慢性腎臟病嚴重度與睡眠品質之相關性研究

Relationship between Renal Function and Quality of Sleep in Subjects with Chronic Kidney Disease

背景：有關慢性腎臟病患者的睡眠品質研究不多，且腎功能惡化嚴重程度與睡眠品質之間的相關性尚無定論，而有關早期慢性腎臟病的研究更少。因此本研究的目的為探討慢性腎臟病之嚴重度分期與睡眠品質間的相關性。方法：本研究以1997年7月至2007年10月間在某國立醫學中心接受自費住院健康檢查之受檢者為研究對象。腎功能係以MDRD (Modification of Diet in Renal Disease)公式計算之預估性腎絲球過濾率作評估，並以美國國家腎臟基金會的指引作為慢性腎臟病分期依據。輕度及以下含第一、二期慢性腎臟病；中度及以上含第三期以上慢性腎臟病。睡眠品質問卷的評估使用中文版匹茲堡睡眠品質量表(Chinese version of Pittsburg Sleep Quality Index)，總分小於或等於6分為睡眠品質良好組；大於6分為睡眠品質不佳組。貧血的定義為男性血紅素值低於13.5g/dL；女性血紅素值低於11.6g/dL。糖尿病定義係依據2008年美國糖尿病學會的診斷標準。Charlson共病症指標依19類疾病計分，總分愈高代表疾病程度愈嚴重。結果：符合慢性腎臟病診斷者共393位，其中男性251位(63.9%)，女性142位(36.1%)。睡眠品質良好組比睡眠品質不佳組有較高比例的男性及運動習慣、較高的舒張壓、總膽固醇、白蛋白、空腹血糖、血紅素以及較高的第一、二期慢性腎臟病之比例。全部慢性腎臟病患者睡眠品質不佳之比例為49.4%，其中第一及二期慢性腎臟病患者睡眠品質不佳的比例為47.2%，第三期及以上慢性腎臟病患者則為64%。第三期以上慢性腎臟病患者比第一、二期慢性腎臟病患者有較高的睡眠品質不佳之比例(p=0.027)。多變項邏輯回歸分析結果顯示第三期以上慢性腎臟病(p=0.033)、女性(p=0.003)、較低的血糖(p=0.015)及較高的身體質量指數(p=0.031)是睡眠品質不佳的獨立相關因子。結論：本研究發現第一、二期慢性腎臟病患者睡眠品質不佳的比例並不低，且較重度的慢性腎臟病、女性、較低的血糖及較高的身體質量指數是造成睡眠品質不佳的獨立因子。因此睡眠品質不佳在慢性腎臟病早期即已存在，而且第三期以上慢性腎臟病患者睡眠品質不佳的情況較第一、二期慢性腎臟病患者更為嚴重。所以在臨床上面對所有慢性腎臟病患者皆需留意其睡眠品質的好壞，特別是第三期以上慢性腎臟病患者。

Background: There is limited information about the quality of sleep in patients with chronic kidney disease (CKD) and of the association between quality of sleep and severity of renal dysfunction. In this study, we investigated the relationship between renal function and quality of sleep in Taiwanese patients with CKD. Methods: We enrolled patients who underwent health checkups at the National Cheng Kung University Hospital medical center from July 1997 to October 2007. Based on guidelines of the National Kidney Foundation, 393 subjects had CKD. Renal function, estimated from glomerular filtration rate, was calculated with the Modification of Diet in Renal Disease equation. Patients were classified as having CKD stage 1-2 or CKD stage 3-5. Sleep quality was assessed with the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). We classified patients with global PSQI scores≤6 as having good sleep quality (GSQ), and patients with global PSQI scores＞6 as having poor sleep quality (PSQ). Results: Among our 393 patients, 251 (63.9%) were male and 142 (46.1%) were female. A total of 194 patients (49.4%) had PSQ. In patients with CKD stage 1-2, 162 (47.2%) had PSQ while in patients with CKD stage 3-5, 32 (64%) had PSQ. Patients with GSQ group were more likely to be male, and to have high diastolic blood pressure, cholesterol, albumin, fasting glucose, and hemoglobin. In addition, GSQ patients tended to perform regular exercise and to have stage 1-2 CKD. CKD stage 3-5, female gender, lower fasting plasma glucose and high body mass index were independently associated with PSQ. Conclusion: About half of our CKD subjects had PSQ. Patients with stage 3-5 CKD, of female gender, lower fasting plasma glucose and with high body mass index were more likely to suffer from PSQ. We suggest that clinicians devote more attention to the sleep quality of subjects with CKD, especially patients with stage 3-5 CKD.