维持性血液透析患者睡眠质量和日间嗜睡状况的研究

Study of sleep quality and daytime sleepiness in maintenance hemodialysis patients

目的 本研究调查维持性血透患者的睡眠质量和日间嗜睡状况,探讨影响睡眠质量的相关因素.方法 112例维持性高通量血透患者和53例健康人对照进行匹兹堡睡眠质量指数（PSQI）问卷评估睡眠质量和Epworth Sleep Scale（ESS）问卷评估日间嗜睡程度,并比较结果.比较睡眠好（PSQI总分≤5）和睡眠差（PSQI总分＞5）的患者PSQI 7部分得分及各种睡眠障碍的原因;观察不同时间段血透患者的睡眠情况;多元线性回归和logistic回归分析年龄、透析龄等临床基本资料以及血钙、磷、血红蛋白等生化指标与睡眠质量的相关性.结果 血透患者PSQI总分高于对照组（7.02±4.94比3.28±2.79,P＜0.05）,而ESS总分低于对照组[3（0～6）比8（4.25～11.75）,P＜0.05].58%的血透患者睡眠差,入睡时间明显延长（30 min比15 min,P＜0.05）,失眠是主要原因.早、中、夜班血透睡眠质量无显著差异.年龄（OR=1.75,P=0.003）、透析龄（OR=1.26,P=0.008）、血红蛋白（OR=0.64,P=0.008）、钙磷乘积（OR=1.60,P=0.02）与睡眠质量评分显著相关.结论 血透患者普遍存在睡眠不良,老年、透析龄长、贫血、钙磷乘积升高是危险因素.

Objective To assess sleep quality and daytime sleepiness in patients on maintenance high flux hemodialysis, and discussed the associated factors. Methods A total of 112 high flux hemodialysis patients and 53 normal subjects were estimated by Pittsburgh sleep quality index （PSQI） and Epworth Sleep Scale （ESS） to assess the sleep quality and day time sleepiness. Global score of these questionnaires were analyzed. Seven components＇ scores and 9 reasons for sleep disturbances were compared between ＂good＂ （global PSQI ≤5） and ＂bad＂ （global PSQI〉5） sleepers. Sleep quality was compared among different shifts of hemodialysis. The impact of clinical factors on sleep quality were analyzed by multivariate linear regression and logistic regression. Results Compared with control group, hemodialysis group had a higher PSQI （7.02±4.94 vs 3.28±2.79, P〈0.05） and a lower ESS score [3（0-6） vs 8（4.25-11.75）, P〈0.05] . 58% patients were ＂bad＂ sleepers and sleep latency was longer （30 min vs 15 min, P〈0.05）. Insomnia was the main problem. Patients on morning shift, afternoon shift and night shift had similar subjective sleep quality. Age （OR=1.75, P=0.003）, dialysis vintage （OR=1.26, P=0.008）,hemoglobin （OR=0.64, P=0.008）, calcium phosphate product （OR=1.60, P=0.02） were significantly related to sleep quality score. Conclusions Sleep disturbance is common in hemodialysis patients. Older age, longer dialysis vintage, anemia and higher calcium phosphate product are risk factors for poor sleep quality