中華心理衛生協會

Purpose: Sleep problems are common in chronic kidney disease (CKD) patients. Prior studies have shown that these sleep problems are associated with various demographic and disease-related characteristics. However, few studies have examined the impact of psychological and behavioral factors. The present study investigated whether CKD patients' poor sleep quality is related to psychological and behavioral factors. Methods: This research used a cross-sectional, questionnaire-based design. Stage 3-5 CKD patients were recruited from July to November, 2013. First, the MMSE was used to rule out those with cognitive impairment, and then all patients completed a survey of demographic data, severity of pain and pruritus, and restless leg symptoms. Patients also completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleep Hygiene Practice Scale, Pre-Sleep Arousal Scale, and Hospital Anxiety and Depression Scale. Laboratory parameters and comorbid conditions were abstracted from each patient's medical report. After eliminating those who did not meet the inclusion criteria (with MMSE scores under 26 or who did not complete all questions or had missing data in the medical report), data from 152 patients, including 77 not on dialysis and 75 on maintenance hemodialysis, were analyzed. Results: The prevalence of poor sleep quality and insomnia were 29.9% and 23.4% in patients not on dialysis, and 57.3% and 28.0% in hemodialysis patients. Multiple regression analysis revealed that MMSE, comorbid conditions, pain severity, and arousal-related behaviors are associated with sleep quality; and that anxiety and depression, arousal-related behaviors, and cognitive arousal were associated with insomnia severity. Among patients not on dialysis, arousal-related behaviors were associated with sleep quality, and cognitive arousal was associated with insomnia severity, even after controlling for other factors. In contrast, among hemodialysis patients, comorbidity and pain severity were associated with sleep quality, and pain severity, pruritus severity, anxiety and depression were associated with insomnia severity. Conclusions: Arousal-related behaviors and cognitive arousal influence sleep in patients not on dialysis. Comorbidity, disease-related symptoms, and mood disturbance are more influential in hemodialysis patients. The findings suggest that effective interventions may be different in these two groups and that further exploration is warranted.