维持性血液透析患者睡眠障碍及其影响因素的研究

A survey on sleep quality and its influencing factors in maintenance hemodialysis patients

目的探讨维持性血液透析患者睡眠障碍现状及其影响因素。方法采用横断面调查法,通过问卷调查及临床资料收集,选取2017年12月至2018年3月期间于新疆医科大学第五附属医院肾病科血液净化中心行规律性血液透析患者160例进行《匹兹堡睡眠质量指数量表(PSQI)》评分,根据结果将其分为睡眠障碍组127例和非睡眠障碍组33例,对所有患者分别进行血常规、生化、甲状旁腺素检查,先进行单因素分析,再将睡眠障碍作为因变量,将年龄、透析龄、尿素清除指数(Kt/V)及上述检验指标作为自变量,进行多元线性回归分析。结果 160例维持性血液透析患者中睡眠障碍的发生率为79.4%(127/160);年龄>65岁的患者睡眠障碍的发生率为91.8%,明显高于年龄≤65岁患者的73.9%,差异有统计学意义(P<0.05);透析龄>3年的患者睡眠障碍的发生率为97.1%,明显高于年龄≤3年患者的65.6%,差异有显著统计学意义(P<0.01);Kt/V值≤1.2者的睡眠障碍发生率为86.5%,明显高于Kt/V值>1.2患者的70.4%,差异有统计学意义(P<0.05);单因素分析结果显示,睡眠障碍组与非睡眠障碍组患者的甲状旁腺激素水平(iPTH)的中位数分别为334 pmol/L与124 pmol/L,睡眠障碍组明显高于非睡眠障碍组,差异有显著统计学意义(P<0.01);睡眠障碍组患者的肌酐水平为709μmol/L,明显高于非睡眠障碍组的543μmol/L;血红蛋白水平为(104.46±16.74) g/L,明显低于非睡眠障碍组的(113.45g±22.59) g/L;血钙浓度为(2.18±0.27) mmol/L,明显低于非睡眠障碍组的(2.31±0.22) mmol/L,差异均有统计学意义(P<0.01或0.05);而性别、透析模式、血磷浓度、白蛋白情况等因素与睡眠障碍无相关性(P>0.05);多元线性回归分析结果显示,年龄、透析龄、i PTH、Kt/V、血红蛋白和肌酐水平与维持性血液透析患者睡眠障碍有关(P<0.05)。结论维持性血液透析患者睡眠障碍的发生率高,高龄、长透析龄、继发性甲状旁腺功能亢进、肾性贫血及透析不充分均与睡眠障碍的发生密切相关。

Objective To explore the current status of sleep disorders and its influencing factors in maintenance hemodialysis patients. Methods Using cross-sectional survey method, 160 patients with regular hemodialysis in the Blood Purification Center of Department of Nephrology of the Fifth Affiliated Hospital of Xinjiang Medical University were selected for questionnaires and clinical data collection from December 2017 to March 2018. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). According to the scores results, the patients were divided into the sleep disorders group (127 cases) and the non-sleep disorder group (33 cases). Blood routine, biochemical, and parathyroid hormone (PTH) tests were performed on all patients, followed by univariate analysis. Using sleep disorders as a dependent variable, age, age of dialysis, urea clearance index (Kt/V) and the above test indicators were used as the independent variables for multiple linear regression analysis. Results The incidence of sleep disorders in 160 maintenance hemodialysis patients was 79.4% (127/160). The incidence of sleep disorders in patients aged > 65 was 91.8%, which was significantly higher than 73.9% of patients aged no more than 65 (P<0.05). The incidence of sleep disorder was 97.1% in patients with dialysis more than 3 years, which was significantly higher than 65.6% in patients with age less than or equal to 3 years (P<0.01). The incidence of sleep disorder in patients with Kt/V value greater than 1.2 was 86.5%, which was significantly higher than 70.4% of patients with Kt/V value > 1.2 (P<0.05). The results of univariate analysis showed that the median iPTH level of PTH in the sleep disorders group was 334 pmol/L, which was significantly higher than 124 pmol/L in the non-sleep disorder group (P<0.01). The creatinine levels in the sleep disorder group was 709 μmol/L, which was significantly higher than 543 μmol/L in the non-sleep disorders group; the hemoglobin levels, blood calcium concentration in the sleep disorder group were (104.46±16.74) g/L, (2.18±0.27) mmol/L, respectively, which were significantly lower than corresponding (113.45±22.59) g/L and (2.31±0.22) mmol/L (all, P<0.01 or 0.05). The factors such as gender, dialysis mode, serum phosphorus concentration and albumin status were not related to sleep disorders (P>0.05). Multiple linear regression analysis showed that age, dialysis age, parathyroid hormone, Kt/V, hemoglobinand creatinine levels were associated with sleep disorders in maintenance hemodialysis patients (P<0.05). Conclusion The incidence of sleep disorders is high in maintenance hemodialysis patients. age, long dialysis age, sever secondary hyperparathyroidism, renal anemia, and inadequate dialysis are closely related to the incidence of sleep disorders.