基于横断面研究血液透析患者睡眠障碍的相关因素分析

Prevalence of Sleep Disorders and Associated Factors among Hemodialyzed Patients: a Cross-sectional Study

目的 接受透析治疗的终末期肾病患者症状负荷重,严重影响其生活质量。本研究的主要目的是确定新冠肺炎流行期间接受血液透析(HD)患者的睡眠障碍患病率,并探讨相关预测因素。方法 基于横断面研究,共有202例维持性血液透析患者纳入研究。采用匹兹堡睡眠质量指数(PSQI)进行睡眠质量评分。采用视觉模拟评分(VAS)评定有无尿毒症瘙痒(UP)及强度。记录每位患者的临床特征和生物化学资料。应用Logistic回归分析探索与HD患者睡眠质量相关的预测因素。结果 PSQI评估结果显示,HD患者的睡眠障碍患病率为42.57%。甲状旁腺素、碱性磷酸酶、铁蛋白的水平和年龄在睡眠障碍组[228.00(156.80~327.05)pg/m L、86.02(69.05~116.50)U/L、410.65(274.14~539.03)μg/L、62.50(49.80~70.00)岁]明显高于睡眠良好的患者[159.00(119.33~268.06)pg/m L、76.52(63.20~97.07)U/L、368.84(220.71~504.50)μg/L、53.00(40.30~61.00)年],Z=-3.335、-2.464、-2.046、-3.920,P<0.05。同样,两组间尿毒症瘙痒也存在差异(χ;=28.269,P<0.001)。维持性血液透析患者的睡眠障碍似乎与血液透析时间班次及性别无相关性。尿毒症瘙痒、年龄越大、PTH升高是睡眠障碍的独立危险因素(Wald值=11.390、5.951、6.309,P<0.05)。结论在新冠肺炎流行期间,睡眠障碍在血液透析患者中常见。睡眠障碍似乎与血液透析时间班次无相关性。横断面研究表明,尿毒症瘙痒、年龄越大、PTH升高是HD患者睡眠障碍的危险因素。对于透析患者睡眠障碍的诊断和管理应给予更多的关注。

Objective Patients undergoing haemodialysis may experience troubling symptoms such as sleep disorders,which may afiect their quality of life.The main purpose of this investigation was to ascertain the prevalence of sleep disorders in HD patients during the epidemic of coronavirus disease,and to explore the contributing predictors.Methods Two hundred and two patients with maintenance hemodialysis(MHD) in the cross-sectional study were included.Pittsburgh sleep quality index (PSQI) and visual analogue scale (VAS) were used to score sleep quality and the presence and intensity of uremic pruritus (UP),respectively.We also reviewed patient demographics,and laboratory test results to evaluate any associated factors of sleep disorders in HD patients.Results The PSQI assessment results showed that the prevalence of sleep disturbance in HD patients was 42.57%.Levels of parathyroid hormone,alkaline phosphatase,ferritin and age in the sleep disorder group[228.00(156.80-327.05) pg/mL,86.02(69.05-116.50) U/L,410.65(274.14-539.03)μg/L,62.50(49.80-70.00) years]were significantly higher than in the well-slept patients[159.00(119.33-268.06)pg/mL,76.52 (63.20-97.07) U/L,368.84(220.71-504.50)μg/L,53.00(40.30-61.00) years],Z=-3.335,-2.464,-2.046,-3.920,P<0.05.There was also a difference in uremic pruritus between the two groups (χ;=28.269,P<0.001).Sleep disturbance in maintenance hemodialysis patients does not appear to be associated with hemodialysis,shifts or gender.Uremic pruritus,older age and elevated PTH were independent risk factors for sleep disturbance (Wald value=11.390,5.951,6.309,P<0.05).Conclusion Sleep disorder are significant problems for patients receiving haemodialysis during the COVID-19 pandemic.Sleep disorders did not seem to be associated with hemodialysis shift.Uremic pruritus,older age and elevated PTH were risk factors for sleep disorders in HD patients.Appropriate interventions to monitor and reduce sleep disorders in dialysis patients are needed.