Relationship Between Sleep Disorders And TCM Syndrome Types In MPD Patients And Analysis Of Influencing Factors

Objective To observe the distribution law of TCM syndromes in patients with maintenance peritoneal dialysis（MPD）with sleep disorders,and analyze patients with MPD with sleep disorders influencing factors,so as to provide a theoretical basis for further research on the improvement of the quality of life of patients with MPD.Methods 1.According to the inclusion and exclusion criteria,patients with end-stage renal disease who underwent maintenance peritoneal dialysis at the Peritoneal Dialysis Center of Wuhan Integrated Traditional Chinese and Western Medicine Hospital from November 01,2021 to January 31,2022 were screened,and the basic conditions and relevant biochemical indicators of the patients were collected;2.The Pittsburgh sleep quality index（PSQI）scale was used to evaluate the sleep quality of patients,and the subjective sleep quality,sleep latency,sleep time,habitual sleep efficiency,cumulative sleep disturbance,sleep medication use and daytime function were evaluated respectively.The total score of this scale is 21 points.The MPD patients with PSQI scale score≤7 points were divided into normal sleep group,the MPD patients with PSQI scale score>7 points were divided into sleep disorders group;3.To formulate a clinical study report form（CRF）for the regularity of TCM syndromes in maintenance peritoneal dialysis patients.The designated TCM physicians conduct TCM syndrome differentiation for MPD patients,and observe the distribution of TCM syndrome types in all MPD patients;4.To study the correlation between the PSQI scale score of MPD patients and basic conditions,biochemical indicators and other factors,to explore the possible influencing factors of sleep disturbance in MPD patients;as well as the differences between TCM syndrome types,study the relationship between TCM syndrome types and sleep disorders in MPD patients.Results 1.A total of 165 MPD patients were included in and completed this research.There were 134 MPD patients with sleep disturbance,and the incidence rate was as high as 81.21%.2.Compared sleep disorders group with normal sleep group,there was no statistical significance in the living conditions,years of education,primary disease,peritoneal dialysis mode,body mass index（BMI）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,dialysis age of MPD patients,peritoneal transport function,cognitive function,weekly residual kidney urea clearance（Kt/V）,weekly peritoneal dialysis urea clearance,white blood cells（WBC）,red blood cells（RBC）,hematocrit（HCT）,serum prealbumin（Pa）,serum creatinine（Scr）,serum urea nitrogen（BUN）,serum uric acid（UA）,carbon dioxide binding capacity（CO₂CP）,serum potassium（K）,serum sodium（Na）,Serum Chloride（Cl）,Serum Magnesium（Mg）,Serum Total Cholesterol（CHOL）,Triglyceride（TG）,High Density Lipoprotein Cholesterol（HDL-C）,Low Density Lipoprotein Cholesterol（LDL-C）,Serum Iron protein（SF）and fasting blood glucose（GLU）（P>0.05）;However,there was statistical significance in gender,grip strength,weekly total urea clearance（weekly total Kt/V）,hemoglobin（HGB）,platelet（PLT）,serum albumin（ALB）,serum calcium（Ca）,serum phosphorus（P）,parathyroid hormone（PTH）and other aspects between sleep disorders group and normal sleep group（P<0.05）.3.There were differences between the sleep disorders group and the normal sleep group in subjective sleep quality,sleep latency,sleep time,habitual sleep efficiency,superimposition of sleep disturbances,sleep medication use,and daytime dysfunction（P<0.05）.4.The correlation analysis between the PSQI scale score of MPD patients and the observed biochemical indicators suggest that gender,grip strength,weekly Kt/V,HGB,ALB,Ca were negatively correlated with the PSQI scale score,and the correlation was significant（P<0.05）;P,PTH and PSQI scale scores were positively correlated,and the correlation was significant（P<0.05）;PLT and PSQI scale scores had no statistical significance（P>0.05）.In the binary logistic regression model,weekly Kt/V（OR=0.158,95%CI0.057～0.439）was found the protective factor for sleep disorders in MPD patients（P<0.05）.In contrast,female（OR=5.902,95%CI1.413～24.647）,PTH（OR=1.003,95%CI 1.000～1.005）were the risk factors for sleep disorders in MPD patients（P<0.05）.5.In terms of TCM syndrome types,the distribution of primary deficiency syndromes of MPD cases was clinically collected:40cases（24.24%）of spleen-kidney qi deficiency syndrome,58 cases（35.15%）of spleen-kidney yang deficiency syndrome,10 cases（6.06%）of liver and kidney yin deficiency syndrome,31 cases of qi and yin deficiency syndrome（18.79%）,and 26 cases（15.76%）of yin and yang deficiency syndrome.The distribution of different syndrome types of concurrent syndromes:46 cases（27.88%）of damp-turbid syndrome,39 cases（23.64%）of damp-heat syndrome,31 cases（18.79%）of congestion syndrome,19 cases（11.51%）of heat-toxin syndrome,0cases of wind-dynamism syndrome Cases（0%）and 30 cases（18.18%）without concurrent evidence.Among them,spleen-kidney yang deficiency with damp turbidity syndrome and spleen-kidney qi deficiency with damp turbidity syndrome were the most common and accounted for the largest proportion.6.Comparing the sleep disorders group and the normal sleep group,in terms of the traditional Chinese medicine syndrome,spleen-kidney yang deficiency syndrome the most;in terms of concurrent syndromes,the sleep disorders group has the largest proportion of wet turbidity syndrome.The proportions of damp-turbid syndrome,damp-heat syndrome,and congestion syndrome in the sleep normal group were equal.In the syndrome of qi and yin deficiency patients,the difference between the both groups was statistically significant（P<0.05）.7.Statistical analysis was performed on the PSQI scores of MPD patients with different TCM syndrome types.MPD patients with different syndrome types of this syndrome had significant differences in the item score of sleep disturbance superposition（P<0.05）,There was no significant difference in the six sleep items among the various syndrome types（P>0.05）;There was no significant difference in the total score of PSQI and other six sleep items among the deficiency syndrome types（P<0.05）.8.Statistical analysis of the biochemical indexes of patients with different TCM syndromes of MPD with sleep disorders suggest that there were not significantly different in Grip strength,weekly Kt/V,PLT,HGB,ALB of MPD with sleep disorders among the different syndromes,ALB,Ca,P,PTH and other items between different TCM syndrome types（P>0.05）.Conclusion 1.In MPD patients,more than half of them have sleep disorders.There are many factors that affect the sleep state of MPD patients.The study found that gender,weekly total Kt/V,PTH are the factors of sleep disorders.2.In terms of TCM syndrome types,MPD patients with sleep disorders are generally characterized by"asthenia in origin and asthenia in superficiality".In terms of primary deficiency syndrome,sleep disorders are most likely to occur with deficiency of both qi and yin.MPD patients with different syndromes of this syndrome have obvious differences in the item score of sleep disturbance superposition;MPD patients with the standard syndrome have different scores in the item of habitual sleep efficiency.Clinically,on the basis of conventional treatment,according to the results of individual TCM syndrome differentiation of MPD patients,supplemented with other therapeutic methods such as nourishing qi,nourishing yin,tonifying spleen and nourishing kidney,in order to alleviate complications such as sleep disorders.