维持性血液透析患者失眠及影响因素分析:一项多中心、横断面、观察性研究

Insomnia and its influencing factors in maintenance hemodialysis patients:A multi-center,crosssectional,observational study

目的失眠是影响维持性血液透析(maintenance hemodialysis,MHD)患者生活质量的重要因素。本研究拟探讨MHD患者失眠状况和严重程度,并进一步分析其相关的危险因素。方法本研究为多中心、横断面、观察性研究,将2020年7月至2020年11月在珠三角地区共7个透析中心的MHD患者作为研究对象。根据《国际睡眠障碍分类-第三版》对患者进行分组并采用匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)计算得分,将其分为睡眠正常组和失眠组(轻度、中度、重度)。研究指标包括:PSQI问卷、瘙痒视觉模拟评分表(visual analogue scale,VAS)、患者一般资料如人口学特征、透析龄、合并疾病、用药情况及临床基线数据,分析MHD患者睡眠情况和失眠程度及相关因素。结果(1)本研究共入组555例MHD患者,年龄(55.37±13.95)岁,男性占55.2%,失眠的患病率是38.49%;(2)与睡眠正常组相比较,失眠组胱抑素C水平和瘙痒VAS评分更高。女性、不宁腿综合征患者、未曾服用铁剂、转铁蛋白饱和度低的患者更容易发生失眠(P<0.05);(3)简单线性回归分析提示,MHD患者睡眠质量指数与年龄、胱抑素C、瘙痒VAS评分、不宁腿综合征呈独立正相关,反之,MHD患者睡眠质量指数与性别(男)、铁剂使用呈独立负相关(P<0.05);(4)二元Logistic回归分析显示,瘙痒(OR=1.077,95%CI:1.012~1.146,P=0.020)、不宁腿综合征(OR=2.403,95%CI:1.225~4.713,P=0.011)、低转铁蛋白饱和度(OR=0.981,95%CI:0.967~0.996,P=0.013)是失眠发生的危险因素;(5)进一步有序Logistic回归分析,结果提示年龄(OR=1.023,95%CI:1.002~0.1.045,P=0.035)、不宁腿综合征(OR=2.573,95%CI:1.039~6.370,P=0.041)、女性(OR=0.573,95%CI:0.334~0.983,P=0.043)是失眠加重的危险因素。结论本研究结果提示瘙痒、不宁腿综合征、低转铁蛋白饱和度可能导致MHD患者失眠,同时,年龄增长、合并不宁腿综合征、女性患者失眠状况较严重。

Objective Insomnia affects quality-of-life in patients on maintenance hemodialysis(MHD).The study was intended to explore the current status and clinical severity of insomnia and examine the related risk factors in MHD patients.Methods For this multi-center,cross-sectional,observational study,555 MHD patients were recruited from seven dialysis centers in Pearl River Delta region from July 2020 to November 2020.They were divided into two groups according to the International Classification of Sleep Disorders:Third Edition.Four grades of normal sleep,mild insomnia,moderate insomnia and severe insomnia were differentiated according to the scores calculated by Pittsburgh Sleep Quality Index(PSQI).The responses of questionnaires were recorded along with demographic profiles,age of dialysis,comorbidities,medications and baseline data.Results The age range was(55.37±13.95)years and 55.2%were males.The prevalence of insomnia was as high as 38.49%.As compared with normal sleep group,the levels of cystatin C and pruritus VAS score were higher in insomnia group.Females,patients with restless leg syndrome,non-takers of iron supplement and those with a lower transferrin saturation were more susceptible to insomnia(P<0.05).However,transferrin saturation was lower in insomnia group(P<0.05).Simple linear regression analysis revealed that sleep quality index was positively correlated with age,cystatin C,pruritus score and restless leg.On the contrary,it was negatively correlated with males and iron supplementing(P<0.05).Binary Logistic regression analysis indicated that pruritus(OR=1.077,95%CI:1.012-1.146,P=0.020),restless leg(OR=2.403,95%CI:1.225-4.713,P=0.011)and lower transferrin saturation(OR=0.981,95%CI:0.967-0.996,P=0.013)were risk factors for insomnia.Further multinomial Logistic regression analysis revealed that age(OR=1.023,95%CI:1.002-0.1.045,P=0.035),restless leg(OR=2.573,95%CI:1.039-6.370,P=0.041)and females(OR=0.573,95%CI:0.334-0.983,P=0.043)were risk factors for worsening insomnia.Conclusion Pruritus,restless leg and lower transferrin saturation may contribute to insomnia in MHD patients.And age,restless leg and females are associated with severer insomnia.