慢性肾脏病患者睡眠呼吸障碍特点分析  

Analysis of characteristics of sleep disordered breathing in chronic kidney disease patients

作　　者：钟益珏[1] 张成[1] 马靖[1] 周天瑜[1] 王云霞[1] 孙超[1] 王广发[1] Zhong Yijue;Zhang Cheng;Ma Jing;Zhou Tianyu;Wang Yunxia;Sun Chao;Wang Guangfa(Department of Respiratory and Critical Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸和危重症医学科,100034

出　　处：《国际呼吸杂志》2018年第13期987-991,共5页International Journal of Respiration

摘　　要：目的分析不同分期慢性肾脏病（CKD）患者的睡眠呼吸障碍特点。方法回顾性分析2012年7月至2017年8月于北京大学第一医院诊断为CKD并行多导睡眠监测的患者92例，根据肾功能分为非终末期CKD组和终末期肾脏病（ESRD）组。比较两组患者的基本资料、睡眠呼吸暂停综合征发生率、睡眠呼吸暂停严重程度及类型、血压、血氧饱和度（SpO2）的差异。结果ESRD组与非终末期CKD组患者的年龄、性别、体质量指数（BMI）、颈围、腰围、吸烟率、饮酒率、合并症发生率差异无统计学意义。35例ESRD患者中33例诊断为睡眠呼吸暂停综合征，发生率为94．3％；57例非终末期CKD患者中42例诊断为睡眠呼吸暂停综合征，发生率为73．7％，两组比较差异有统计学意义（P=0．013）。ESRD组AHI较非终末期CKD组明显增高（44．0±27．6次／h比28．6±24．9次／h，P=0．007），重度睡眠呼吸暂停综合征患者明显增多（71．4％比45．6％，P=0．016）。ESRD组中枢性呼吸暂停指数（CAI）及CAI占AHI比例均较非终末期CKD组明显增高（P=0．012及P=0．016）；而两组患者的阻塞性呼吸暂停指数（OAI）、混合性呼吸暂停指数（MAI）、低通气指数（HI）、（）AI占AHI比例、MAI占AHI比例、HI占AHI比例差异均无统计学意义（P值均〉0．05）。两组患者SpO2〈90％时间，SpO2最低值，睡眠时SpO2平均值差异无统计学意义（P均〉0．05）。ESRD组患者睡前收缩压、舒张压、晨起收缩压均较非终末期CKD组增高[（146±20）mmHg比（131±17）mmHg，（93±14）mmHg比（844-11）mmHg，（148±18）mmHg比（138±19）mmHg，P均〈O．05]；两组患者晨起舒张压差异无统计学意义（P〉0．05）。结论ESRD患者睡眠呼吸暂停综合征发生率较非终末期CKD患者高，严重程度更重，存在较多的中枢性睡眠呼吸暂停，应引起临床各科医师的关注。Objective To explore the characteristics of sleep disordered breathing in different stage chronic kidney disease （CKD） patients. Methods A total of 92 patients diagnosed as CKD who received overnight polysomnography （PSG） in Peking University First Hospital from July 2012 to August 2017 were retrospectively analyzed. The participants were divided into non end stage CKD group and end stage renal disease （ESRD） group according to the renal function. The baseline characteristics, the incidence of sleep apnea syndrome （SAS）, the severity and type of sleep apnea, the differences of blood pressure and blood oxygen saturation between these two groups were explored. Results There was no significant difference in age, sex, body mass index （BMI）, neck circumference, waist circumference, smoking rate, drinking rate and the occurrence of complications between two groups. There showed significant difference in the incidence of SAS between 94.3% in ESRD group and 73.7% in non end stage CKD group （ P=0. 013）. The AHI and the rate of patients with severe SAS in ESRD group was significantly higher than that of the non end stage CKD group. The central apnea index （CAI） and CAI/AHI ratio were higher too （ P=0.012, P=0.016 respeetively）.But there was no significant difference in obstructive apnea index （OAI）, mixed apnea index （MAI）, hypopnea index （HI） and in OAI/AHI ration, MAI/AHI ration and HI/AHI ratio （ P〉0.05 respectively）. No significant difference was found in the time with SpO2 〈 90%,the lowest SpO2 value, and the mean value of SpO2 during sleep between two groups. In ESRD group, systolic blood pressure, diastolic blood pressure before sleep and morning systolic blood pressure were higher than in non end stage CKD group （146±20） mmHg vs （131±17） mmHg, （93±14） mmHg vs （84±11） mmHg,（148±18） mmHg vs （138±19） mmHg （P 〈0.05 respectively）. There was no difference in morning diastolic blood pressure between two groups. Conclusions Much attenti

关 键 词：睡眠呼吸暂停综合征 多导睡眠监测 终末期肾脏病 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学] R766[医药卫生—外科学]