Fitzpatrick Jessica, Kerns Eric S, Kim Esther D, Sozio Stephen M, Jaar Bernard G, Estrella Michelle M, Tereshchenko Larisa G, Monroy-Trujillo Jose M, Parekh Rulan S, Bourjeily Ghada
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
Lahey Hospital and Medical Center, Burlington, Massachusetts.
J Clin Sleep Med. 2021 Aug 1;17(8):1707-1715. doi: 10.5664/jcsm.9304.
Patients with end-stage kidney disease commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in patients on hemodialysis, but the burden of symptoms from sleep disturbances has emerged as a marker that may shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary cardiovascular outcomes or mortality among adults initiating hemodialysis.
In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary cardiovascular outcomes included QT correction (ms), heart rate variance (ms), left ventricular mass index (g/m), and left ventricular hypertrophy. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression.
Mean age was 55 years, and median body mass index was 28 kg/m (interquartile range, 24, 33), with 70% of patients being African Americans. Median FOSQ-10 score was 19.7 (interquartile range, 17.1, 20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (hazard ratio, 1.09; 95% confidence interval, 1.01-1.18). Lower FOSQ-10 scores were associated with longer QT correction duration and lower heart rate variance but not left ventricular mass index or left ventricular mass index.
In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in patients with end-stage kidney disease to identify individuals at increased risk for cardiovascular complications and death.
Fitzpatrick J, Kerns ES, Kim ED, et al. Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in patients on incident hemodialysis. . 2021;17(8):1707-1715.
终末期肾病患者常出现睡眠障碍。睡眠障碍与血液透析患者的死亡风险之间的关联并不一致，但睡眠障碍的症状负担已成为一个可能有助于解释这些差异并指导治疗决策的指标。本研究旨在探讨睡眠的功能结局是否与开始血液透析的成年人发生中间心血管结局或死亡的风险增加相关。
在228名参与终末期肾病心律失常和心血管风险预测研究的参与者中，在入组后6个月内进行了睡眠功能结局问卷-10（FOSQ-10）评估，该问卷用于评估白天嗜睡的功能结局。中间心血管结局包括QT校正（毫秒）、心率变异性（毫秒）、左心室质量指数（克/平方米）和左心室肥厚。使用比例风险回归分析FOSQ-10评分与全因死亡率之间的关联。
平均年龄为55岁，体重指数中位数为28kg/m²（四分位间距为24,33），70%的患者为非裔美国人。FOSQ-10评分中位数为19.7（四分位间距为17.1,20.0）。FOSQ-10评分降低10%与死亡风险增加相关（风险比为1.09；95%置信区间为1.01-1.18）。较低的FOSQ-10评分与较长的QT校正持续时间和较低的心率变异性相关，但与左心室质量指数或左心室肥厚无关。
在开始透析的成年人中，与睡眠相关的功能损害很常见，并且与中间心血管疾病指标和死亡风险增加相关。未来的研究应评估对终末期肾病患者进行睡眠障碍筛查的影响，以识别心血管并发症和死亡风险增加的个体。
Fitzpatrick J, Kerns ES, Kim ED,等。睡眠功能结局可预测初次血液透析患者的心血管中间结局和全因死亡率。……2021；17(8):1707-1715。
