Prather Aric A, Gao Ying, Betancourt Legna, Kordahl Rose C, Sriram Anya, Huang Chiung-Yu, Hays Steven R, Kukreja Jasleen, Calabrese Daniel R, Venado Aida, Kapse Bhavya, Greenland John R, Singer Jonathan P
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco.
Department of Medicine, University of California San Francisco.
medRxiv. 2024 Jan 23:2023.10.12.23296973. doi: 10.1101/2023.10.12.23296973.
Many lung transplant recipients fail to derive the expected improvements in functioning, HRQL, or long-term survival. Sleep may represent an important, albeit rarely examined, factor influencing lung transplant outcomes. Within a larger cohort study, 141 lung transplant recipients completed the Medical Outcomes Study (MOS) Sleep Scale along with a broader survey of patient-reported outcome (PRO) measures and frailty assessment. MOS Sleep yields the Sleep Problems Index (SPI); we also derived an insomnia-specific subscale. Potential perioperative predictors of disturbed sleep and time to chronic lung allograft dysfunction (CLAD) and death were derived from medical records. We investigated associations between perioperative predictors on SPI and Insomnia and associations between SPI and Insomnia on PROs and frailty by linear regressions, adjusting for age, sex, and lung function. We evaluated the associations between SPI and Insomnia on time to CLAD and death using Cox models, adjusting for age, sex, and transplant indication. Post-transplant hospital length of stay >30 days was associated with worse sleep by SPI and insomnia (SPI: p=0.01; Insomnia p=0.02). Worse sleep by SPI and insomnia was associated with worse depression, cognitive function, HRQL, physical disability, health utilities, and Fried Frailty Phenotype frailty (all p<0.01). Those in the worst quartile of SPI and insomnia exhibited increased risk of CLAD (HR 2.18; 95%CI: 1.22-3.89 ; p=0.01 for SPI and HR 1.96; 95%CI 1.09-3.53; p=0.03 for insomnia). Worsening in SPI but not insomnia was also associated with mortality (HR: 1.29; 95%CI: 1.05-1.58; p=0.01). Poor sleep after lung transplant may be a novel predictor of patient reported outcomes, frailty, CLAD, and death with potentially important screening and treatment implications.
许多肺移植受者未能在功能、健康相关生活质量（HRQL）或长期生存方面取得预期改善。睡眠可能是影响肺移植结果的一个重要因素，尽管很少有人对此进行研究。在一项更大规模的队列研究中，141名肺移植受者完成了医学结局研究（MOS）睡眠量表，以及一项关于患者报告结局（PRO）指标和虚弱评估的更广泛调查。MOS睡眠量表得出睡眠问题指数（SPI）；我们还得出了一个特定于失眠的子量表。睡眠障碍以及慢性肺移植功能障碍（CLAD）和死亡时间的潜在围手术期预测因素来自病历。我们通过线性回归研究了围手术期预测因素与SPI和失眠之间的关联，以及SPI和失眠与PRO指标和虚弱之间的关联，并对年龄、性别和肺功能进行了调整。我们使用Cox模型评估了SPI和失眠与CLAD和死亡时间之间的关联，并对年龄、性别和移植指征进行了调整。移植后住院时间>30天与SPI和失眠导致的睡眠质量较差相关（SPI：p = 0.01；失眠：p = 0.02）。SPI和失眠导致的睡眠质量较差与更严重的抑郁、认知功能、HRQL、身体残疾、健康效用以及Fried虚弱表型虚弱相关（所有p<0.01）。SPI和失眠处于最差四分位数的患者发生CLAD的风险增加（SPI的HR为2.18；95%CI：1.22 - 3.89；p = 0.01，失眠的HR为1.96；95%CI 1.09 - 3.53；p = 0.03）。SPI恶化但失眠未恶化也与死亡率相关（HR：1.29；95%CI：1.05 - 1.58；p = 0.01）。肺移植后睡眠质量差可能是患者报告结局、虚弱、CLAD和死亡的一个新的预测因素，可能具有重要的筛查和治疗意义。
