Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan,
Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan,
Nephron. 2024;148(3):152-159. doi: 10.1159/000533418. Epub 2023 Aug 16.
Among patients on hemodialysis (HD), physical frailty and sleep disturbances are not only common but also associated with adverse outcomes. The aim of this study was to evaluate the association between physical frailty and sleep disturbances in patients on HD.
This cross-sectional study was conducted from June 2017 to March 2021, with outpatients receiving HD 3 times a week at two dialysis facilities in Japan. Sleep disturbances were identified with the Athens Insomnia Scale (AIS). Physical frailty was defined using the Fried Frailty Phenotype. Patients were classified as "non-frailty (number of frailty components: 0-2)" or "frailty (3-5)." We examined the association of sleep disturbances with physical frailty and its components by performing a logistic regression analysis.
We analyzed 360 patients (mean age 65.6 years; 62% men). Eighty-one patients (23%) were classified into the group with frailty, and the mean AIS score was 5.2 ± 4.2 points. After adjusting for clinical characteristics, increasing the AIS score per 1 point was associated with higher odds of physical frailty (odds ratio, 1.12; 95% confidence interval, 1.05-1.20; p < 0.01). As for the frailty components, exhaustion, low physical activity, and weak grip strength showed an association with sleep disturbances (all p < 0.05).
Sleep disturbances were independently associated with physical frailty in patients on HD. Future studies are warranted to investigate the causality between physical frailty and sleep disturbances in this population.
在血液透析（HD）患者中，身体虚弱和睡眠障碍不仅常见，而且与不良结局相关。本研究旨在评估 HD 患者身体虚弱与睡眠障碍之间的关系。
本横断面研究于 2017 年 6 月至 2021 年 3 月进行，在日本的两家透析中心每周接受 3 次 HD 的门诊患者参与了研究。使用雅典失眠量表（AIS）来识别睡眠障碍。身体虚弱使用 Fried 虚弱表型来定义。患者被分为“非虚弱（虚弱成分数：0-2）”或“虚弱（3-5）”。我们通过逻辑回归分析来检查睡眠障碍与身体虚弱及其组成部分的关系。
我们分析了 360 名患者（平均年龄 65.6 岁；62%为男性）。81 名患者（23%）被归类为虚弱组，AIS 平均得分为 5.2±4.2 分。在调整了临床特征后，AIS 评分每增加 1 分，身体虚弱的可能性就会增加（优势比，1.12；95%置信区间，1.05-1.20；p＜0.01）。对于虚弱成分，疲劳、低身体活动和握力弱与睡眠障碍有关（均 p＜0.05）。
睡眠障碍与 HD 患者的身体虚弱独立相关。未来的研究需要进一步探讨该人群中身体虚弱和睡眠障碍之间的因果关系。
