that the low-AHI group (N=21, 9 F, AHI=1.8+/-1.3) had better functional capacity, and performed better in muscle strength and endurance tests compared to the high-AHI group. There were no differences in lean body mass and % total body fat between groups, however, values for VAT, VAT/TAT ratio and thigh muscles' fat infiltration were increased in the high-AHI group. VAT correlated with BMI (r=0.682, P=0.001), functional capacity (r=0.558, P=0.001) apnoea hypopnoea index (r=0.530, P=0.001). There were no statistical significant differences in quality of life between the two groups. To further account for age and BMI differences, a subgroup of patients was matched by age, sex and BMI (N=10/group). In the matched analysis, all the above statistical differences remained, between the low-AHI and high-AHI groups.
Haemodialysis patients with sleep apnoea syndrome demonstrate poorer functional capacity, physical performance and muscle composition, compared to non-apneic dialysis patients. Overall, sleep apnoea appears to partly contribute to the total diminished functional capacity of haemodialysis patients.
睡眠呼吸暂停经常影响终末期肾病患者。然而，睡眠障碍是否以及在何种程度上会影响血液透析患者的功能能力和生活质量仍不清楚。我们检验了这样一个假设：与无呼吸暂停的血液透析患者相比，因缺乏恢复性睡眠而出现呼吸暂停的透析患者功能能力会进一步降低，生活质量会进一步受损。
对43例临床稳定的血液透析患者（13例女性，年龄56.6±19.4岁）进行了检查。经多导睡眠图分析后，根据计算得出的呼吸暂停低通气指数（AHI；临界值为5）将患者分为两组。主要结局指标为两组间在以下方面的差异：（1）通过功能测试评估的身体能力和肌肉表现；（2）通过SF-36评估的生活质量；（3）通过双能X线吸收法测量的身体成分；（4）肌肉成分和大小；以及（5）通过计算机断层扫描计算得出的内脏（VAT）和皮下（SAT）脂肪组织。
22例患者的AHI>5（4例女性，AHI=28.8±22.3）。对年龄、体重指数和透析治疗年限进行校正分析后发现，低AHI组（n=21，9例女性，AHI=1.8±1.3）的功能能力更好，在肌肉力量和耐力测试中的表现优于高AHI组。两组间瘦体重和全身脂肪百分比无差异，然而，高AHI组的VAT、VAT/TAT比值和大腿肌肉脂肪浸润值升高。VAT与体重指数（r=0.682，P=0.001）、功能能力（r=0.558，P=0.001）、呼吸暂停低通气指数（r=0.530，P=0.001）相关。两组间生活质量无统计学显著差异。为进一步考虑年龄和体重指数差异，按年龄、性别和体重指数对一组患者进行匹配（每组n=10）。在匹配分析中，低AHI组和高AHI组之间上述所有统计学差异依然存在。
与无呼吸暂停的透析患者相比，患有睡眠呼吸暂停综合征的血液透析患者功能能力、身体表现和肌肉成分较差。总体而言，睡眠呼吸暂停似乎在一定程度上导致了血液透析患者整体功能能力的下降。
