Objective To explore the potential categories and influencing factors for sleep quality in maintenance hemodialysis (MHD) patients. Methods A total of 480 MHD patients were recruited from hemodialysis center of The Central Hospital Affiliated to Jiangnan University and other 3 hospitals by convenient sampling method. General information questionnaire, Pittsburgh Sleep Quality Scale (PSQI), Patient Health Questionnaire, and Generalized Anxiety Scale were used for the investigation. Results The prevalence of sleep disorders in MHD patients was 50.7%. By selecting the optimal model, sleep quality could be classified into four potential categories: overall better sleep group (C1, 22.8%), typical insomnia group (C2, 14.2%), daytime dysfunction with nocturnal sleep disorder group (C3, 28.4%), and overall worse sleep group (C4, 34.6%). Logistic regression analysis showed that the influencing factors for sleep disorders in C4 group included age (OR=1.028, 95% CI: 1.005～1.052, P=0.015), depression (OR=16.097, 95% CI: 6.397～40.503, P＜0.001) and anxiety (OR=3.511, 95% CI: 1.038～11.873, P=0.043), when C1 group was used as the reference group; the influencing factors for sleep disorders in C4 group included depression (OR=13.683, 95% CI: 5.072～36.917, P＜0.001) and dialysis age (OR=6.983, 95% CI: 1.510～32.284, P=0.013), when C2 group was used as the reference group. Conclusion The sleep quality is heterogeneous in MHD patients. Clinical healthcare professionals should focus on the sleep status and intervene the sleep disorders in MHD patients especially in those with older age, having dialysis age more than 10 years, and complicated with depression and anxiety.
参考文献
[1]Hashmi M F, Benjamin O, Lappin S L. End-Stage Renal Disease[M]. 2023.
[2]Bikbov B, Purcell C A, Levey A S, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet, 2020,395(10225):709-733.
[3]中国医药教育协会肾病与血液净化专业委员会血液透析低血压防治专家组. 血液透析中低血压防治专家共识（2022）[J]. 中华内科杂志, 2022,61(3):269-281.
[4] 田秀珣, 张蓝月, 雷艳, 等. 维持性血液透析患者失眠及影响因素分析：一项多中心、横断面、观察性研究[J]. 临床肾脏病杂志, 2022,22(07):546-552.
[5]Xu R, Miao L, Ni J, et al. Risk factors and prediction model of sleep disturbance in patients with maintenance hemodialysis: A single center study[J]. Frontiers in neurology, 2022,13:955352.
[6]Al N Z, Gormley K, Noble H, et al. Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis[J]. BMC Nephrol, 2021,22(1):157.
[7]Al-Ali F, Elshirbeny M, Hamad A, et al. Prevalence of Depression and Sleep Disorders in Patients on Dialysis: A Cross-Sectional Study in Qatar[J]. International Journal of Nephrology, 2021,2021:1-7.
[8]He S, Zhu J, Jiang W, et al. Sleep disturbance, negative affect and health-related quality of life in patients with maintenance hemodialysis[J]. Psychology, Health & Medicine, 2018,24(3):294-304.
[9]Han Q, Liu B, Lin S, et al. Pittsburgh Sleep Quality Index score predicts all-cause mortality in Chinese dialysis patients[J]. International Urology and Nephrology, 2021,53(11):2369-2376.
[10]Fitzpatrick J, Kerns E S, Kim E D, et al. Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in patients on incident hemodialysis[J]. Journal of Clinical Sleep Medicine, 2021,17(8):1707-1715.
[11]朱方方, 吕倩, 许宝玲, 等. 维持性血液透析患者睡眠障碍影响因素的Meta分析[J]. 现代临床护理, 2022,21(09):67-77.
[12]温忠麟, 谢晋艳, 王惠惠. 潜在类别模型的原理、步骤及程序[J]. 华东师范大学学报(教育科学版), 2023,41(01):1-15.
[13]Charan J, Biswas T. How to calculate sample size for different study designs in medical research?[J]. Indian J Psychol Med, 2013,35(2):121-126.
[14]Buysse D J, Reynolds C F, Monk T H, et al. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research[J]. Psychiatry Research, 1989,28(2):193-213.
[15]路桃影, 李艳, 夏萍, 等. 匹兹堡睡眠质量指数的信度及效度分析[J]. 重庆医学, 2014,43(03):260-263.
[16]Kroenke K, Spitzer R L, Williams J B. The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001,16(9):606-613.
[17]Spitzer R L, Kroenke K, Williams J B W, et al. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7[J]. Archives of internal medicine (1960), 2006,166(10):1092-1097.
[18]牟焕玉. 养老机构老年人睡眠的潜在类别及其与生活质量的关系[D]. 山东大学, 2019.
[19]赵敬娜, 罗莉, 苏香彪, 等. 维持性血液透析患者严重睡眠障碍调查及原因分析[J]. 中国血液净化, 2019,18(11):783-786.
[20]Daraghmeh M, Badran M, Janajreh A, et al. Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: a multicenter study[J]. BMC nephrology, 2022,23(1):213-218.
[21]Berry R B, Carney P R, Geyer J D. Clinical sleep disorders[M]. Philadelphia: Lippincott Williams & Wilkins, 2005.
[22]罗俊. 维持性血液透析患者抑郁状态的危险因素研究[D]. 遵义医科大学, 2021.
[23]张伟杰, 方庆珊, 秦艳东. 分析维持性血液透析患者睡眠障碍的影响因素[J]. 世界睡眠医学杂志, 2022,9(01):39-41.
[24]Semaan V, Noureddine S, Farhood L. Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis[J]. Applied Nursing Research, 2018,43:80-85.
[25]Ling C, Evans D, Zhang Y, et al. The effects of cognitive behavioural therapy on depression and quality of life in patients with maintenance haemodialysis: a systematic review[J]. BMC Psychiatry, 2020,20(1):369.
[26]罗丹, 戴榕娟, 陈静, 等. 维持性血液透析患者疾病相关应对方式与症状负担和生活质量的相关性研究[J]. 解放军护理杂志, 2018,35(19):6-10.
[27]Carneiro E R, Azoubel L A, Dias R C, et al. Correlation of sleep quality and cardiac autonomic modulation in hemodialysis patients[J]. Sleep Science, 2022,15(Spec 1):59-64.
[28]Mehrabi S, Sarikhani S, Roozbeh J. Sleep Quality in Patients Undergoing Long-term Hemodialysis Using the Pittsburgh Sleep Quality Index[J]. Nephro-urology monthly, 2017,9(2).
[29]Pan K, Hung S, Chen C, et al. Social support as a mediator between sleep disturbances, depressive symptoms, and health-related quality of life in patients undergoing hemodialysis[J]. PLOS ONE, 2019,14(4):e216045.
[30]Zhu L, Li X, Shi R, et al. Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis[J]. Renal failure, 2023,45(1):2201361.
[31]孙亚洁. 不同睡眠质量血液透析患者褪黑素水平及影响因素的研究[D]. 新疆医科大学, 2019.
