主诉失眠的门诊就诊者主客观评估的睡眠质量与生命质量

Objective and subjective sleep quality and quality of life in patients with chief complaint of insomnia

目的:失眠者的主观睡眠感与实际睡眠情况常有不一致的现象,本研究通过探讨以失眠为主诉的门诊就诊者睡眠质量的主观、客观评估指标与生命质量的相关性,为临床制定失眠的整体治疗方案提供参考依据。方法:连续收集64例以失眠为主诉的接受多导睡眠图(PSG)检查的门诊患者的资料,用匹兹堡睡眠质量指数(PSQI)评估主观睡眠质量,SF-36健康调查量表评估生命质量,用贝克抑郁问卷(BDI)、贝克焦虑问卷(BAI)评估情绪状态。以17例正常人的PSG数据作为客观睡眠质量的基础对照。结果:本组失眠就诊者90%主观评价睡眠质量差,其PSG指标中与正常对照相比睡眠潜伏期延长、清醒次数增加、睡眠效率降低、快动眼睡眠潜伏期延长(均P<0.05)。失眠就诊者PSQI总分与SF-36生理健康总分呈负相关(r=-0.25,P<0.05),但以BDI、BAI分作为控制变量进行偏相关分析显示,PSQI总分及各因子分与SF-36生理健康和心理健康总分相关性无统计学意义;PSG主要指标与SF-36生理健康和心理健康总分相关性无统计学意义。结论:本研究显示失眠者主观感受的睡眠质量更可能与生命质量相关,但与失眠相关的抑郁、焦虑情绪可能起到主要作用,这提示失眠治疗中应重视改善患者的主观睡眠质量,以及识别和处理情绪问题。

Objective： There are differences between subjective and objective assessment of sleep in the insomniacs. In this study, we compared the correlation between the subjective and objective assessment of sleep and quality of life in patients with the chief complaint of insomnia, in order to provide clinical evidence for the treatment of insomnia. Methods： A total of 64 patients with the chief complaint of insomnia were examined successively with polysomnography （PSG）, and the PSG paramenters were used to assess objective sleep. The PSG data of 17 heathy people were used as control. The Pittsburgh Sleep Quality Index （PSQI） was used to evaluate the subjective sleep quality, the Short Form 36 Health survery Questionnaire （SF-36） were used to evaluate quality of life, and the Beck Depression Inventory （BDI） and Beck Anxiety Inventory （BAI） were used to evaluate emotional status. Results： Ninety percent of patients had poor subjective sleep quality. Compared with healthy controls, patients demonstrated prolonged sleep latency, increased wakefulness time after slee＇p onset, lower sleep efficiency and prolonged rapid eye movement sleep latency （Ps 〈 0. 05）. The PSQI scores had negative correlation with SF-36 physical health scores （r = -0. 25, P 〈0. 05）, but the significance was reduced when controlled for scores of BDI and BAI. There was no significant correlation between PSG parameters and SF-36 physical health scores. Conclusion： In patients with insomnia, subjective assessment of sleep quality might have stronger correlation with quality of life, in which the insomnia related depressive and anxious symptoms may play a major role. It indicates that we should pay attention to the improvement of subjective sleep quality, also identify and manage the emotional problems promptly in the treat- ment of insomnia.