Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Kidney Int. 2010 Jun;77(11):1031-8. doi: 10.1038/ki.2010.76. Epub 2010 Mar 17.
Sleep apnea syndrome is increasingly recognized in peritoneal dialysis patients; however, its prognostic implication in this population is unknown. To study this, we prospectively followed the clinical outcome of 93 peritoneal dialysis patients with baseline polysomnography. Of these, 51 were diagnosed with the syndrome defined by an apnea-hypopnea index (AHI) of at least 15 per hour. During a median follow-up of 41 months, there were 30 deaths, of which 17 were due to cardiovascular causes. Kaplan-Meier analysis for the entire follow-up period indicated that patients with sleep apnea at baseline had significantly higher all-cause and cardiovascular mortality during follow-up than those without. Minimal nocturnal saturation and desaturation indices were predictors of mortality and cardiovascular events at univariate analysis. Multivariable Cox regression analysis identified significant sleep apnea syndrome at baseline as an independent predictor of increased all-cause mortality independent of age, male gender, and diabetic status. Further, an absolute increase in the AHI was associated with an incremental risk of cardiovascular events. Thus, sleep apnea syndrome, detected at the start of peritoneal dialysis, is a novel risk predictor for subsequent mortality and cardiovascular events.
睡眠呼吸暂停综合征在腹膜透析患者中越来越受到重视；然而，其在该人群中的预后意义尚不清楚。为了研究这一点，我们前瞻性地随访了 93 例基线多导睡眠图的腹膜透析患者的临床结局。其中，51 例被诊断为睡眠呼吸暂停低通气指数（AHI）至少为 15 次/小时的综合征。在中位数为 41 个月的随访期间，有 30 例死亡，其中 17 例死于心血管原因。整个随访期间的 Kaplan-Meier 分析表明，基线时患有睡眠呼吸暂停的患者在随访期间的全因死亡率和心血管死亡率明显高于无睡眠呼吸暂停的患者。最小夜间饱和度和去饱和度指数是死亡和心血管事件的单因素分析的预测因素。多变量 Cox 回归分析确定，基线时存在明显的睡眠呼吸暂停综合征是全因死亡率增加的独立预测因素，独立于年龄、男性和糖尿病状态。此外，AHI 的绝对增加与心血管事件的风险增加相关。因此，腹膜透析开始时发现的睡眠呼吸暂停综合征是随后发生死亡和心血管事件的新的风险预测因子。
