慢性肾脏病患者睡眠障碍的相关因素分析

Analysis of factors related to sleep disorders in patients with chronic kidney disease

目的评估慢性肾脏病(CKD)患者的睡眠质量,并探讨CKD患者睡眠障碍的相关因素。方法收集肾脏内科住院的未行肾脏替代治疗的CKD患者的临床资料;采用匹兹堡睡眠质量指数(PSQI)量表来评估患者睡眠质量,PSQI评分≤5分的患者分为睡眠正常组,PSQI评分>5分的患者分为睡眠障碍组;比较两组间的临床资料的差异;采用Logistic回归分析探讨CKD患者睡眠障碍的相关因素。结果共纳入189例未行肾脏替代治疗的CKD患者,男性114例(60.3%),女性75例(39.7%),年龄(56.5±15.23)岁。PSQI评分7.00(5.00,8.00),睡眠正常组58例,睡眠障碍组131例,睡眠障碍患病率高达69.3%。本研究显示在CKD1-3期中,患者睡眠正常组的比重更大(46.6%),而在CKD4-5期中,睡眠障碍组的占比更大(84.7%)。睡眠障碍组与睡眠正常组在主观睡眠质量、睡眠潜伏期、睡眠时间、习惯睡眠效率、睡眠紊乱叠加问题及日间功能紊乱等项目均具有差异(P<0.05),而在睡眠药物使用项目的得分差异无统计学意义。Logistic回归分析显示,退休或无业(OR=6.509,95%CI:1.844~22.976)与女性(OR=4.561,95%CI:1.241~16.767)是睡眠障碍的独立危险因素,而估算的肾小球滤过率(eGFR)(OR=0.960,95%CI:0.931~0.991)是睡眠障碍的保护性因素。结论未行肾脏替代治疗的慢性肾脏病患者随着eGFR的下降、CKD分期的增加,睡眠障碍的风险升高。此外,女性与无业或退休CKD患者的睡眠质量需要重点关注。

Objective To evaluate the sleep quality of patients with chronic kidney disease(CKD)and to explore the related factors of sleep disorder in patients with CKD.Methods The basic data of hospitalization patients with CKD without renal replacement therapy were prospectively collected,and the Pittsburgh sleep quality index(PSQI)scale was used to evaluate the sleep quality of patients.Patients with a PSQI score of≤5 were divided into the normal sleep group,and patients with a PSQI score of>5 were divided into the sleep disorder group.Logistic regression analysis was used to explore the related factors of sleep disorder in patients with CKD.Results A total of 189 patients with CKD who did not receive renal replacement therapy were included,including 114 males(60.3%)and 75 females(39.7%),aged 56.5±15.23 years.The PSQI score was 7.00(5.00,8.00),there were 58 cases in the normal sleep group and 131 cases in the sleep disorder group,and the prevalence of sleep disorder was as high as 69.3%.As the CKD stage progresses,the prevalence of sleep disorders gradually increases.There were differences between the sleep disorder group and the normal sleep group in subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,sleep disorder superposition problems,and daytime dysfunction(P<0.05),while there was no statistically significant difference in the scores of sleep medication use.Retirement or unemployed(OR=6.509,95%CI:1.844-22.976)and women(OR=4.561,95%CI:1.241-16.767)were independent risk factors for sleep disorders,while eGFR(OR=0.960,95%CI:0.931-0.991)was a protective factor for sleep disorders,P<0.05.Conclusion The prevalence of sleep disorders in patients with chronic kidney disease without renal replacement therapy gradually increases with the decrease of eGFR and the increase of CKD stage,but they do not receive timely intervention with sleep improvement drugs.Clinicians need to focus on assessing sleep quality in women versus unemployed or retired patients with CKD.