말기신부전 환자의 수면장애와 심근손상 = Sleep Disturbance and Myocardial Damage in Patients with End-Stage Renal Disease

다국어 초록 (Multilingual Abstract)

Background:Recently, it was suggested that sleep disorders, like sleep apnea and periodic limb movements during sleep, are associated with the cardiovascular complications and outcomes seen in ESRD patients. This study investigated the association between sleep disturbances, including nocturnal hypoxemia, and myocardial damage in ESRD patients.
Methods:We conducted a cross-sectional study of 15 hemodialysis patients (age=50±8 years, M:F= 11:4, diabetes=6) who were classified as at high risk of sleep disturbance using the Epworth Sleepiness Scale and Sleep Disorders Questionnaire. Overnight polysomnographic studies were performed in these 15 patients to evaluate sleep parameters. The predialysis serum concentration of cardiac troponin T (cTnT) was measured as a marker of myocardial damage.
Results:Apnea＋hypopnea index >5, which is a diagnostic criterion of sleep-related breathing disorder, was found in 12 (80%) patients. Several sleep parameters were associated with cTnT concentration. Sleep efficiency and lowest oxygen saturation decreased (p<0.05 and p=0.06, respectively), and average desaturation increased (p<0.05) with increasing cTnT concentration. Spearman's Rho, which was used to assess the relationships between the severity of sleep apnea and clinical parameters, showed that apnea＋hypopnea index and oxygen desaturation index were negatively correlated (both p<0.01) with the serum concentration of uric acid. In multivariate analysis, the uric acid concentration was also independently associated with apnea＋hypopnea index and oxygen desaturation index.
Conclusion:Elevated concentration of cTnT was associated with poor sleep efficiency and severe oxygen desaturation during sleep, and the serum concentration of uric acid was lower in patients with severe sleep apnea.

국문 초록 (Abstract)

배 경:말기신부전 환자에서 수면무호흡증이나 수면중주기성하지운동증과 같은 수면장애들이 심혈관질환의 발생 및 예후와 연관되어 있을 가능성이 최근 제기되고 있다. 저자들은 말기신부전 환자에서 수면장애로 인한 저산소혈증 발생과 심근손상과의 관련성을 알아보고자 하였다.
방 법:유지 혈액투석 중인 환자 중 수면 설문조사인 Epworth Sleepiness Scale과 Sleep Disorders Questionnaire를 시행하여 수면장애 고위험군으로 분류된 15명의 환자 (연령=50±8세, 남:여=11:4, 당뇨=6명)를 대상으로 단면적 연구를 시행하였다. 야간수면다원검사를 시행하여 수면장애 지표들을 구하였고, 심근손상의 지표로서 cardiac troponin T (cTnT)의 혈청 농도를 측정하여 다음과 같은 결과를 얻었다.
결 과:수면호흡장애의 진단 기준인 무호흡＋저호흡지수 5회/시간 이상은 12명 (80%)의 환자에서 관찰되었다. 몇 가지 수면장애 지표들이 cTnT 농도와 관련이 있었다. cTnT 농도가 상승함에 따라 수면효율과 최저산소포화도는 감소하였고 (각각 p<0.05, p=0.06), 평균산소포화도감소량은 증가하였다 (p<0.05). Spearman 상관분석으로 수면무호흡증의 정도와 임상 지표들의 관계들을 분석하였을 때, 혈중 항산화제 중의 하나인 요산의 혈청 농도가 무호흡＋저호흡지수 및 산소포화도저하지수와 음의 상관관계 (둘 다 p<0.01)를 보였고, 다변량 분석에서도 요산 농도는 무호흡＋저호흡지수 및 산소포화도저하지수와 독립적으로 관련이 있었다.

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