中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (11): 783-786.doi: 10.3969/j.issn.1671-4091.2019.11.014

• 透析心理学 • 上一篇    下一篇

维持性血液透析患者严重睡眠障碍调查及原因分析

赵敬娜1,罗莉1,苏香彪1,李雪1,张东亮1   

  1. 1. 北京大学国际医院血液净化中心
  • 收稿日期:2019-04-28 修回日期:2019-09-06 出版日期:2019-11-12 发布日期:2019-10-28
  • 通讯作者: 张东亮 zdlycy@163.com E-mail:zdlycy@163.com

Investigation on the cause of severe sleep disorder in maintenance hemodialysis patients

  1.  1Peking University International Hospital, Beijing 102206, China
  • Received:2019-04-28 Revised:2019-09-06 Online:2019-11-12 Published:2019-10-28

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摘要：

【摘要】目的调查维持性血液透析(maintenance hemodialysis,MHD)患者的睡眠质量，并分析其影响因素。方法采用匹兹堡睡眠质量指数量表(Pittsburg sleep quality index,PSQI)，社会支持评定量表(social support rating scale，SSRS)、焦虑自评量表(self-rating anxiety scale，SAS)、抑郁自评量表(self-rating depression scale，SDS)调查112 名MHD 患者的睡眠情况，根据PSQI 评分将≤10
分者归为无睡眠严重障碍组，＞10 分者归为睡眠严重障碍组，焦虑自评量表(self rating anxiety scale,SAS)、抑郁自评量表(self rating depression scale,SDS)进行焦虑抑郁评价，同时比较各临床参数。结果112 名MHD 患者中38 名(33.93%)患者PSQI 评分＞10 分。2 组在年龄[(62.20±10.62)比(51.51 ± 15.12) 岁，t=4.253，P＜0.001]、透析龄[(78.46 ± 88.96) 比(46.12 ± 45.68) 月，t=2.028，P=0.048]、白蛋白[(37.94±2.86)比(39.37±2.49)g/L，t=2.542，P=0.013]、甲状旁腺激素[(243.32±158.85)比(327.54±209.34)pg/ml，t=2.324, P=0.022]、抑郁得分分布(χ2=7.110, P=0.029)存在统计学差异。建立预测睡眠质量的Logistic 回归模型f(x) =1/(1 + e0.074289x1 + 0.055897x2 + 0.99036) (其中x1 为年龄, Z=-2.600, P=0.009；x2 为抑郁得分Z=-2.004, P=0.028)，准确度71.9%, AUC=0.748。结论MHD 患者普遍存在睡眠质量问题，老年、透析龄长、白蛋白低、甲状旁腺激素偏低、抑郁患者存在严重睡眠质量差。用于预测睡眠质量的Logistic回归模型具有一定的预测能力。

关键词: 维持性血液透析, 匹兹堡睡眠质量指数, 社会支持评定量表, 焦虑评定量表, 抑郁评定量表, 睡眠障碍

Abstract:

【Abstract】Objective The sleep quality in maintenance hemodialysis (MHD) patients was investigated and its influencing factors were analyzed. Methods The sleep quality of 112 MHD patients was investigated using the Pittsburg Sleep Quality Index (PSQI) scale, Social Support Rating Scale (SSRS), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). According to the PSQI score, patients with scores less than or equal to 10 were classified as a group without severe poor sleep quality (G1), and those with scores of >10 were classified as a group with severe poor sleep quality (G2). SSRS, SAS and SDS were used to evaluate the influences of anxiety and depression on sleep quality. Results Thirty-eight of the 112 MHD
patients (33.93%) had a PSQI score of >10. Four factors were significant different between the two groups: age (62.20 ± 10.62 years vs. 51.51±15.12 years, t=4.253, P＜0.001), months of dialysis (78.46±88.96 months vs. 46.12±45.68 months, t=2.028, P=0.048), albumin (37.94±2.86 g/L vs. 39.37±2.49 g/L, t=2.542, P=0.013), and PTH (243.32±158.85 pg/ml vs. 327.54±209.34 pg/ml, t=2.324, P=0.022). SDS score was also significant different between the two groups (χ2=7.110, P=0.029). A logistic regression model was established to predict the sleep quality: f(x) =1/(1 + e0.074289x1 + 0.055897x2 + 0.99036) (x1 is age; Z =- 2.600, P =0.009, and x2 is SDS score, Z =-2.004, P=0.028). The model had the accuracy of 71.9% and the area under curve of 0.748. Conclusions Sleep quality is a common problem in MHD patients. Severe sleep quality problem usually exists in elderly patients, patients with long dialysis period, low albumin, and low PTH. Patients with depression are easily to have severe sleep problem. We have established a logistic regression model to predict sleep quality, which may be clinically useful.

Key words: Maintenance hemodialysis, Pittsburgh Sleep Quality Index, Social Support Rating Scale, Self-rating Anxiety Scale, Self-rating Depression Scale, Sleep disorder

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