论文部分内容阅读
目的探讨不同严重程度慢性肾脏病(CKD)患者睡眠呼吸障碍(SDB)的发生状况及相关危险因素。方法选取2014年9月至2015年9月就诊的144例非透析的CKD住院患者,按肾功能严重程度分为CKD1~2期、CKD 3~4期和CKD 5期。比较各组患者SDB、夜间低氧血症及日间嗜睡(EDS)患病率的差异,采用Logistic回归分析影响CKD患者合并SDB的危险因素。结果 CKD 1~2期、CKD 3~4期及CKD 5期合并中度SDB的患病率分别为30.0%、53.5%及60.5%(P=0.03);夜间低氧血症的患病率分别为23.3%、56.3%及65.1%(P=0.001);EDS的患病率分别为33.3%、57.7%及62.8%(P=0.032)。Logistic回归分析结果显示年龄、男性、体重指数(BMI)、高血压、糖尿病及心功能不全均为CKD患者合并中至重度SDB的独立危险因素,其中心功能不全的危险程度最高(OR=7.034,95%CI 1.255~39.420);与CKD 1~2期和CKD 3~4期比较,CKD 5期的危险程度更高(OR=3.569,95%CI 1.324~9.620)。相关性分析结果显示,肾小球滤过率(e GFR)与睡眠呼吸暂停低通气指数(AHI)呈负相关(r=–0.327,P=0.000)。结论 CKD患者普遍存在SDB(以阻塞性为主),且随着肾功能下降,SDB的患病风险增加。CKD患者并发相关合并症,尤其心功能不全,是影响患者合并SDB的重要危险因素。
Objective To investigate the occurrence and related risk factors of sleep disordered breathing (SDB) in patients with different severity of chronic kidney disease (CKD). Methods A total of 144 hospitalized non-dialysis CKD patients from September 2014 to September 2015 were divided into two groups according to the severity of renal function: stage 1 to stage 2, stage 3 to 4, and stage 5 for CKD. The differences of the prevalence of SDB, nocturnal hypoxemia and daytime lethargy (EDS) in each group were compared. Logistic regression analysis was used to analyze the risk factors of combined SDB in CKD patients. Results The prevalences of moderate SDB with CKD stage 1 ~ 2, CKD stage 3 ~ 4 and CKD stage 5 were 30.0%, 53.5% and 60.5%, respectively (P = 0.03). The prevalences of nocturnal hypoxemia Were 23.3%, 56.3% and 65.1%, respectively (P = 0.001). The prevalence of EDS was 33.3%, 57.7% and 62.8% respectively (P = 0.032). Logistic regression analysis showed that age, male, body mass index (BMI), hypertension, diabetes mellitus and cardiac insufficiency were all independent risk factors for moderate to severe SDB in patients with CKD. The risk of central insufficiency was the highest (OR = 7.034, 95% CI 1.255-39.420). Compared with CKD1 ~ 2 and CKD3 ~ 4, the risk of CKD stage 5 was higher (OR = 3.569, 95% CI 1.324 ~ 9.620). Correlation analysis showed that glomerular filtration rate (e GFR) was negatively correlated with sleep apnea-hypopnea index (AHI) (r = -0.327, P = 0.000). Conclusion The prevalence of SDB (mainly obstructive) in CKD patients and the increased risk of SDB with renal function decline. Concurrent complications associated with CKD, especially cardiac insufficiency, are important risk factors affecting patients with combined SDB.