University of Pittsburgh, Presbyterian Hospital C1111, Pittsburgh, PA 15213, USA.
Am J Nephrol. 2011;33(5):398-406. doi: 10.1159/000326343. Epub 2011 Apr 8.
Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients.
Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality.
The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001).
These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.
睡眠质量差是终末期肾病（ESRD）患者常见、持续且重要的问题。本报告研究了在一大群血液透析（HD）患者中，睡眠质量是否与透析治疗因素和其他可改变的临床因素有关。
对 Frequent Hemodialysis Network 试验参与者的基线数据进行了横断面分析。使用医疗结局研究睡眠问题指数 II（SPI II）测量睡眠质量，SPI II 是一个 9 项测量睡眠质量的指标，得分越高反映睡眠质量越差。
参与者的年龄为 51.2±13.6 岁，61%为男性，38%为黑人，42%患有糖尿病。透析前血清磷（每 0.5mg/ml）较高（OR 0.91；95%CI 0.85，0.96）和抑郁（OR 0.16；95%CI 0.10，0.25）与睡眠质量下降独立相关。从透析中恢复的时间也存在差异，第四 SPI II 四分位与第一 SPI II 四分位相比（5.1 小时；p<0.0001）。
这些发现强调了睡眠与白天功能之间的联系，并表明改善睡眠可能有机会改善 ESRD 患者的结局。在 HD 人群中，血清磷降低或抑郁治疗是否可以改善睡眠问题值得进一步研究。
