脑梗死后焦虑抑郁共病患者睡眠障碍特征及影响因素分析

The characteristics of sleep disturbance in patients with comorbid anxiety and depression after cerebral in- farction and their related factors

目的研究脑梗死后焦虑抑郁共病患者的睡眠障碍特征及其影响因素。方法共选取首发脑梗死患者216例，根据患者汉密顿焦虑量表（HAMA）及汉密顿抑郁量表（HAMD）评分，将其划分为焦虑抑郁组、单纯焦虑组、单纯抑郁组及无焦虑抑郁组。对各组患者吸烟、饮酒、文化程度、生活工作压力、日常锻炼频度等一般资料进行比较；运用“匹兹堡睡眠质量指数量表（PSQI）”评价患者睡眠状况，并分析影响焦虑抑郁共病患者睡眠质量的相关因素。结果各组患者吸烟、饮酒、文化程度、工作生活压力、日常锻炼频度等情况组间差异均无统计学意义（P〉0．05）；各组患者HAMA及HAMD评分组间差异均具有统计学意义（P〈0．05），其中焦虑抑郁组患者HAMD总分明显高于其他各组（P〈0．01），HAMA总分则明显高于单纯抑郁组和无焦虑抑郁组（P〈0．001）；睡眠质量各维度评分组间差异亦具有统计学意义（P〈0．05），其中焦虑抑郁组PSQI总分及各因子得分均显著高于无焦虑抑郁组（P〈0．05）；焦虑抑郁组主观睡眠、睡眠潜伏、睡眠持续性、睡眠效率、白天功能紊乱及PSQI总分显著高于单纯焦虑组（P〈0．05）；焦虑抑郁组睡眠潜伏、睡眠持续性、白天功能紊乱及PSQI总分显著高于单纯抑郁组（P〈0．05）。通过回归分析发现，年龄、生活工作压力、吸烟、饮酒等是焦虑抑郁共病患者睡眠质量的主要影响因素。结论焦虑抑郁共病患者睡眠质量较差，主要体现在主观睡眠、睡眠潜伏期、睡眠持续性、睡眠效率、白天功能紊乱等方面；年龄、生活工作压力、吸烟、饮酒是焦虑抑郁共病患者睡眠质量的主要影响因素。

Objective To investigate the factors influencing sleep disturbance and comorbid anxiety and depression after cerebral infarction. Methods A total of 216 patients with first onset of cerebral infarction were enrolled and divided into a post-stroke comorbid anxiety and depression （PSCAD） group, a pure anxiety group, a pure depression group and a non-anxiety and no-depression group. Smoking, alcohol intake, educational background, life or work pressure and exercise frequency were compared among the four groups along with ultrasound images of the carotid artery and brain blood vessels. The subjects＇ sleep quality was evaluated with the Pittsburgh sleep quality index （PSQI）. Results The conditions studied showed no significant difference among the four groups. There were significant differences among the four groups in HAMA and HAMD scores. HAMD overall scores were higher in the PSCAD group than in the other three groups. HAMA overall scores were higher in the PSCAD group than in the pure depression group or the non-anxiety and no-depression groups. The PSCAD group showed significantly higher scores on all the dimensions and in their overall scores than those in the non-anxiety and no-depression group. Subjective sleep quality, sleep latency, sleep duration, sleep efficiency, day-time dysfunction and the overall PSQI score were all significantly higher in the PSCAD group than in the pure anxiety group. Sleep latency, sleep duration, day-time dysfunction and the overall PSQI scores were significantly higher in the PSCAD group than in the pure depression group. Age, life or work pressure, smoking, alcohol intake were the main factors influencing sleep quality in the PSCAD group. Conclusions The sleep quality of anxious and depressed patients after cerebral infarction is worse than that of those suffering only anxiety or depression alone, especially in terms of subjective sleep quality, sleep latency, sleep duration, sleep efficiency and day-time dysfunction. Age, life or work pressure, smoking and alcohol intake arc the main factors influencing sleep quality in such eomorbid individuals after cerebral infarction.