Division of Nephrology, Başkent University Faculty of Medicine, İzmir Zübeyde Hanım Application and Research Centre, İzmir, Turkey.
Division of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Aging Clin Exp Res. 2022 Mar;34(3):573-581. doi: 10.1007/s40520-021-01966-0. Epub 2021 Aug 27.
Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.
The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.
This cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).
The mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38-4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B, and folate (p > 0.05).
EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.
白天过度嗜睡（EDS）不仅在老年人中普遍存在，而且在慢性肾脏病（CKD）患者中也很常见，并且与更高的发病率和死亡率相关。
本研究旨在确定 EDS 与营养状况以及老年 CKD 患者的血清营养素水平之间的关系。
这项横断面研究纳入了 367 名（年龄≥65 岁）患有 CKD（eGFR<60ml/min/1.73m，或>30mg/天的蛋白尿持续时间>3 个月）的患者。使用 Epworth 嗜睡量表（得分≥11）记录 EDS。根据 Mini 营养评估（MNA）工具（得分<17）诊断营养不良。
患者的平均年龄为 81±7 岁，248 名（67%）为女性。99 名（26.9%）患者存在 EDS。与无 EDS 者相比，有 EDS 者的 MNA 评分显著较低，且营养不良更常见（p<0.05）。在调整年龄、性别、脑血管疾病、痴呆、药物数量和夜间排尿次数以及 Charlson 合并症指数后，营养不良与 EDS 之间的关系仍然存在（OR 2.58，95%CI 1.38-4.83，p=0.003）。在存在 EDS 的情况下，血清维生素 D、维生素 B 和叶酸的水平或缺乏并没有显著差异（p>0.05）。
EDS 与老年 CKD 患者的营养不良有关。因此，在临床实践中应同时评估 EDS 和营养状况。然而，需要进一步的研究来确定营养不良和 EDS 之间的关联方向，并评估饮食干预是否可以改善 EDS。
