终末期肾脏病患者睡眠质量及生活质量的调查分析

The investigation of sleep quality and the quality of life in end-stage renal disease patients

目的评估终末期肾脏病（ESRD）患者的睡眠质量和生活质量，分析二者相关关系及其影响因素。方法选取2015年12月至2016年5月在武汉大学中南医院、武汉市第一医院、武汉大学人民医院肾内科和血液净化中心就诊的终末期。肾脏病患者141例，采用匹茨堡睡眠质量指数量表（PSQI）和肾病生活质量评价量表（KDQOL—SF1．2）问卷调查方法评估患者睡眠质量和生活质量，并分析其影响因素。收集患者年龄、性别、文化程度、家庭收入、原发病等一般资料。按PSQI总分分为睡眠障碍组和非睡眠障碍组。结果141例ESRD患者睡眠障碍发生率为56％，睡眠障碍组患者在主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠紊乱、日间功能障碍等项目的评分均高于非睡眠障碍组，两组间的差异有统计学意义（均P〈0．05）。生活质量方面，非睡眠障碍组患者生理职能、精神健康、情感职能、社会功能、症状、肾脏病的负担、工作状态、认知功能、社交质量等项目评分高于睡眠障碍组，两组间差异有统计学意义（均P〈0．05）。与生活质量相关的透析相关症状（OR=0．944，P=0．03），健康状况变化（OR=1．024，P=0．02）是睡眠障碍发生的独立危险因素。家庭社会因素影响方面，睡眠障碍的发生与患者是否进入血液透析（r=0．252，P=0．003），家庭支持度（r=0．174，P=0．040），体重指数（r=0．189，P=0．025）相关。进一步的回归分析发现，是否进入血液透析（OR=0．544，P=0．011）和家庭支持度（OR=0．686，P=0．030）是睡眠障碍发生的独立危险因素。结论终末期肾脏病患者睡眠质量及生活质量均降低。有睡眠障碍的患者，其生活质量进一步降低。临床医护人员需重视患者睡眠障碍的预防和干预，提高终末期肾脏病患者生活质量。

Objective To evaluate the sleep quality as well as the quality of life in end-stage renal disease （ESRD） patients, analyze the relationships between them and explore the influence factors. Methods A total of 141 ESRD patients from three hospitals were enrolled. The patients＇ general information including age, gender, degree of education, income, primary disease and years on dialysis were collected. Pittsburgh Sleep Quality Index （PSQI） was used to assess the sleep quality of the patients, and the life quality was assessed by using Kidney Disease Quality of Lifeshort form （KDQOL-SF）. Results The incidence of sleep disorder was 56% in these 141 ESRD patients. The patients who suffered from sleep disorder had a higher sleep index score in all aspects of PSQI except in usage of sleep medications （P 〈 0.05）. On the aspect of life - qualityassociated factors, dialysisrelated symptoms （OR=0.944, P=0.026）, and change of health status （OR=1.024, P=1.024） were independent risk factors for sleep disorders. As for familysocial factors, sleep quality was closely associated with dialysis （r=-0.252, P=0.003）, family support （r=-0.174, P=0.040）, and BMI （r=-0.189, P=0.025）. Further regression analysis found that hemodialysis or peritoneal dialysis （OR= 0.544, P= 0.011）, poor family support （OR=0.686, P=0.030） were independently risk factors of sleep disorders. Conclusions Poor sleep quality is common in ESRD patients and it is associated with lower quality of life. More attention should be paid on assessment and management of sleep disorder in ESRD patients in order to improve their quality of life.