Ogna Adam, Forni Ogna Valentina, Haba Rubio José, Tobback Nadia, Andries Dana, Preisig Martin, Tafti Mehdi, Vollenweider Peter, Waeber Gerard, Marques-Vidal Pedro, Heinzer Raphaël
Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Service of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Sleep. 2016 Apr 1;39(4):945-53. doi: 10.5665/sleep.5660.
To evaluate the association between early stages of chronic kidney disease (CKD) and sleep disordered breathing (SDB), restless legs syndrome (RLS), and subjective and objective sleep quality (SQ).
Cross-sectional analysis of a general population-based cohort (HypnoLaus). 1,760 adults (862 men, 898 women; age 59.3 (± 11.4) y) underwent complete polysomnography at home.
8.2% of participants had mild CKD (stage 1-2, estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m(2) with albuminuria) and 7.8% moderate CKD (stage 3, eGFR 30-60 mL/min/1.73 m(2)). 37.3% of our sample had moderate-to-severe SDB (apnea-hypopnea index [AHI] ≥ 15/h) and 15.3% had severe SDB (AHI ≥ 30/h). SDB prevalence was positively associated with CKD stages and negatively with eGFR. In multivariate analysis, age, male sex, and body mass index were independently associated with SDB (all P < 0.001), but kidney function was not. The prevalence of RLS was 17.5%, without difference between CKD stages. Periodic leg movements index (PLMI) was independently associated with CKD stages. Subjective and objective SQ decreased and the use of sleep medication was more frequent with declining kidney function. Older age, female sex, and the severity of SDB were the strongest predictors of poor SQ in multivariate regression analysis but CKD stage was also independently associated with reduced objective SQ.
Patients with early stages of CKD have impaired SQ, use more hypnotic drugs, and have an increased prevalence of SDB and PLM. After controlling for confounders, objective SQ and PLMI were still independently associated with declining kidney function.
评估慢性肾脏病（CKD）早期阶段与睡眠呼吸紊乱（SDB）、不宁腿综合征（RLS）以及主观和客观睡眠质量（SQ）之间的关联。
对基于一般人群的队列（HypnoLaus）进行横断面分析。1760名成年人（862名男性，898名女性；年龄59.3（±11.4）岁）在家中接受了完整的多导睡眠图检查。
8.2%的参与者患有轻度CKD（1 - 2期，估计肾小球滤过率[eGFR]≥60 mL/min/1.73 m²且有蛋白尿），7.8%患有中度CKD（3期，eGFR 30 - 60 mL/min/1.73 m²）。我们样本中的37.3%患有中度至重度SDB（呼吸暂停低通气指数[AHI]≥15/h），15.3%患有重度SDB（AHI≥30/h）。SDB患病率与CKD分期呈正相关，与eGFR呈负相关。在多变量分析中，年龄、男性性别和体重指数与SDB独立相关（均P < 0.001），但肾功能与SDB无关。RLS患病率为17.5%，在CKD各期之间无差异。周期性腿部运动指数（PLMI）与CKD分期独立相关。随着肾功能下降，主观和客观SQ降低，且使用睡眠药物更为频繁。在多变量回归分析中，年龄较大、女性性别和SDB严重程度是SQ差的最强预测因素，但CKD分期也与客观SQ降低独立相关。
CKD早期患者的SQ受损，使用更多催眠药物，且SDB和PLM的患病率增加。在控制混杂因素后，客观SQ和PLMI仍与肾功能下降独立相关。
