Sumida Keiichi, Hoshino Junichi, Suwabe Tatsuya, Kasai Takatoshi, Hayami Noriko, Mise Koki, Kawada Masahiro, Imafuku Aya, Hiramatsu Rikako, Hasegawa Eiko, Yamanouchi Masayuki, Sawa Naoki, Narui Koji, Takaichi Kenmei, Ubara Yoshifumi
Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and
Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan; Nephrology Center and.
Clin J Am Soc Nephrol. 2015 Jun 5;10(6):949-56. doi: 10.2215/CJN.06930714. Epub 2015 Mar 30.
Sleep-disordered breathing (SDB) is prevalent among patients with CKD, but its prevalence among patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) and its association with total liver and kidney volume remain unclear.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study examined the association between height-adjusted total liver and kidney volume (htTLKV) and SDB in a cross-sectional study of 304 adult patients with symptomatic ADPKD who were hospitalized at Toranomon Hospital for transcatheter arterial embolization and who underwent pulse oximetry between April 2008 and November 2013. SDB was defined as having a 3% oxygen desaturation index of ≥15 events per hour of sleep. Logistic regression was performed with sex-specific quartiles of htTLKV as the main predictor, using patient data and comorbidities as covariates.
Overall (54.6% women, mean age 56.2±9.4 years, 83.5% on hemodialysis), 177 of 304 patients (58.2%) had SDB. SDB was strongly associated with htTLKV quartiles, demonstrating that odds ratios (ORs) and 95% confidence intervals (95% CIs) for SDB were 1.63 (0.76 to 3.48), 2.35 (1.09 to 5.06), and 4.61 (1.98 to 10.7) for htTLKV quartiles 2-4 (P for trend, P=0.003), respectively. Older age (OR, 1.81 per 10 years; 95% CI, 1.29 to 2.55), male sex (OR, 3.87; 95% CI, 1.96 to 7.66), receiving hemodialysis (OR, 3.46; 95% CI, 1.62 to 12.1), and higher body mass index (≥25 kg/m(2)) (OR, 3.03; 95% CI, 1.08 to 8.52) were also associated with SDB.
In this highly selected population of patients with symptomatic ADPKD referred for transcatheter arterial embolization, SDB was highly prevalent and independently associated with higher htTLKV.
睡眠呼吸障碍（SDB）在慢性肾脏病（CKD）患者中很常见，但其在有症状的常染色体显性多囊肾病（ADPKD）患者中的患病率及其与肝脏和肾脏总体积的关系尚不清楚。
设计、地点、参与者及测量方法：本研究在一项横断面研究中，调查了304例因有症状的ADPKD而在虎之门医院住院接受经导管动脉栓塞术，并于2008年4月至2013年11月期间进行脉搏血氧饱和度测定的成年患者中，身高校正后的肝脏和肾脏总体积（htTLKV）与SDB之间的关联。SDB定义为睡眠期间每小时氧饱和度下降≥3%且事件数≥15次。以htTLKV的性别特异性四分位数作为主要预测因素进行逻辑回归分析，将患者数据和合并症作为协变量。
总体而言（女性占54.6%，平均年龄56.2±9.4岁，83.5%接受血液透析），304例患者中有177例（58.2%）患有SDB。SDB与htTLKV四分位数密切相关，表明htTLKV四分位数2 - 4对应的SDB的比值比（OR）和95%置信区间（95%CI）分别为1.63（0.76至3.48）、2.35（1.09至5.06）和4.61（1.98至10.7）（趋势P值，P = 0.003）。年龄较大（每10岁OR为1.81；95%CI为1.29至2.55）、男性（OR为3.87；95%CI为1.96至7.66）、接受血液透析（OR为3.46；95%CI为1.62至12.1）以及较高的体重指数（≥25kg/m²）（OR为3.03；95%CI为1.08至8.52）也与SDB相关。
在这群因经导管动脉栓塞术而被高度选择的有症状ADPKD患者中，SDB非常普遍，且与较高的htTLKV独立相关。
