Impact of Nocturnal Hemodialysis on Sleep Apnea, Sleep Quality & Daytime Symptoms

描述（由申请人提供）：尽管透析技术有了显著改进，并强调提供足够剂量的血液透析，但接受常规每周三次血液透析（CHD）的300，000例患者中的大多数患有睡眠呼吸暂停、睡眠质量差以及白天嗜睡和疲劳症状。由于血液透析患者报告白天嗜睡和疲劳的症状会强烈影响他们对透析方式的选择，并且许多血液透析患者会因嗜睡和疲劳而感到受损，因此描述夜间血液透析如何影响睡眠至关重要。根据MEMO研究的结果，即增加透析剂量或膜通量对生活质量或生存期无显著益处，注意力已转向夜间血液透析（NHD）的潜在获益。与任何其他类型的血液透析相比，NHD提供了最高剂量的透析，并且更有可能随着时间的推移减少生理变化。在小型的非对照研究中，NHD被报道有益于日间症状并减少睡眠呼吸暂停。NI DDK赞助的频繁血液透析网络（FHN）是一项随机临床试验，旨在确定与CHD相比，NHD（每周6次）是否能在12个月内显着改善心血管功能和身体健康。我们建议补充这项研究的睡眠和疲劳的测量，利用便携式睡眠呼吸暂停监测仪，睡眠-觉醒行为的自然措施，频繁的生态采样方法的嗜睡和疲劳，集中电话调查的睡眠质量，以收集关键信息的睡眠和疲劳，同时限制父母的研究负担。具体而言，我们建议确定夜间血液透析对睡眠呼吸暂停的影响，评估夜间血液透析对睡眠质量和睡眠/觉醒行为的影响，并评估夜间血液透析与传统血液透析相比对白天嗜睡和疲劳症状的益处。这项拟议的研究利用了一个多学科团队的优势，该团队为评估FHN试验中接受血液透析的患者的睡眠和疲劳提供了一个特殊的基础。该提案解决了一个主要的公共卫生问题，因为CHD人群已被证明具有较高的睡眠障碍率，并报告了严重的白天嗜睡和疲劳症状。

DESCRIPTION (provided by applicant): Despite marked improvements in dialysis technology and emphasis on delivery of an adequate dose of hemodialysis, a majority of the 300,000 patients undergoing conventional thrice-weekly hemodialysis (CHD) have sleep apnea, poor sleep quality, and daytime symptoms of sleepiness and fatigue. Since hemodialysis patients report symptoms of daytime sleepiness and fatigue would strongly influence their choice of dialysis modality and many hemodialysis patients feel impaired by sleepiness and fatigue, it is crucial to characterize how nocturnal hemodialysis will impact sleep. In light of the findings from the MEMO Study which demonstrated no significant quality of life or survival benefit from increased dialysis dose or membrane flux, attention has turned to the potential benefits of nocturnal hemodialysis (NHD). NHD provides the highest dose of dialysis and is more likely to decrease physiologic variations over time compared to any other type of hemodialysis. In small, uncontrolled studies, NHD has been reported to benefit daytime symptoms and reduce sleep apnea. The NI DDK-sponsored Frequent Hemodialysis Network (FHN) is a randomized clinical trial to determine whether NHD (6 times per week) leads to significant improvements in cardiovascular function and physical well-being compared to CHD over a 12-month period. We propose to complement this study with measurements of sleep and fatigue which utilize portable sleep apnea monitors, naturalistic measures of sleep-wake behavior, frequent ecologic sampling methods of sleepiness and fatigue, and centralized telephone surveys of sleep quality in order to gather crucial information of sleep and fatigue while limiting the burden on the parent study. Specifically, we propose to determine the impact of nocturnal hemodialysis on sleep apnea, to evaluate the effect of nocturnal hemodialysis on sleep quality and sleep/wake behaviors, and to assess the benefit of nocturnal hemodialysis on daytime symptoms of sleepiness and fatigue compared to conventional hemodialysis. The proposed study takes advantage of a multi-disciplinary team which offers an exceptional foundation to assess sleep and fatigue among those undergoing hemodialysis in the FHN Trial. This proposal addresses a major public health concern since the CHD population has been shown to have high rates of sleep disorders and reports severe daytime symptoms of sleepiness and fatigue.