不同肾功能分期的慢性肾脏病患者睡眠情况及其影响因素研究  

Prevalence and Associated Factors of Sleep-disordered Breathing in Patients with Different Stages of Chronic Kidney Disease

作　　者：封怡多 龚勇[1] 张寅[1] 王冬雪[1] 丁霞 吴昱[1] 张常勤[1] 周亦伦[1] FENG Yi-duo;GONG Yong;ZHANG Yin;WANG Dong-xue;DING Xia;WU Yu;ZHANG Chang-qin;ZHOU Yi-lun(Department of Nephrology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院肾内科,北京市100050

出　　处：《中国全科医学》2018年第19期2319-2323,共5页Chinese General Practice

摘　　要：目的探讨不同肾功能分期慢性肾脏病(CKD)患者睡眠情况及其影响因素。方法选取2016年8月—2017年5月于首都医科大学附属北京天坛医院肾内科病房住院的132例患者为研究对象,根据CKD定义及经我国人群校正的EPI公式计算得出的估算肾小球滤过率(e GFR)水平将患者分为无CKD组、CKD 1~3期组、CKD 4~5期和透析组。对患者进行基本信息采集和实验室检查。所有患者行睡眠呼吸监测,数据由云端服务器经Morpheus Ox软件自动分析,可得参数睡眠暂停低通气指数(AHI)、氧减指数(ODI)等。采用爱泼沃斯嗜睡量表(ESS)和匹兹堡睡眠质量指数量表(PSQI)行睡眠情况的评估。比较3组患者上述指标的差异,采用Logistic回归分析确定中重度SDB的影响因素。结果 3组患者性别、吸烟情况、过度饮酒情况、糖尿病病史、舒张压(DBP)、体质指数(BMI)比较,差异无统计学意义(P>0.05);年龄、高血压病史、心血管疾病病史、收缩压(SBP)比较,差异有统计学意义(P<0.05)。3组患者e GFR、血红蛋白、清蛋白比较,差异有统计学意义(P<0.05);总胆固醇、空腹血糖比较,差异无统计学意义(P>0.05)。3组AHI、AHI≥15次/h者所占比例、ESS评分比较,差异无统计学意义(P>0.05);ODI、PSQI评分比较,差异有统计学意义(P<0.05)。两两比较,CKD 4~5期和透析组ODI≥5者所占比例高于无CKD组,差异有统计学意义(P<0.017);CKD 4~5期和透析组PSQI评分高于无CKD、CKD 1~3期组,差异有统计学意义(P<0.017)。单因素Logistic回归分析结果显示,年龄、高血压病史、BMI、e GFR水平是中重度SDB发生的影响因素(P<0.05);多因素Logistic逐步回归分析显示,BMI、e GFR水平是中重度SDB发生的影响因素(P<0.05)。结论不同肾功能分期CKD患者,ODI、PSQI评分不同;低e GFR水平和高BMI是中重度SDB发生的危险因素。ObjectiveTo evaluate the prevalence and associated factors of sleep-disordered breathing （SDB） in patients with different stages of chronic kidney disease （CKD）.MethodsA total of 132 inpatients from Department of Nephrology,Beijing Tiantan Hospital were enrolled during August 2016 to May 2017.We collected their baseline characteristics,laboratory test data,available parameters associated with sleep quality such as apnea-hypopnea index （AHI） and oxygen desaturation index （ODI） derived from the automatic analysis of overnight sleep monitoring results （performed in the department） by Morpheus Ox web-based server software.Based on the definition of CKD and the eGFR level calculated by the modified CKD-EPI equation for Chinese populations with CKD,the patients were divided into non-CKD group,CKD 1-3 stages group,CKD 4-5 stages with dialysis group.Sleep quality was assessed by the Epworth Sleepiness Scale （ESS）and the Pittsburgh Sleep Quality Index （PSQI） .Statistical significance of the differences between three groups was tested using one-way ANOVA for continuous variables and χ2 test for categorical variables.Multivariable Logistic regression analysis was used to investigate the associated factors of moderate to severe SDB.ResultsThe distribution of age and systolic blood pressure （SBP）,percentages of hypertension history,and cardiovascular disease history differed significantly between the three groups （P〈0.05）,while the distribution of sex,diastolic blood pressure （DBP） and body mass index （BMI）,prevalence of smoking and alcohol consumption,percentage of diabetes history did not （P〉0.05）.The distribution of eGFR,hemoglobin and albumin levels varied obviously between the three groups （P〈0.05）,but that of total cholesterol and fasting blood glucose levels did not（P〉0.05）.Three groups demonstrated similar mean AHI,similar percent of patients with an AHI≥ 15 and similar mean ESS score （P〉005）,but significantly different mean ODI and PSQI （P�

关 键 词：肾病 睡眠呼吸暂停综合征 肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学] R563.8[医药卫生—外科学]