Taiwan J Fam Med Vol.19 No ; 19: chronic kidney disease, estimated glomerular filtration rate, quality of sleep, Chinese version o

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1 [] ,2 1, ,2 1,2 背景 : 方法 : MDRD Modification of Diet in Renal Disease Chinese version of Pittsburg Sleep Quality Index g/dl 11.6 g/dl 2008 Charlson19 結果 : % % 49.4% 47.2%64% p=0.027 p=0.033 p=0.003p=0.015 p=0.031 結論 :

2 Taiwan J Fam Med Vol.19 No ; 19: chronic kidney disease, estimated glomerular filtration rate, quality of sleep, Chinese version of Pittsburg Sleep Quality Index Walker 54 80% [1] 45-80% [2] Iliescu 89 [3] Williams242 [4] Valderrabano [5] [3] [3] [6,7] [8] [8,9] [9] [2,10,11] Eduard Pittsburg Sleep Quality Index, PSQI % PSQIsleep efficiency score PSQI [2] Kurella KDQOL Kidney Disease Quality of Life 78 78

3 % 13-34% [10] non-african American Estimated Glomerular Filtration rrate, egfrkdqol [10] De Santo 52 80% functional [11] [2,10,11] aminoglycoside National Kidney Foundation, NKF % % 20 body mass index, BMI kg m BMI18.5 kg/m kg/m kg/ m 2 27 kg/m SX, Johnson and Johnson, assembled in Mexico /

4 Taiwan J Fam Med Vol.19 No [12] 200 mg/dl 126 mg/dl 200 mg/dl 13.5 g/dl 11.6 g/dl Modification of Diet in Renal Disease MDRD Estimated Glomerular Filtration Rate, egfr egfr [13] MDRD-GFR = S cr S BUN Alb Kidney Disease Outcomes Quality Initiative KDOQI egfr>90 ml/min/1.73m 2 egfr60-89 ml/min/1.73m 2 egfr30-59 ml/min/1.73m 2 egfr ml/min/1.73m 2 egfr 15 ml/min/1.73m 2 [14] PSQI a a % % % 2 65% 3 5b5j PSQI [15] C h a r l s o n

5 comorbidity index Charlson [16] % 194/ % 162/ % 32/50 p= PSQI p=0.001 p=0.012 p=0.019 p = p=0.011 p=0.014 p=

6 Taiwan J Fam Med Vol.19 No.1 1 PSQI 6 > 6 p n=199 n= % % % kg/m cm mmhg mmhg mg/dl ml/min/ 1.73m mg/dl mg/dl mg/dl mg/dl g/dl g/dl Charlson % % % % % % n=343 n= PSQI p

7 [25-29] BMI p=0.033 p=0.003 p=0.015 p=0.031 PSQI6 6 90% 67% [15] 3 95% p kg/m mmhg g/dl g/dl mg/dl mg/dl PSQI 6

8 Taiwan J Fam Med Vol.19 No % [2,10,11] 45-80% [1] 53% [2] 80% [11] 64% 47.2% [2,10,11] De Santo [11] [17] Iliescu [2] Kurella [10] Hanly Kimmel polysomnography obstructive sleep apnea periodic leg movement during sleep [18,19] Parker psychological and functional status [20] Charlson Charlson [21] [22-24] [22-24]

9 [25-28] [29] 研究限制 1. Walker S, Fine A, Kryger MH: Sleep complaints are common in a dialysis unit. Am J Kidney Dis 1995; 26: Iliescu EA, Yeates KE, Holland DC: Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplant 2004; 19: Iliescu EA, Coo H, McMurray MH, et al: Quality of sleep and health-related quality of life in hemodialysis patients. Nephrol Dial Transplant 2003; 18: Williams SW, Tell GS, Zheng B, Shumaker S, Rocco MV, Sevick MA: Correlates of sleep behavior among hemodialysis patients. Am J Nephrol 2002; 22: Valderrabano F, Jofre R, Lopez-Gomez JM: Quality of life in end-stage renal disease patients. Am J Kidney Dis 2001; 38: Zoccali C, Benedetto FA, Tripepi G, et al: Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients. Kidney Int 1998; 53: Zoccali C, Mallamaci F, Tripepi G: Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients. J Am Soc Nephrol 2002; 13: Benz RL, Pressman MR, Hovick ET, Peterson DD: A preliminary study of the effects of correction of anemia with recombinant human erythropoietin therapy on sleep, sleep disorders, and daytime sleepiness in hemodialysis patients The SLEEPO study. Am J Kidney Dis 1999; 34: Koo JR, Yoon JW, Kim SG, et al: Association

10 Taiwan J Fam Med Vol.19 No.1 of depression with malnutrition in chronic hemodialysis patients. Am J Kidney Dis 2003; 41: Kurella M, Luan J, Lash JP, Chertow GM: Self-assessed sleep quality in chronic kidney disease. Int Urol Nephrol 2005; 37: De Santo RM, Bartiromo M, Cesare MC, Di Iorio BR: Sleeping disorders in early chronic kidney disease. Semin Nephrol 2006; 26: American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2008; 31 Suppl 1 : S55-S Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: National Kidney Foundation: NKF/KDOQI guidelines Accessed May 26, 2009, at: guidelines_ckd/p4_class_g1.htm 15. Tsai PS, Wang SY, Wang MY, et al: Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index CPSQI in primary insomnia and control subjects. Qual Life Res 2005; 14: Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: Traynor J, Mactier R, Geddes CC, Fox JG: How to measure renal function in clinical practice. BMJ 2006; 333: Hanly PJ, Pierratos A: Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001; 344: Kimmel PL, Miller G, Mendelson WB: Sleep apnea syndrome in chronic renal disease. Am J Med 1989; 86: Parker KP, Bliwise DL, Bailey JL, Rye DB: Polysomnographic measures of nocturnal sleep in patients on chronic, intermittent daytime haemodialysis vs those with chronic kidney disease. Nephrol Dial Transplant 2005; 20: Harrington JJ, Lee-Chiong T Jr: Sleep and older patients. Clin Chest Med 2007; 28: Roth T: Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med 2007; 3: S7-S Doi Y, Minowa M, Uchiyama M, Okawa M: Subjective sleep quality and sleep problems in the general Japanese adult population. Psychiatry Clin Neurosci 2001; 55: Soares CN, Murray BJ: Sleep disorders in women: Clinical evidence and treatment strategies. Psychiatr Clin N Am 2006; 29: Bjorvatn B, Sagen IM, Oyane N, et al: The association between sleep duration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res 2007; 16: Kohatsu ND, Tsai R, Young T, et al: Sleep duration and body mass index in a rural population. Arch Intern Med 2006; 166: Singh M, Drake CL, Roehrs T, Hudgel DW, Roth T: The association between obesity and short sleep duration: a population based study.

11 J Clin Sleep Med 2005; 1: Vgontzas AN, Lin HM, Papaliaga M, et al: Short sleep duration and obesity: the role of emotional stress and sleep disturbances. Int J 29. Namysłowski G, Scierski W, Mrówka-Kata K, Kawecka I, Kawecki D, Czecior E: Sleep study in patients with overweight and obesity. J Physiol Pharmacol 2005; 56: S59-S65. Obes 2008; 32: a. 30 b. c. d. e. f. g. h. i. j

12 Taiwan J Fam Med Vol.19 No.1 2 Charlson BC

13 [Original Article] 61 Relationship between Renal Function and Quality of Sleep in Subjects with Chronic Kidney Disease Lun-Hsin Yang 1, Jin-Shang Wu 1,2, Yi-Ching Yang 1,2, Zih-Jie Sun 1, Ying-Hsiang Huang 1, Feng-Hwa Lu 1,2 and Chih-Jen Chang 1,2 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 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. (Taiwan J Fam Med 2009; 19: 49-61) 1 Department of Family Medicine, National Cheng Kung University Hospital; 2 Department of Family Medicine, College of Medicine, National Cheng Kung University Received: January 19, 2009; Accepted: May 17, 2009.

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