[骨关节炎和终末期肾病患者的自我报告睡眠和觉醒障碍]

Filchenko I A, Korostovtseva L S, Tereshchenko N M, Tsed A N, Sviryaev Yu V

Sechenov Institute of Evolutionary Physiology and Biochemistry of RAS, St. Petersburg, Russia.

Almazov National Medical Research Centre, St. Petersburg, Russia.

Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(4. Vyp. 2):80-91. doi: 10.17116/jnevro202112104280.

OBJECTIVE

This study aimed to assess subjective sleep and wake disorders (SWD) in patients with osteoarthritis and comorbid end-stage renal disease (ESRD) receiving hemodialysis (ESRD-HD) compared to patients with osteoarthritis and without chronic kidney disease (CKD) as well as to clarify of the association of subjective sleep characteristics with the levels of anxiety and depression and pain, general health score and laboratory parameters in these cohorts.

MATERIAL AND METHODS

This pilot case-control study included the patients with stage III hip osteoarthritis with ESRD-HD (=19) and without CKD (=19) aged 18-85 years. The patients received the consultations of orthopedic surgeon and internal medicine specialist with anthropometry and clinical and biochemical blood tests. Subjective SWD were assessed with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Insomnia Severity Index (ISI), diagnostic criteria for restless legs syndrome (RLS) and Berlin questionnaire. Anxiety and depression were assessed with Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Subjective general health and osteoarthritis-related pain were assessed with visual analog scales (VAS).

RESULTS

Compared to the patients with osteoarthritis and without CKD, the patients with osteoarthritis and ESRD-HD had a lower VAS score for general health (50.00 (40.00-75.00) points and 80.00 (70.00-80.00) points, =0.014), a higher PSQI (12.0 (8.5-14.5) points and 8.0 (6.0-11.0) points, =0.046), a higher incidence of RLS (59% and 16.8%, =0.017) and a lower level of anxiety according to HADS (0.0 (0.0-3.0) points and 3.0 (2.0-5.5) points, =0.025). The correlation and regression analysis showed the association of PSQI score with VAS score for general health (b= -1.7 points, =0.002 with adjustment for age, sex and ESRD-HD), as well as the association of SWD with laboratory markers (PSQI score with creatinine level, FSS with eosinophil count, RLS with creatinine, urea and potassium levels).

CONCLUSION

The results of our study demonstrated the high incidence of SWD in patients with osteoarthritis. These SWD have complex pathogenesis and require specific approach in patients with osteoarthritis and ESRD-HD.

目的

本研究旨在评估骨关节炎合并终末期肾病（ESRD）且接受血液透析（ESRD-HD）的患者与无慢性肾脏病（CKD）的骨关节炎患者相比的主观睡眠和觉醒障碍（SWD），并阐明这些队列中主观睡眠特征与焦虑、抑郁水平、疼痛、总体健康评分及实验室参数之间的关联。

材料与方法

这项前瞻性病例对照研究纳入了年龄在18 - 85岁之间的III期髋骨关节炎合并ESRD-HD（n = 19）和无CKD（n = 19）的患者。患者接受了骨科医生和内科专家的会诊，进行了人体测量以及临床和生化血液检查。使用匹兹堡睡眠质量指数（PSQI）、爱泼华嗜睡量表（ESS）、疲劳严重程度量表（FSS）、失眠严重程度指数（ISI）、不宁腿综合征（RLS）诊断标准和柏林问卷评估主观SWD。使用医院焦虑抑郁量表（HADS）和贝克抑郁量表（BDI）评估焦虑和抑郁。使用视觉模拟量表（VAS）评估主观总体健康和骨关节炎相关疼痛。

结果

与无CKD的骨关节炎患者相比，骨关节炎合并ESRD-HD的患者总体健康的VAS评分更低（分别为50.00（40.00 - 75.00）分和80.00（70.00 - 80.00）分，P = 0.014），PSQI更高（分别为12.0（8.5 - 14.5）分和8.0（6.0 - 11.0）分，P = 0.046），RLS发病率更高（分别为59%和16.8%，P = 0.017），且根据HADS评估焦虑水平更低（分别为0.0（0.0 - 3.0）分和3.0（2.0 - 5.5）分，P = 0.025）。相关性和回归分析显示PSQI评分与总体健康的VAS评分相关（调整年龄、性别和ESRD-HD后，b = -1.7分，P = 0.002），以及SWD与实验室指标相关（PSQI评分与肌酐水平、FSS与嗜酸性粒细胞计数、RLS与肌酐、尿素和钾水平）。