Sleep apnea and dialysis therapies: things that go bump in the night?
Sleep apnea and dialysis therapies: things that go bump in the night?
复制标题
睡眠呼吸暂停和透析治疗：晚上会发生什么事情？
DOI：
10.1111/j.1542-4758.2007.00203.x
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Unruh,MarkL
中科院分区：
文献类型：
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作者：
Unruh,MarkL
睡眠呼吸暂停与一般人群中的日间过度嗜睡、抑郁情绪、高血压和心血管疾病有关。在常规每周三次血液透析人群中，重度睡眠呼吸暂停的患病率估计超过50%。睡眠呼吸暂停导致低氧血症、高碳酸血症、睡眠中断和交感神经系统激活的反复发作。与睡眠呼吸暂停相关的低氧血症、觉醒和胸内压变化导致交感神经激活、内皮功能障碍、氧化应激和炎症。由于睡眠呼吸暂停在传统透析人群中广泛存在，因此睡眠呼吸暂停可能会导致该人群中的嗜睡、生活质量差和心血管疾病。传统透析和睡眠呼吸暂停之间的因果关系仍然是推测性的，但可能有多种与容量状态和氮质血症相关的因素导致透析患者中重度睡眠呼吸暂停的高发生率。夜间自动腹膜透析和夜间血液透析均与睡眠呼吸暂停严重程度降低相关。夜间透析方式可以提供工具，以增加我们对尿毒症睡眠呼吸暂停的理解，也可以为患有严重睡眠呼吸暂停的终末期肾病患者提供治疗选择。总之，睡眠呼吸暂停是透析人群的一个重要但被忽视的公共卫生问题。睡眠呼吸暂停治疗对这一高危人群的影响可能包括减少嗜睡、改善情绪和血压，以及降低心血管疾病的风险。
Sleep apnea has been linked to excessive daytime sleepiness, depressed mood, hypertension, and cardiovascular disease in the general population. The prevalence of severe sleep apnea in the conventional thrice‐weekly hemodialysis population has been estimated to be more than 50%. Sleep apnea leads to repetitive episodes of hypoxemia, hypercapnia, sleep disruption, and activation of the sympathetic nervous system. The hypoxemia, arousals, and intrathoracic pressure changes associated with sleep apnea lead to sympathetic activation, endothelial dysfunction, oxidative stress, and inflammation. Because sleep apnea has been shown to be widespread in the conventional dialysis population, it may be that sleep apnea contributes substantially to the sleepiness, poor quality of life, and cardiovascular disease found in this population. The causal links between conventional dialysis and sleep apnea remain speculative, but there are likely multiple factors related to volume status and azotemia that contribute to the high rate of severe sleep apnea in dialysis patients. Both nocturnal automated peritoneal dialysis and nocturnal hemodialysis have been associated with reduced severity of sleep apnea. Nocturnal dialysis modalities may provide tools to increase our understanding of the uremic sleep apnea and may also provide therapeutic alternatives for end‐stage renal disease patients with severe sleep apnea. In conclusion, sleep apnea is an important, but overlooked, public health problem for the dialysis population. The impact of sleep apnea treatment in this high‐risk population may include reduced sleepiness, better mood and blood pressure, and lowered risk of cardiovascular disease.