Chu Ginger, Price Emma, Paech Gemma M, Choi Peter, McDonald Vanessa M
Department of Nephrology, Medical and Interventional Services, John Hunter Hospital, Hunter New England Local Health District New South Wales, Australia.
School of Nursing and Midwifery, University of Newcastle New South Wales, Australia.
Kidney Med. 2020 May 20;2(4):388-397. doi: 10.1016/j.xkme.2020.02.006. eCollection 2020 Jul-Aug.
RATIONALE & OBJECTIVE: More than 50% of hemodialysis patients experience sleep disturbance and most have coexisting sleep apnea. However, how sleep apnea affects sleep and the overall experience of patients with chronic kidney disease treated by hemodialysis has not been evaluated.
A mixed-methods design, incorporating cross-sectional observational and descriptive qualitative methodologies.
SETTING & PARTICIPANTS: Patients receiving maintenance hemodialysis in Newcastle, New South Wales, Australia, with newly diagnosed sleep apnea (apnea-hypopnea index ≥ 5 per hour).
In-laboratory polysomnography to assess sleep apnea and objective sleep parameters. Epworth Sleepiness Scale to assess daytime symptoms. A semi-structured qualitative interview to explore patient experience.
Descriptive and iterative thematic analysis.
We analyzed 36 patients with newly diagnosed sleep apnea and interviewed 26 (mean age, 62 years, median apnea-hypopnea index, 32 per hour). Severity of sleep apnea did not affect patients' sleep duration, sleep efficiency, or self-reported Epworth Sleepiness Scale score. From the qualitative interviews, 4 themes emerged: "broken sleep" related to short sleep duration, with waking and dozing off a common sleep cycle, caused by uncontrolled pain and dialysis. Many participants reported regularly "feeling unrefreshed" on waking. "Impact of sleep disturbance" included reduced physical, mental, and self-management capacity. Finally, interviewees described the need to use strategies to "soldier on" with symptoms.
Participants' views are only transferrable to hemodialysis patients with sleep apnea.
Our findings suggest that severity of sleep apnea does not affect sleep time or patient-reported daytime sleepiness; however, hemodialysis patients with sleep apnea report disturbed and unrefreshed sleep and the debilitating effects of sleep disturbance is profound. Broken and unrefreshed sleep were the dominant symptoms of sleep apnea and should be assessed routinely to identify patients with sleep apnea and improve quality of life in patients with chronic kidney disease treated with hemodialysis.
超过50%的血液透析患者存在睡眠障碍，且大多数同时患有睡眠呼吸暂停。然而，睡眠呼吸暂停如何影响睡眠以及接受血液透析治疗的慢性肾脏病患者的整体体验尚未得到评估。
采用混合方法设计，纳入横断面观察和描述性定性方法。
在澳大利亚新南威尔士州纽卡斯尔接受维持性血液透析且新诊断为睡眠呼吸暂停（呼吸暂停低通气指数≥每小时5次）的患者。
通过实验室多导睡眠图评估睡眠呼吸暂停和客观睡眠参数。采用爱泼华嗜睡量表评估日间症状。进行半结构化定性访谈以探究患者体验。
描述性和迭代主题分析。
我们分析了36例新诊断为睡眠呼吸暂停的患者，并对26例患者进行了访谈（平均年龄62岁，呼吸暂停低通气指数中位数为每小时32次）。睡眠呼吸暂停的严重程度并未影响患者的睡眠时间、睡眠效率或自我报告的爱泼华嗜睡量表评分。从定性访谈中，出现了4个主题：“睡眠中断”与睡眠时间短有关，在常见的睡眠周期中醒来和打瞌睡，原因是疼痛未得到控制和透析。许多参与者报告醒来后经常“感觉没有恢复精力”。“睡眠障碍的影响”包括身体机能、精神状态和自我管理能力下降。最后，受访者描述了需要使用策略来“坚持应对”这些症状。
参与者的观点仅适用于患有睡眠呼吸暂停的血液透析患者。
我们的研究结果表明，睡眠呼吸暂停的严重程度不会影响睡眠时间或患者报告的日间嗜睡情况；然而，患有睡眠呼吸暂停的血液透析患者报告睡眠受到干扰且未恢复精力，睡眠障碍的衰弱影响是深远的。睡眠中断和未恢复精力是睡眠呼吸暂停的主要症状，应进行常规评估，以识别睡眠呼吸暂停患者并改善接受血液透析治疗的慢性肾脏病患者的生活质量。
