Kimmel P L, Miller G, Mendelson W B
Department of Medicine, George Washington University Medical Center, Washington, D.C. 20037.
Am J Med. 1989 Mar;86(3):308-14. doi: 10.1016/0002-9343(89)90301-x.
We performed this study in order to expand on an earlier report indicating a high prevalence of the sleep apnea syndrome in male patients with end-stage renal disease treated with hemodialysis and to determine whether patients with chronic renal insufficiency (prior to the initiation of therapy for end-stage renal disease) and female patients with end-stage renal disease treated with hemodialysis were affected.
Polysomnography was performed in 26 male and female patients with chronic renal insufficiency and end-stage renal disease treated with hemodialysis who were not receiving testosterone. They included 22 whose histories were suggestive of sleep apnea ("symptomatic") and four whose histories were not ("asymptomatic").
Sixteen of the symptomatic (73 percent) and none of the asymptomatic patients were found to have clinically significant sleep apnea syndrome (p less than 0.02). Both female patients and patients with chronic renal insufficiency had sleep apnea. In nine of these 16 cases, the disorder was primarily of the obstructive type.
These preliminary data raise the possibility of an association of chronic renal disease and the sleep apnea syndrome, and suggest that some of the daytime sleepiness and disturbed nocturnal sleep in such patients may be related to sleep apnea. They also indicate that questioning patients with chronic renal disease and symptoms suggestive of a sleep disorder is useful in determining who are at high risk for the sleep apnea syndrome. Further study is required to establish a causal relationship between chronic renal disease and the sleep apnea syndrome, and to determine the prevalence of the latter in patients with end-stage renal disease.
我们开展这项研究是为了进一步拓展一份早期报告，该报告指出接受血液透析治疗的终末期肾病男性患者中睡眠呼吸暂停综合征的患病率较高，并确定慢性肾功能不全患者（在开始终末期肾病治疗之前）以及接受血液透析治疗的终末期肾病女性患者是否受到影响。
对26例未接受睾酮治疗、患有慢性肾功能不全和终末期肾病且接受血液透析的男性和女性患者进行了多导睡眠图检查。其中22例患者的病史提示存在睡眠呼吸暂停（“有症状”），4例患者的病史未提示存在睡眠呼吸暂停（“无症状”）。
有症状的患者中有16例（73%）被发现患有具有临床意义的睡眠呼吸暂停综合征，无症状患者中无一例患病（p<0.02）。女性患者和慢性肾功能不全患者均存在睡眠呼吸暂停。在这16例病例中的9例中，该病症主要为阻塞型。
这些初步数据增加了慢性肾病与睡眠呼吸暂停综合征之间存在关联的可能性，并表明此类患者的一些日间嗜睡和夜间睡眠障碍可能与睡眠呼吸暂停有关。它们还表明，询问患有慢性肾病且有睡眠障碍症状提示的患者，对于确定哪些人有睡眠呼吸暂停综合征的高风险很有用。需要进一步研究以确立慢性肾病与睡眠呼吸暂停综合征之间的因果关系，并确定后者在终末期肾病患者中的患病率。
