Zusammenfassung
Fragestellung:
Bei Patienten mit finaler Nierenerkrankung ist eine hohe Prävalenz von Schlafstörungen (Insomnie, Periodische Beinbewegungen, Schlafapnoe) zu beobachten. Die Lebensqualität ist dadurch zusätzlich eingeschränkt und das kardiovaskuläre Risiko erhöht.Das Auftreten von schlafbezogenen Atmungsstörungen bei Patienten unter Langzeitdialyse wurde bisher nur wenig beleuchtet.
Patienten und Methodik:
Wir rekrutierten 20 Patienten mit finaler Nierenerkrankung und einer mehr als 10 Jahre andauernden Hämodialyse. Es wurde die komplette Schlafanamnese, inklusive der Epworth Sleepiness Scale, erhoben sowie eine polysomnographische Untersuchung durchgeführt.
Ergebnisse:
Alle Patienten hatten einen gestörten Schlaf mit häufigem Erwachen (durchschnittl. Arousal Index=19.1±15.4 Ereignisse/Std., durchschnittl. Schlafeffizienz 79.3%±11%).Die gesamte Schlafzeit betrug 376±90 min. Acht Patienten erfüllten die Diagnosekriterien für eine schlafbezogene Atmungsstörung, mit einem AHI von > 5/h. Wir fanden signifikante Unterschiede zwischen den zwei separierten Gruppen (Patienten mit vs. ohne schlafbezogene Atmungsstörungen) hinsichtlich des BMI, des Serumkreatinins und der Blut-Harnstoff-Stickstoff-Konzentration (BUN – blood urea nitrogen).
Schlussfolgerung:
Schlafbezogene Atmungsstörungen treten bei Patienten mit finaler Nierenerkrankung unter Langzeitdialyse (> 10 Jahre) im Vergleich zur Allgemeinbevölkerung häufiger auf. Möglicherweise ist dies eine Konsequenz aus der langjährigen Nierenerkrankung und aus der urämischen Milieuexposition.
Summary
Background
It is proven that in patients with endstage renal disease (ESRD) the prevalence of sleep disorders (insomnia, periodic leg movement and sleep apnea) is high. This fact may contribute to an impaired quality of life and to an increased risk for cardiovascular diseases. However, only few published data are available with regard to sleepdisordered breathing in long-term hemodialysed patients.
Patients and methods
We recruited twenty patients with end-stage renal disease who had been dialysed for more than 10 years. Sleep disorders were confirmed by polysomnography, a sleep-questionnaire and the Epworth Sleepiness Scale.
Results
All patients had disturbed sleep with frequent awakenings (mean arousal index 19.1±15.4 events/hour, mean sleep efficiency 79.3%±11%). Total sleep time in patients was 376±90 min. Eight (40%) patients met the criteria of sleep-disordered breathing (SDB) with an AHI of >5/h and more than two major symptoms. We found significant differences between the two subgroups (patients with SDB vs. patients without SDB) due to body mass index, serum cre- atinine and blood urea nitrogen.
Conclusions
Sleep-disordered breathing is more frequent in longterm hemodialysed patients (> 10 years) than in general population. It is possibly a consequence of the long process of renal failure and the exposure to the uremic milieu.
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Mucenica, E.C., Boisteanu, D., Wirth, J.A. et al. Sleep-disordered breathing in patients with end-stage renal disease and long-term dialysis. Somnologie 11, 211–215 (2007). https://doi.org/10.1007/s11818-007-0309-5
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DOI: https://doi.org/10.1007/s11818-007-0309-5