不同失眠症易患群体的睡眠特征比较

Comparison of sleep characteristics in different insomnia easy-suffering populations

目的:调查老年人群和轮班人员的睡眠状况,对比分析不同失眠症易患群体的睡眠特点,为改善睡眠质量提供帮助。方法:于2005-07-15/19在解放军总医院对396名年龄>65岁的老年人、388名轮班人员、100名正常人进行匹兹堡睡眠质量指数的测查和睡眠特征分析,用DSM-Ⅳ标准进行失眠症的诊断。分为老年组、轮班人员组、正常组。采用问卷调查法,问卷包括一般情况(包括姓名、性别、年龄、病情等)和匹兹堡睡眠质量自评量表两部分。匹兹堡睡眠质量自评量表由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,>7分者表示睡眠质量差,总分越高示睡眠质量越差。对比老年组、轮班组和正常对照组的失眠率及匹兹堡睡眠质量自评量表中7个成分得分和睡眠质量指数总分情况,分析3组的睡眠质量特征。结果:共发放问卷调查900份,回收有效问卷884份,调查应答率98.22%,老年组396名、轮班组388名、正常组100名,进入结果分析。①老年组睡眠差者占58.05%,确诊为失眠症的占总群体的32.58%,轮班人员睡眠状况差者占72.02%,确诊失眠的占64.69%。②老年组、轮班组匹兹堡睡眠质量指数均高于正常组,差异有显著性(8.61±5.07,8.52±3.57,3.36±2.24;t=5.903,7.74,P=0.000),老年组、轮班组总体睡眠质量差异无显著性(t=0.318,P=0.753)。③轮班组以入睡困难、白天功能障碍为突出表现(χ2=53.970,145.705,P=0.000),老年人以睡眠时间减少、睡眠效率降低、睡眠障碍多、催眠药物使用多为特点(χ2=38.808,65.943,16.840,91.652,P=0.000)。④影响夜间睡眠的因素中,老人起夜多(每周>1～2次)的占总体的72.23%。早醒(每周>1～2次)的占总体的56.06%。轮班人员早醒的占总体的53.09%,起夜多(每周>1～2次)的占34.79%。结论:老年人群和轮班人员的睡眠状况较普通人群差。轮班人员主要表现为入睡困难、白天功能障碍,可能与睡眠剥夺和生物钟紊乱有关;老年人以睡眠时间减少、睡眠效率降低、睡眠障碍多、催眠药物使用多为特点,似乎与脑功能退化有关。临床上应采用针对性的干预措施来改善不同群体的睡眠。

AIM： To investigate the sleep status of elderly people and shift workers, compare the characteristics of sleep in different easy-suffering insomnia population and provide assistance for improving sleep quality, METHODS： From July 15^th to 19^th 2005, 396 elderly people aged over 65 years, 388 shift workers and 100 normal persons were selected from General Hospital of Chinese PLA to conduct the investigation with Pittsburgh Sleep Quality Index （PSQI） and the analysis on sleep characteristics. Diagnosis of insomnia was done according to DSM-Ⅳ standard. They were assigned into elderly people group, shift workers group and normal group. Questionnaire survey method was used, and the questionnaire included general condition （composed of name, sex, age and patient＇s condition, etc.） and self-rating scale of PSQI that consisted of 23 items, dividing 7 components, containing sleep quality, sleep time, sleep duration, sleep efficiency, sleep disturbances, soporific using and daily functions, counting 0- 3 points. The total score was equal to the sum of every item. People with over 7 points suggested that the sleep quality was bad; the higher the total score, the worse the sleep quality was. Agrypnia rate and the scores on the 7 components of self-rating of PSQI and the general score of sleep quality index in the elderly people group, shift worker group and the normal control group were compared. The characteristics of sleep quality of the 3 groups were analyzed. RESULTS： Totally 900 questionnaires were sent out, and 884 qualified questionnaires were retrieved with the answering rate of 98.22%. 396 people in the elderly people group, 388 people in the shift workers group and 100 people in the normal group were involved in the result analysis. ① 58.05% persons in the elderly group had bad sleep quality. 32.58% persons were diagnosed with insomnia. 72.02% shift workers had bad sleep status. 64.69% persons were diagnosed with insomnia. ② The scores on PSQI in the elderly people group and the shift workers group were higher than those in the normal group, and had significant difference （8.61±5.07, 8.52±3.57,3.36±2.24;t=5.903,7.74,P=0.000）. The general sleep quality in the elderly people group and the shift workers group had insignificant difference （t=0.318,P＇=0.753）. ③ People in the shift workers group manifested difficult to sleep and daily dysfunction （X^2=53.970,145.705,P=0.000）. The elderly people characterized diminution of sleep time, reduction of sleep efficiency, sleep disorder and more hypnotic using （22=38.808, 65.943, 16.840, 91.652,P=0.000）. ④ Among the factors that affected nighttime sleep, 72.23% elderly people got up in the nighttime （above 1-2 times per week）; 56.06% got up early in the morning （above 1-2 times per week）. 53.09% shift workers got up early in the morning, and got up in the nighttime frequently （above 1-2 times per week）, occupying 34.79%. CONCLUSION： The sleep status in the elderly population and shift workers is worse than that in the normal people. The shift workers characterize difficult to fall into sleep and daily dysfunction, which can be related to the sleep deprivation and derangement of bioclock. The elderly population characterizes diminution of sleep time, reduction of sleep efficiency, sleep disorder and more hypnotic using, which seems related to cerebral functional deterioration. Pointed interventional study should be used in clinic to ameliorate the sleep in different cohort.