老年住院患者心理状况与睡眠质量的调查

Mental status and sleep quality in elder inpatients

目的:调查老年住院患者心理健康状况和睡眠质量情况,分析二者的相互关系。方法:纳入2002-01/2003-01在哈尔滨医科大学附属第四医院老年住院患者150例。以匹兹堡睡眠质量指数≥8作为判别睡眠障碍的标准,将150例患者按匹兹堡睡眠质量指数<4,5～7,>8分为3组,分别为35例、42例、73例。采用匹兹堡睡眠质量指数(由23个条目构成,分为7个成分,包括睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、安眠药物和日间功能,每个成分按0～3计分,各域分相加为匹兹堡睡眠质量指数总分,总分越高示睡眠质量越差)评价老年住院患者的心理状况与睡眠质量;采用心理卫生自评量表(90项症状自评量表记录症状自评量表总分、躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性和其他)评价患者心理状况对睡眠质量的影响。测试前向患者说明调查目的及意义,要求患者在1～2h内独立完成答卷。采用χ2检验,t检验,F检验,以Spearman作相关分析。结果:按意向处理分析,150例患者全部进入结果分析。①匹兹堡睡眠质量指数>8分的患者症状自评量表中躯体化、强迫、抑郁、焦虑、精神病性5个因子及总均分显著高于5～8分和<4分的患者犤(0.9±0.6,0.6±0.3,0.5±0.3);(1.1±0.6,0.7±0.3,0.6±0.6);(0.9±0.5,0.7±0.5,0.5±0.6);(0.6±0.5,0.5±0.4,0.2±0.3);(0.7±0.4,0.4±0.4,0.4±0.4);(54.2±37.3,43.0±33.0,38.2±36.7);F=1.424～34.648,P<0.01～0.05犦,且匹兹堡睡眠质量指数得分越高,症状自评量表各因子及总分得分越高。②症状自评量表中躯体化、强迫、抑郁、焦虑、精神病性5个因子及总分与睡眠质量呈显著正相关(相关系数分别为:0.4570,0.2636,0.1541,0.2434,0.1795,0.2026),其中其他、躯体化、强迫3个因子与睡眠质量、入睡时间、睡眠时间、睡眠效率呈现非常显著正相关(相关系数分别为:0.6422,0.5383,0.2405,0.3412;0.4570,0.2929,0.0212,0.3130;0.2636,0.1546,0.0087,0.2670),抑郁、焦虑和症状自评量表总分与睡眠效率呈显著正相关(相关系数分别为:0.1229,0.1304,0.1467)。结论:老年住院患者睡眠质量愈差,焦虑分和抑郁分就愈高,呈极显著的正相关,并且促使焦虑,抑郁等多种情绪障碍的发生。说明住院老年人失眠不单单是一个睡眠生理紊乱,同时还有一个心理紊乱过程。

AIM： To investigate the mental health status and sleep quality in elderly inpatients, and probe into the relationship between them. METHODS：A total of 150 elderly inpatients were selected from the Fourth Affiliated Hospital of Harbin Medical University from January 2002 to January 2003. Pittsburgh sleep quality index （PSQI） equal to or more than 8 was used as the judging standard of sleep disorder. The 150 patients were divided into PSQI less than 4 group（n=35）, PSQI from 5 to 7 group（n=42）, and PSQI more than 8 group（n=73） according to their PSQI. The PSQ1 consisting of 23 items including 7 parts： sleep quality, time for falling asleep, time of sleep, efficiency of sleep, sleep disorder, sleeping potion and function during daytime; Each part was scored from 0 to 3 marks, and the marks of each part were added equal to the total marks of PSQI; The higher the score was, the poorer the sleep quality was） was used to assess the mental status and sleep quality. The symptom checklist 90 （SCL-90, the total score, the score of somatization, compulsion, interpersonal sensitivity, depression, anxiety, hostility, crankiness, psychoticism and others） was used to assess the influence of mental status on the sleep quality. The objective and significance were explained to the patients before test. The patients were asked to finish the questionnaires within 1 to 2 hours independently. The correlation analysis based on Spearman was performed by x^2 test, t test and F test. RESULTS ：According to the intention, all the 150 patients were analyzed in the result.①The score of somatization, compulsion, depression, anxiety and psychoticism and the total score were significantly higher in PSQI more than 8 group than in the PSQI from 5 to 8 and less than 4 groups[0.9±0.6 vs 0.6±0.3, 0.5±0.3; 1.1±0.6 vs 0.7±0.3, 0.6±0.6; 0.9±0.5 vs 0.7±0.5, 0.5±0.6; 0.6±0.5 vs 0.5±0.4, 0.2±0.3; 0.7±0.4 vs 0.4±0.4, 0.4±0.4; 54.2±37.3 vs 43.0±33.0, 38.2±36.7; F=1.424 to 34.648, P 〈 0.01 to 0.05]. The higher the score of PSQI was, the higher the score of factors and the total score of SCL-90 were. ②The score of somatization, compulsion, depression, anxiety and psychoticism and the total score were in a highly positive correlation with the sleep quality with the correlation coefficient of 0.457 0, 0.263 6, 0.154 1, 0.243 4, 0.179 5 and 0.202 6 respectively, and the score of others, somatization, compulsion were in a significantly positive correlation with the score of sleep, time for falling asleep, time of sleep, efficiency of sleep with the correlation coefficient of 0.642 2, 0.538 3, 0.240 5, 0.341 2; 0.457 0, 0.292 9, 0.021 2, 0.313 0; 0.263 6, 0.154 6, 0.008 7, 0.267 0 respectively. The score of depression and anxiety and the total score of SCL-90 were in a highly positive correlation with the efficiency of sleep with the correlation coefficient of 0.122 9, 0.130 4, 0.146 7. CONCLUSION：The poorer the sleep quality in elder inpatients is, the higher the score of depression and anxiety is, so they are in a remarkable positive correlation; The poor sleep quality causes the emotional disorder such as depression and anxiety. Our results indicate that sleeplessness is not only a kind of physical order, but also a kind of mental order.