Hamzi Mohamed Amine, Hassani Kawtar, Asseraji Mohamed, El Kabbaj Driss
Hemodialysis Unit, 5th Military Hospital, Guelmim, Morocco.
Department of Nephrology, Dialysis and Renal Transplantation, Military Training Hospital Mohammed V, Faculty of Medicine and Pharmacy, University Mohammed V Souissi, Rabat, Morocco.
Saudi J Kidney Dis Transpl. 2017 Sep-Oct;28(5):1112-1118. doi: 10.4103/1319-2442.215152.
Previous studies have shown that insomnia is a common sleep disorder in patients with end-stage renal disease. This study aims to determine the prevalence and risk factors of insomnia in our chronic hemodialysis (HD) patients. This is a cross-sectional study conducted in three HD units in Morocco. To assess the prevalence of insomnia, we used a specific questionnaire. Patients complaining of difficulty in falling asleep and/or nocturnal awakenings occurring seven nights a week during the last month were included in the group "insomnia;" the other patients were used as controls. Clinical, biological, and dialysis data were recorded for each patient. Sleep disorders and their subjective causes were also identified. Eighty-nine percent of questioned patients admitted to having sleep disturbances of different degrees. Insomnia was significantly associated with female gender and time of dialysis. Age, body mass index, inter-dialytic weight gain, and blood pressure were similar between the two groups, as well as dialytic parameters and drug use. There was no significant difference in the values of plasma creatinine, urea, hemoglobin, parathyroid hormone, calcium, phosphorus, C-reactive protein, and albumin between the groups. Disorders most frequently encountered in patients with insomnia were waking up at night (90%), difficulty falling asleep (60%), and daytime sleepiness (60%). The restless legs syndrome was seen in half of these patients. The main reported causes of insomnia were anxiety and/or depression (70%) and bone pain (67%). Insomnia is common in HD patients and is frequently associated with other disorders of sleep. Female sex and duration on dialysis are the two risk factors found in our study. Insomnia does not appear related to any biochemical or dialysis parameters. Increased attention should be given to the management of dialysis patients regarding the diagnosis and management of insomnia and associated sleep disorders.
既往研究表明，失眠是终末期肾病患者常见的睡眠障碍。本研究旨在确定我们慢性血液透析（HD）患者中失眠的患病率及危险因素。这是一项在摩洛哥三个血液透析单元开展的横断面研究。为评估失眠的患病率，我们使用了一份特定问卷。在上个月每周七个晚上都存在入睡困难和/或夜间觉醒问题的患者被纳入“失眠”组；其他患者作为对照。记录每位患者的临床、生物学和透析数据。还确定了睡眠障碍及其主观原因。89%的受调查患者承认有不同程度的睡眠障碍。失眠与女性性别和透析时间显著相关。两组之间的年龄、体重指数、透析间期体重增加和血压相似，透析参数和药物使用情况也相似。两组之间血浆肌酐、尿素、血红蛋白、甲状旁腺激素、钙、磷、C反应蛋白和白蛋白的值无显著差异。失眠患者最常出现的症状是夜间醒来（90%）、入睡困难（60%）和日间嗜睡（60%）。这些患者中有一半出现不宁腿综合征。报告的失眠主要原因是焦虑和/或抑郁（70%）以及骨痛（67%）。失眠在血液透析患者中很常见，且常与其他睡眠障碍相关。女性性别和透析时长是我们研究中发现的两个危险因素。失眠似乎与任何生化或透析参数无关。在透析患者失眠及相关睡眠障碍的诊断和管理方面，应给予更多关注。
