Department of Nephrology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
Ann Palliat Med. 2022 Jun;11(6):1865-1875. doi: 10.21037/apm-21-3416. Epub 2022 Mar 7.
Sleep disturbance is well documented as a crucial element that impairs health. Depression and health-related quality of life (HRQOL), which on behalf of a patient's overall perception of emotional, physical and social well-being, are increasingly emphasized self-reported health outcomes especially during the coronavirus disease 2019 (COVID-19) pandemic. Among dialysis patients, sleep disturbance is associated with depression and poorer HRQOL. The study was designed to depict the prevalence of sleep disturbance, and to explore the association among sleep, depression, and HRQOL in patients with non-dialysis chronic kidney disease (CKD) during the COVID-19 pandemic.
A total of 172 non-dialysis CKD patients enrolled in this cross-sectional study, with sociodemographic and clinical data recorded. Sleep, HRQOL, and depression were evaluated via the Pittsburgh Sleep Quality Index (PSQI), the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), and the 9-item Patient Health Questionnaire (PHQ-9), respectively.
A total of 100 (58%) met the criteria for poor sleep. Good sleepers had strikingly disparate HRQOL and depression scores compared to poor sleepers. Sleep disorders were significantly associated with decreased HRQOL and increased depression in regression models adjusted or unadjusted for sociodemographic and clinical characteristics. Mediation analysis indicated depression was a significant mediator explaining 51% of the relationship between sleep status with physical component summary (PCS) and played a fully mediating role in the association between sleep and mental component summary (MCS).
Our study suggested the high incidence of sleep disorders in patients with non-dialysis CKD during the COVID-19 pandemic, as well as the tight associations among sleep, depression, and HRQOL. Considering the negative influences of sleep and depression on HRQOL, appropriate screening and treatment for these treatable health-related domains are necessary for patients with non-dialysis CKD.
睡眠障碍是公认的损害健康的关键因素。抑郁和与健康相关的生活质量（HRQOL），代表了患者对情感、身体和社会福祉的整体感知，越来越受到重视，尤其是在 2019 年冠状病毒病（COVID-19）大流行期间的自我报告健康结果。在透析患者中，睡眠障碍与抑郁和较差的 HRQOL 有关。本研究旨在描述 COVID-19 大流行期间非透析慢性肾脏病（CKD）患者睡眠障碍的流行情况，并探讨睡眠、抑郁与 HRQOL 之间的关系。
本横断面研究共纳入 172 名非透析 CKD 患者，记录其社会人口统计学和临床数据。通过匹兹堡睡眠质量指数（PSQI）、肾脏病生活质量 36 项简短调查（KDQOL-36）和 9 项患者健康问卷（PHQ-9）分别评估睡眠、HRQOL 和抑郁情况。
共有 100 名（58%）患者符合睡眠不佳的标准。与睡眠不佳者相比，睡眠良好者的 HRQOL 和抑郁评分差异显著。在调整或未调整社会人口统计学和临床特征的回归模型中，睡眠障碍与 HRQOL 下降和抑郁增加显著相关。中介分析表明，抑郁是睡眠状况与生理成分综合评分（PCS）之间关系的一个重要中介变量，占睡眠与心理成分综合评分（MCS）之间关系的 51%，并在两者之间起到完全中介作用。
我们的研究表明，COVID-19 大流行期间非透析 CKD 患者睡眠障碍发生率较高，睡眠、抑郁和 HRQOL 之间存在紧密联系。考虑到睡眠和抑郁对 HRQOL 的负面影响，非透析 CKD 患者需要对这些可治疗的健康相关领域进行适当的筛查和治疗。
