Liao Jin-Lan, van den Broek-Best Oliver, Smyth Brendan, Hong Daqing, Vo Kha, Zuo Li, Gray Nicholas A, Chan Christopher T, de Zoysa Janak, Perkovic Vlado, Jiang Lei, Jardine Meg
Renal Division, Peking University Shenzhen Hospital, Shenzhen, China.
Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Nephrology (Carlton). 2019 Apr;24(4):430-437. doi: 10.1111/nep.13236.
Poor sleep quality is common in haemodialysis patients and associated with worse outcomes. In this pre-specified analysis, we examined the impact of extended hours haemodialysis on sleep quality.
The ACTIVE Dialysis trial randomized 200 participants to extended (≥24 h/week) or standard (target 12-15 h) hours haemodialysis over 12 months. Sleep quality was measured in the Kidney Disease Quality of Life Short Form 1.3 (KDQOL-SF) by overall sleep quality score (0-10, 10 = 'very good') and the sleep subscale (0-100, 100 = 'best possible sleep') every 3 months via blinded telephone interview. The average intervention effect was calculated by mixed linear regression adjusted by time point and baseline score. Factors predicting sleep quality were assessed by multivariate regression analysis.
Overall sleep quality score and sleep subscale at baseline were similar in both groups (5.9 [95%CI 5.4-6.4] vs. 6.3 [5.9-6.8]; 65.0 [60.9-69.1] vs. 63.2 [59.1-67.3]; extended and standard hours, respectively). Extended hours haemodialysis led to a non-significant improvement in overall sleep quality score (average intervention effect 0.44 (-0.01 to 0.89), P = 0.053) and sleep subscale (average intervention effect 3.58 (-0.02 to 7.18), P = 0.051). Poor sleep quality was associated with being female and with current smoking. Sleep quality was positively associated with EuroQol-5D (EQ5D) and the SF-36 Physical Component and Mental Component Summary Scores but not with hospitalizations.
Sleep quality was not significantly improved by extended hours dialysis in this study. Sleep quality is positively correlated with quality of life in haemodialysis patients and is poorer in women and current smokers.
睡眠质量差在血液透析患者中很常见，且与更差的预后相关。在这项预先设定的分析中，我们研究了延长透析时间对睡眠质量的影响。
ACTIVE透析试验将200名参与者随机分为延长（≥24小时/周）或标准（目标12 - 15小时）透析时间组，为期12个月。通过肾病生活质量简表1.3（KDQOL - SF）中的总体睡眠质量评分（0 - 10分，10分 = “非常好”）和睡眠子量表（0 - 100分，100分 = “最佳睡眠”），每3个月通过盲法电话访谈来测量睡眠质量。通过混合线性回归，根据时间点和基线评分进行调整，计算平均干预效果。通过多变量回归分析评估预测睡眠质量的因素。
两组在基线时的总体睡眠质量评分和睡眠子量表相似（分别为5.9 [95%置信区间5.4 - 6.4] 与6.3 [5.9 - 6.8]；65.0 [60.9 - 69.1] 与63.2 [59.1 - 67.3]；分别为延长透析时间组和标准透析时间组）。延长透析时间使总体睡眠质量评分有非显著改善（平均干预效果0.44（-0.01至0.89），P = 0.053），睡眠子量表也有非显著改善（平均干预效果3.58（-0.02至7.18），P = 0.051）。睡眠质量差与女性和当前吸烟有关。睡眠质量与欧洲五维健康量表（EQ5D）以及SF - 36身体成分和精神成分汇总评分呈正相关，但与住院情况无关。
在本研究中，延长透析时间并未显著改善睡眠质量。睡眠质量与血液透析患者的生活质量呈正相关，女性和当前吸烟者的睡眠质量较差。
