慢性肾功能不全血液透析和不宁腿综合征患者的睡眠质量分析

Analysis of sleeping quality in patients with chronic renal insufficiency hemodialysis and restless leg syndrome

目的:调查老年和老年前期不宁腿综合征与血液透析患者的睡眠质量,并分析影响其睡眠质量的因素。方法:以2003-07中山大学第一附属医院、广东省人民医院、中山大学孙逸仙纪念医院及中山大学第三附属医院因慢性肾功能不全进行血液透析的患者123例及广州市社区居民59人为观察对象。按年龄分为老年前期(50～59岁)70例,老年期(≥60岁)112例。每组又分3小组,分别为透析伴不宁腿综合征组(简称不宁腿综合征组),透析不伴不宁腿综合征组(简称透析组),社区人群组。采用自行设计的一般情况调查表调查性别,年龄,职业,患病病程等。不宁腿综合征的诊断采用国际不宁腿综合征研究小组制定的不宁腿诊断标准量表。睡眠质量评定采用匹茨堡睡眠质量指数量表,由23个项目7个因子构成,各因子累计得分系匹茨堡睡眠质量指数量表总分。将总分以4分,8分为界限将睡眠分为好,中,差3个级别进行分析。结果:纳入的123例透析患者及社区老年人59人,全部进入结果分析。①透析患者中不宁腿综合征者的患病率为25.2%(31/123);其中老年前期组为31%(16/52);老年组为21%(15/71);差异无显著性(χ2=1.48,P>0.05)。②不宁腿综合征组匹茨堡睡眠质量指数量表的主观睡眠质量、睡眠潜伏期、催眠药物与日间功能障碍项目分及总分均比透析组、社区人群高(P<0.05);透析组的睡眠潜伏期与催眠药物项目得分及总分比社区人群高(P<0.05)。②不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分比透析组得分高(P<0.05);而睡眠潜伏期、用睡眠药物、睡眠总分比社区人群组高(P<0.05)。③老年前期不宁腿综合征组的主观睡眠质量、睡眠潜伏期、睡眠持续时间、用睡眠药物、白天功能障碍和总分高于透析组(P<0.05);而睡眠潜伏期、用睡眠药物、睡眠总分高于社区人群组(P<0.05)。④老年期不宁腿综合征组的睡眠潜伏期、用睡眠药物、白天功能紊乱和总分高于社区人群组,透析组也高于社区人群组,差异有显著性(P<0.05)。⑤老年前期组与老年期组不宁腿综合征患者之间仅在睡眠持续性上差异有显著(P<0.05),老年前期组与老年期组非不宁腿综合征患者仅在日间功能障碍上差异有显著性(P<0.05)。结论:透析伴不宁腿综合征对老年前期和老年期患者的睡眠质量有明显影响,透析不伴不宁腿综合征对老年前期患者的睡眠质量无影响。在肾脏血液透析的患者中,年龄因素与睡眠质量关系不明显。

AIM： To study the sleeping quality of senile and presenile patients with restless leg syndrome and those treated with hemodialysis, analyze influencing factors of sleeping quality. METHODS： 123 patients with chronic renal insufficiency receiving hemodialysis in First Affiliated Hospital, Second Affiliated Hospital, Third Affiliated Hospital, Sun Yat-sen University and Guangdong Province People＇s Hospital and 59 community residents of Guangzhou in July 2003 were divided into 2 groups according to the age： Senile group（n=70, aged 50-59）, presenile group （n=l12, aging≥ 60）, and then divided into restless leg syndrome group, hemodialysis group and community group respectively. Age, gender, job and course were investigated with self-designed scale, quality of sleeping were assayed with Pittsburgh sleep quality index （PSQI）, which consisted of 7 factors of 23 items. Accumulative score of each factor was the total score of PSQI. Score below 4 points as good, score between 4 points and 8 points as moderate, score above 8 points as poor. RESULTS： A total of 123 patients with hemodialysis and 59 elderly residents were involved in the analysis of results. ① Prevalence rate of restless leg syndrome accounted for 25.2% （31/123）in patients received hemodialysis, of which 31%（16/52） in the presenile group, 21%（15/71） in the senile group, and differences were not significant（X2 =1.48,P 〉 0.05）.② Factor scores and total score of subjective sleep quality,sleep latency, using of hypnotic and functional disorder in daytime of PSQI were higher than those in the hemodialysis group and community group（P 〈 0.05）. Scores of sleep latency and using of hypnotic in the hemodialysis group were higher than those in the community group（P 〈 0.05）. ③Factor scores and total score of subjective sleep quality, sleep latency, sleep lasting time, using of hypnotic and functional disorder in daytime in the restless leg syndrome group of presenile were higher than those in the hemodialysis group （P 〈 0.05）; Total score of sleep latency and using of hypnotic were higher than those in the community group （P 〈 0.05）. ④Factor scores of sleep latency, using of hypnotic, functional disorder in daytime and total score in the restless leg syndrome group of senile were higher than those in the community group, and those in the hemodialysis group were higher than those in the community group, and differences were significant （P 〈 0.05）. ⑤ There were significant differences in patients with restless leg syndrome of the presenile group and senile group （P 〈 0.05）, and functional disorder were significantly different in patients without restless leg syndrome of the presenile group and senile group（P 〈 0.05）. CONCLUSION： Restless leg syndrome with hemodialysis has a obvious effect on the sleep quality of presenile and senile patients, non restless leg syndrome with hemodialysis has no effect on the sleep quality of presenile patients. In patients received kidney hemodialysis, there are no significant relationship between age and sleep quality.