不同严重程度慢性肾脏病患者合并睡眠呼吸障碍患病率和危险因素分析

发布时间：2018-03-15 10:41

本文选题：慢性肾脏病　切入点：睡眠呼吸障碍　出处：《中国呼吸与危重监护杂志》2017年04期 　论文类型：期刊论文

【摘要】：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。
[Abstract]:Objective to investigate the incidence and risk factors of sleep apnea disorder (SDBs) in patients with chronic kidney disease (CKD) with different severity. Methods 144 non-dialysis CKD inpatients were selected from September 2014 to September 2015. According to the severity of renal function, the patients were divided into CKD1~2 stage, CKD3 stage 4 and CKD stage 5. The prevalence of SDBs, nocturnal hypoxemia and daytime sleepiness were compared among the three groups. Logistic regression analysis was used to analyze the risk factors of SDB in patients with CKD. Results the prevalence rates of CKD 1 / 2 stage D 3 / 4 and CKD 5 with moderate SDB were 30.05% and 60.5% respectively, while the nocturnal hypoxemia prevalence rates were 23.3C 56.3% and 65.1 P0.001EDS, respectively53.5% and 65.1P0.001EDS, respectively53.5% and 65.1P0.001EDS, respectively. The logistic regression analysis showed that the age was 57.7% and 62.8% respectively. Male, BMI, hypertension, diabetes and cardiac insufficiency were independent risk factors for moderate to severe SDB in CKD patients. The risk degree of cardiac insufficiency was highest (CI 1.255 ~ 39.420), and the risk of CKD D _ 5 was higher than that of CKD _ 1 / 2 and CKD _ (3) / D _ (4). The correlation analysis showed that the risk of heart failure was higher than that of CKD _ (1) and CKD _ (3) ~ (4). The results of correlation analysis showed that the risk of heart failure was higher than that of CKD _ (1) and CKD _ (3) (P < 0.05). There was a negative correlation between glomerular filtration rate (GFR) and sleep apnea hypopnea index (AHI). Conclusion SDBs are common in patients with CKD. Especially cardiac insufficiency is an important risk factor for patients with SDB.
【作者单位】：武汉大学人民医院重症医学科;武汉大学人民医院呼吸科;
【基金】：国家自然科学基金(81370181)
【分类号】：R692;R766

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