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, San Francisco, California.
Department of Medicine, University of California San Francisco, San Francisco, California.
JHLT Open. 2024 Oct 30;7:100170. doi: 10.1016/j.jhlto.2024.100170. eCollection 2025 Feb.
Many lung transplant recipients fail to derive the expected improvements in health-related quality of life (HRQL) and survival. Sleep may represent an important, albeit rarely examined, factor associated with lung transplant outcomes.
Within a larger cohort study, 141 lung transplant recipients completed the Medical Outcomes Study Sleep Problems Index (SPI) Revised scale along with a broader survey of patient-reported outcome (PRO) measures and frailty assessment. From the SPI, we also derived an insomnia-specific subscale. Potential perioperative risk factors for disturbed sleep 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 chronic lung allograft dysfunction (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: = 0.01; insomnia = 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 < 0.01). Those in the worst quartile of SPI and insomnia exhibited an increased risk of CLAD (hazard ratio [HR] 2.18; 95% confidence interval [CI]: 1.22-3.89; = 0.01 for SPI and HR 1.96; 95%CI 1.09-3.53; = 0.03 for insomnia). Worsening in SPI but not insomnia was also associated with mortality (HR: 1.29; 95%CI: 1.05-1.58; = 0.01).
Poor sleep after lung transplant appears associated with PROs, frailty, CLAD, and death. Clarifying the nature of this association may have important screening implications.
许多肺移植受者未能在健康相关生活质量（HRQL）和生存率方面获得预期的改善。睡眠可能是与肺移植结局相关的一个重要因素，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睡眠问题指数（SPI）修订量表以及一项更广泛的患者报告结局（PRO）测量和衰弱评估调查。从SPI中，我们还得出了一个特定于失眠的子量表。睡眠障碍的潜在围手术期风险因素来自病历。我们通过线性回归研究了围手术期预测因素与SPI及失眠之间的关联，以及SPI和失眠与PRO及衰弱之间的关联，并对年龄、性别和肺功能进行了校正。我们使用Cox模型评估了SPI和失眠与慢性肺移植功能障碍（CLAD）发生时间及死亡之间的关联，并对年龄、性别和移植指征进行了校正。
移植后住院时间>30天与SPI评估的更差睡眠及失眠相关（SPI：=0.01；失眠：=0.02）。SPI评估的更差睡眠及失眠与更差的抑郁、认知功能、HRQL、身体残疾、健康效用和弗里德衰弱表型衰弱相关（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（风险比[HR]2.18；95%置信区间[CI]：1.22 - 3.89；SPI的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）。
肺移植后睡眠不佳似乎与PRO、衰弱、CLAD和死亡相关。阐明这种关联的性质可能具有重要的筛查意义。
