炎症性肠病患者睡眠质量对生活质量的影响:焦虑抑郁的完全中介作用

Effects of sleep quality on quality of life in patients with inflammatory bowel disease: a complete mediator between anxiety and depression

目的:探讨炎症性肠病(IBD)患者睡眠质量、焦虑抑郁与生活质量的内在关系,为改善IBD患者生活质量寻找新的突破口。方法:以2020年7月至2021年2月在南京市某三甲医院消化科住院的303例IBD患者为研究对象,采用一般资料调查表、匹兹堡睡眠质量指数(PSQI)、医院焦虑抑郁量表(HADS)和炎症性肠病生活质量问卷(IBDQ),评估患者的一般情况、睡眠质量、焦虑抑郁和生活质量。进一步分析并检验睡眠质量对生活质量的影响中存在的中介效应。结果:IBD患者睡眠质量、焦虑抑郁及生活质量评分分别为9(6,12)、10(6,15)、168(148,187)分,睡眠质量与焦虑抑郁呈正相关(r=0.403,P<0.001),生活质量与睡眠质量、焦虑抑郁均呈负相关(r=-0.405、r=-0.754,P<0.001)。中介效应检验显示,睡眠质量对IBD患者焦虑抑郁的直接预测作用显著(β=0.31, 95%CI 0.15~0.46,P<0.001);焦虑抑郁直接负向预测生活质量(β=-0.84, 95%CI-0.90~-0.77,P=0.002);睡眠质量对生活质量影响的间接效应显著(β=-0.26, 95%CI-0.39~-0.13,P<0.001);睡眠质量与生活质量的之间的路径系数无统计学意义(β=-0.09, 95%CI-0.14~0.03,P=0.061),提示焦虑抑郁在睡眠质量和生活质量间起完全中介作用。结论:睡眠质量可通过焦虑抑郁影响生活质量。临床医护人员需重点评估患者睡眠质量和焦虑抑郁状态,及时提供相应的干预,以提高其生活质量。

Objective: To explore the relationship among anxiety-depression, sleep quality and quality of life in patients with inflammatory bowel disease(IBD), and to clarify main intervention direction of quality of life in patients with IBD. Methods: The subjects were 303 IBD patients who were hospitalized in the digestive department of a tertiary a-level hospital in Nanjing from July 2020 to February 2021. General information questionnaire, Pittsburgh sleep quality index(PSQI), hospital anxiety and depression scale(HADS) and inflammatory bowel disease questionnaire(IBDQ) were used to assess the general condition, sleep quality, anxiety-depression and quality of life. Results: The scores of sleep quality, anxiety-depression and life quality of IBD patients were 9(6,12), 10(6,15), 168(148,187), sleep quality was positively correlated with anxiety-depression(r=0.403, P<0.001), quality of life was negatively correlated with sleep quality anxiety-depression(r=0.405 and-0.754, P<0.001). The medicating effect test showed that sleep quality had a direct predictive effect on anxiety and depression(β=0.31, 95%CI 0.15-0.46, P<0.001), anxiety and depression had a direct negative effect on quality of life(β=-0.84, 95%CI-0.90--0.77, P=0.002), sleep quality had an indirect effect on quality of life(β=-0.26, 95%CI-0.39--0.13,P<0.001), the path coefficient between sleep quality and quality of life was not statistically significant(β=-0.09, 95%CI-0.14-0.03, P=0.061), which showed that anxiety-depression was a complete mediator between sleep quality and quality of life. Conclusion: Sleep quality affects life quality through a complete mediating effect of anxiety-depression. The clinical medical staff should focus on evaluating the sleep quality and anxiety-depression status of patients, and timely provide corresponding interventions to improve their quality of life.