慢性血液透析患者睡眠和额叶功能的改变：发病机制和治疗前景。

IF 2.6 3区心理学 Q2 BEHAVIORAL SCIENCES

Behavioural Brain Research Pub Date : 2024-11-13 DOI:10.1016/j.bbr.2024.115337

Giulia Belluardo, Concetto Sessa, Walter Morale

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引用次数: 0

摘要

慢性肾脏病（CKD），尤其是慢性血液透析（HD）患者患睡眠障碍和执行功能障碍的风险很高。睡眠障碍在血液透析人群中的发病率高达 75%，其发生有多种原因：交感-迷走神经失衡、褪黑激素分泌过低、维生素 D 缺乏、脑血流动力学改变和血液透析引起的血管压力。约 55% 的血液透析患者会出现执行功能障碍。其原因可归结为额叶功能障碍。血液透析患者表现出额叶脑萎缩、大脑活动减少以及多个额叶和前额叶区域的连接性降低。睡眠质量对执行功能也有重大影响；低效和零碎的睡眠会降低执行功能的效率，增加痴呆症的风险。睡眠不足也会改变多个额叶区域的连接和结构。因此，睡眠和执行功能似乎密切相关。对患有慢性肾脏病和 HD 的患者进行多学科护理似乎是至关重要的，这样才能制定预防性干预措施、药物和非药物治疗方法，从而改善睡眠质量、保持执行功能的完整性并提高他们的生活质量。

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The alterations of sleep and frontal functions in chronic hemodialysis: Pathogenesis and therapeutic perspectives

Chronic kidney disease (CKD) and, in particular, chronic haemodialysis (HD) patients have a high risk of developing sleep disorders and executive dysfunction. Sleep disorders have a prevalence of 75 % in the haemodialysed population and several causes are behind their occurrence: sympatho-vagal imbalances, low melatonin production, vitamin D deficiency, altered cerebral haemodynamics and haemodialysis-induced vascular stress. Executive dysfunction affects about 55 % of haemodialysis patients. The causes can be ascribed to dysfunctions of the frontal lobes. HD patients show frontal brain atrophy and reduced brain activity and connectivity of several frontal and prefrontal areas. Sleep quality also has a significant impact on executive functions; inefficient and fragmented sleep reduces the efficiency of executive functions and increases the risk of dementia. Sleep deprivation also alters the connectivity and structure of several frontal areas. Thus, sleep and executive functions seem to be closely linked. Multidisciplinary care of patients with CKD and in HD appears essential to structure preventive interventions, pharmacological and non-pharmacological treatments that can improve sleep quality, preserve the integrity of executive functions and improve their quality of life.

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来源期刊

Behavioural Brain Research 医学-行为科学

CiteScore

5.60

自引率

0.00%

发文量

383

审稿时长

61 days

期刊介绍： Behavioural Brain Research is an international, interdisciplinary journal dedicated to the publication of articles in the field of behavioural neuroscience, broadly defined. Contributions from the entire range of disciplines that comprise the neurosciences, behavioural sciences or cognitive sciences are appropriate, as long as the goal is to delineate the neural mechanisms underlying behaviour. Thus, studies may range from neurophysiological, neuroanatomical, neurochemical or neuropharmacological analysis of brain-behaviour relations, including the use of molecular genetic or behavioural genetic approaches, to studies that involve the use of brain imaging techniques, to neuroethological studies. Reports of original research, of major methodological advances, or of novel conceptual approaches are all encouraged. The journal will also consider critical reviews on selected topics.