Analysis Of Influencing Factors Of Sleep Disorders In Maintenance Hemodialysis Patients

Objective: Sleep disorders are common in maintenance hemodialysis(MHD)patients,and their clinical manifestations are various,which not only affect the quality of life of MHD patients,but also affect the prognosis and survival rate of patients.The purpose of this study is to provide a basis for clinical decision-making by analyzing the influencing factors of sleep disorders in patients with MHD.Methods: A cross-sectional study was conducted of 57 patients who had been diagnosed as end-stage renal disease(ESRD)and received long-term regular hemodialysis treatment in the Hemodialysis Center of the third Hospital of Hebei Medical University during December 2020 to January 2021.There were 32 males and 25 females,aged from 26 to 79 years old,with an average of(53.35 ±13.72)years old.The duration of dialysis was 38(24.5,72)months.There were 28 cases of diabetic kidney disease(DKD),5 cases of chronic glomerulonephritis,2 cases of lupus nephritis,2 cases of polycystic kidney,1 case of Henoch-Schonlein purpura nephritis,1 case of anti-glomerular basement membrane disease,1 case of renal damage in Sjogren’s syndrome and 17 cases of unknown primary disease.The data of sex,age,duration of dialysis,smoking status,primary disease,previous medical history and mean blood pressure before 5 hemodialysis were collected.The same investigator explained the filling method and answer options of the scale to the patients,and collected the scores of Athens Insomnia Scale(AIS),Self-Rating Depression Scale(SDS)and the severity of restless legs syndrome questionnaire.The laboratory indexes included biochemical indexes such as serum creatinine(Scr)and blood urea nitrogen(BUN)before and after dialysis,albumin(Alb),serum calcium and phosphorus,and related inflammatory indexes such as tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and hypersensitive C-reactive protein(hs-CRP)and so on.Platelet/lymphocyte ratio(PLR),neutrophil/lymphocyte ratio(NLR)and serum C-reactive protein/albumin ratio(CAR)were calculated.The related indexes of DKD group and NDKD group were compared;Patients were grouped according to the scores of AIS scale,and the related indexes of insomnia group and non-insomnia group were analyzed by univariate analysis,the correlation between the scores of AIS scale and the indexes with statistical difference between the two groups was analyzed.Whether or not insomnia was taken as the dependent variable,and the variables which were P<0.05 in the univariate analysis were taken as covariates for Logistic regression.Results: The average of systolic blood pressure(P=0.01),white blood cell count(P=0.01),NLR(P=0.032),hs-CRP(P=0.043),CAR(P=0.05),TNF-α(P=0.043)in DKD group were higher than those in NDKD group,while the duration of dialysis(P=0.002),i PTH(P=0.015)and pre-dialysis creatinine(P=0.002)in DKD group were lower than those in NDKD group.The prevalence rates of insomnia(P=0.045)and restless legs syndrome(P=0.044)in DKD group were higher than those in NDKD group.Then patients were divided into two groups according to the scores of AIS scale(non-insomnia group: <6 points,insomnia group: ≥6 points): older age(P=0.035),higher systolic blood pressure(P=0.012),lower serum albumin(P=0.006),and high levels of NLR(P=0.005),hs-CRP(P=0.009),CAR(P=0.008),IL-1β(P=0.005),TNF-α(P=0.025)were risk factors for insomnia in patients with MHD.The number of diabetic kidney disease patients in insomnia group was higher than that in non-insomnia group(P=0.045).The prevalence rates of restless legs syndrome(P=0.023)and depression(P=0.003)in insomnia group were higher than those in non-insomnia group.Further analysis of Spearman correlation coefficient showed that the scores of AIS scale was negatively correlated with serum albumin(r=-0.302,P=0.022),and positively correlated with hs-CRP(r=0.394,P=0.002),CAR(r=0.403,P=0.002),IL-1β(r=0.454,P < 0.001),TNF-α(r=0.313,P=0.018),and positively correlated with the scores of Self-Rating Depression Scale(r=0.373,P=0.004)and the severity scores of restless legs syndrome(r=0.306,P=0.020).Depression was identified as an independent risk factor for insomnia in patients with MHD(OR=8.667,P=0.009)after Logistic regression.Conclusions: Older age,higher systolic blood pressure,lower serum albumin,microinflammatory state,higher prevalence rates of restless legs syndrome and depression are the risk factors of insomnia in MHD patients,among which depression is the independent risk factor.Compared with the non-diabetic kidney disease group,the diabetic kidney disease group has more obvious microinflammation and higher prevalence rates of insomnia and restless legs syndrome in MHD patients.