Department of Nutrition, C.W. Post Campus of Long Island University, Brookville, New York 11548, USA.
J Ren Nutr. 2012 Sep;22(5):461-71. doi: 10.1053/j.jrn.2011.08.004. Epub 2011 Nov 3.
To explore the relationship between sleep quality and common measures of nutritional status in the Hemodialysis (HEMO) Study cohort. To investigate sleep quality scores based on longitudinal changes in measures of nutritional status, adjusting for case mix, lifestyle, and comorbidity factors.
Secondary analysis of the HEMO Study data.
A 7-year, prospective, multicenter, randomized clinical trial in maintenance hemodialysis patients.
Eighteen hundred forty-six patients aged between 18 and 80 years were randomized; 1,803 (97.7%) completed the Kidney Disease Quality of Life Long Form (KDQOL-LF) at baseline. Mean age was 58 years, 44% were male, 64% were Black, 37% had diabetes, and 32% had hypertension; mean duration of dialysis was 3.8 years.
The univariate and multivariate relationships of measures of nutritional status (i.e., serum albumin, serum creatinine, postdialysis weight, body mass index, dietary protein and energy intake, and assessment of appetite) and sleep quality assessed using the sleep subscale from the KDQOL-LF.
In univariate analysis, sleep quality score decreased significantly in a linear fashion as appetite rating decreased from very good to very poor on both dialysis days (63.6 ± 21.8 to 43.6 ± 22.9, P < .0001) and nondialysis days (63.2 ± 21.6 to 40.7 ± 25.7, P < .0001), with higher scores reflecting better sleep quality. In multivariable analysis, serum creatinine was the only laboratory variable that was significantly associated with sleep quality score (β = 0.49, P = .0004). Poorer appetite on both dialysis days (β = -1.5, P < .0001) and nondialysis days (β = -1.7, P < .0001) was associated with poor sleep quality.
Self-reported sleep quality was associated with appetite and serum creatinine. A simple questionnaire to assess sleep disorders in dialysis patients should be administered routinely to detect those patients at risk of sleep complaints. However, further studies are needed to determine whether improving sleep quality, directly or indirectly, would improve morbidity and mortality.
探讨血液透析（HEMO）研究队列中睡眠质量与常见营养状况测量指标之间的关系。根据营养状况测量指标的纵向变化，调整病例组合、生活方式和合并症因素，探讨睡眠质量评分。
HEMO 研究数据的二次分析。
一项为期 7 年、前瞻性、多中心、随机临床试验，纳入维持性血液透析患者。
1846 名年龄在 18 至 80 岁之间的患者被随机分组；其中 1803 名（97.7%）在基线时完成了肾脏病生活质量简表（KDQOL-LF）的睡眠部分。平均年龄为 58 岁，44%为男性，64%为黑人，37%患有糖尿病，32%患有高血压；平均透析时间为 3.8 年。
使用 KDQOL-LF 的睡眠分量表评估的营养状况测量指标（即血清白蛋白、血清肌酐、透析后体重、体重指数、膳食蛋白质和能量摄入以及食欲评估）与睡眠质量的单变量和多变量关系。
在单变量分析中，随着透析日（63.6 ± 21.8 至 43.6 ± 22.9，P <.0001）和非透析日（63.2 ± 21.6 至 40.7 ± 25.7，P <.0001）食欲评分从非常好到非常差，睡眠质量评分呈线性显著下降，得分越高表示睡眠质量越好。在多变量分析中，血清肌酐是唯一与睡眠质量评分显著相关的实验室变量（β = 0.49，P =.0004）。透析日（β = -1.5，P <.0001）和非透析日（β = -1.7，P <.0001）食欲较差与睡眠质量差相关。
自我报告的睡眠质量与食欲和血清肌酐有关。应常规为透析患者提供简单的睡眠障碍问卷，以发现有睡眠问题风险的患者。然而，还需要进一步的研究来确定改善睡眠质量是否会直接或间接改善发病率和死亡率。
