Sleep Related Respiratory Disorders in End-Stage Renal Disease Patients on Peritoneal Dialysis
Sleep Related Respiratory Disorders in End-Stage Renal Disease Patients on Peritoneal Dialysis
复制标题
腹膜透析终末期肾病患者睡眠相关呼吸系统疾病
DOI：
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发表时间：
1992
影响因子：
2.8
通讯作者：
W. Mendelson
中科院分区：
文献类型：
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作者：
N. Wadhwa;M. Seliger;H. Greenberg;E. Bergofsky;W. Mendelson
研究目的评估腹膜透析（PD）对睡眠相关呼吸的可能影响，这可能是由于腹部的透析液体积负荷和/或睡眠期间呼吸代谢控制的改变所致。设计前瞻性比较11例接受腹膜透析的终末期肾病（ESRD）患者在随机分配的腹膜腔内有腹膜透析液（2.0 L）和无腹膜透析液的夜晚的睡眠主观和客观指标。设置三级转诊大学医院。患者和方法选择15例连续腹膜透析患者，他们主诉慢性睡眠障碍并要求镇静。4例患者拒绝多导睡眠图检查。因此，研究了11例平均年龄为63±4（SEM）岁的ESRD患者（8例男性和3例女性）。结果11例患者中有8例报告多种类型的睡眠困难。多导睡眠图记录显示，11例患者中有6例在2个晚上中的至少1个晚上出现明显的阻塞性睡眠呼吸暂停。在整个组中，腹膜腔中存在和不存在腹膜透析液的夜间动脉血pH值、PaO 2和PaC 02没有差异。在6例睡眠呼吸暂停患者中，夜间使用腹膜透析液（Pa 02 =78±7 mmHg）的Pa 02显著低于夜间未使用腹膜透析液（Pa 02 =92±4 mmHg）（p<0.05）。在窒息患者中，早上排出的透析液量与夜间最低动脉血氧饱和度呈负相关（r=-0.94; p<0.005）。结论PD患者的慢性睡眠障碍与睡眠呼吸暂停综合征有明显的相关性。这些数据表明，呼吸暂停患者可能容易发生透析液体积效应对氧饱和度下降的并发症。
Study Objective To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep. Design Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD. Setting Tertiary-referral university hospital. Patients and Methods Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63±4 (SEM) years were studied. Results Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paC02 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, Pa02 was significantly lower (p<0.05) during the night with (Pa02=78±7 mmHg) than during the night without PD fluid (Pa02=92±4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r=-0.94; p<0.005). Conclusions This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.