原发性失眠主客观睡眠质量与日间功能损害的关系

Association between Sleep Quality and Impaired Daytime Functioning in Patients with Primary Insomnia

目的探讨原发性失眠患者日间功能损害及其影响因素。方法选取2010年3月-12月符合美国《精神障碍诊断与统计手册》第4版诊断标准的原发性失眠者62例,另选择性别、年龄匹配的健康睡眠者53例。失眠组和对照组均采用匹茨堡睡眠质量指数量表(PSQI)评估1个月的主观睡眠质量,多导睡眠监测(PSG)评估客观睡眠质量,并通过"主观睡眠时间/客观睡眠时间×100%"计算睡眠知觉,PSG监测后受试者完成一系列日间功能评定,包括Epworth嗜睡量表(ESS)评价嗜睡程度、Flinders疲劳量表(FFS)评价疲劳程度、贝克抑郁量表(BDI)和状态-特质焦虑量表(STAI)评估情绪状态。结果①与对照组相比,失眠组主客观睡眠质量均较差;PSQI分数更高[(14.37±2.44)、(2.74±1.79)分,P<0.001)];睡眠知觉差[(49.76±33.29)、(99.36±12.79)分,P<0.001)]。②失眠组FSS、BDI、SAI、TAI分数明显高于对照组,ESS分数低于对照组(P值均<0.05)。③PSQI总分与ESS呈负相关(r=0.17,P<0.01),与FSS、BDI、SAI、TAI分数呈正相关(r=0.54,r=0.66,r=0.70,r=0.87)(P值均<0.01)。客观睡眠时间与ESS(r=0.01,P=0.138)、FSS(r=0.02,P=0.019)、BDI(r=0.03,P=0.022)、SAI(r=0.03,P=0.086)、TAI(r=0.04,P=0.015)分数均无明显相关性。结论原发性失眠者主观睡眠质量与多项日间功能损害相关,这为有效的治疗失眠和改善日间症状提供理论依据。

Objective To investigate impaired daytime functioning and its influence factors in patients with primary insomnia（PI）.Methods From March to December 2010,62 PI patients and 53 good sleeper controls（GSC） matched on age and sex were included in the study.All participants completed the Pittsburgh Sleep Quality Index（PSQI） assessment,including all-night polysomnography（PSG）,a battery of daytime functioning questionnaires and a medical disorders checklist.The daytime functioning assessment included Epworth Sleepiness Scale（ESS）,Flinders Fatigue Scale（FSS）,Beck Depression Inventory（BDI）,and State-trait Anxiety Inventory（STAI）.Sleep perception was calculated as subjective sleep time/objective sleep time×100%.Results PI patients demonstrated significant impairment on sleep quality compared with GSC.PI patients had significantly greater scores of PSQI than the controls（14.37 ± 2.44,2.74 ± 1.79;P0.001）.The mean sleep perception scores were 49.76 ± 33.29 for the insomniacs and 99.36 ± 12.79 for the controls（P0.001）.Compared with the controls,PI patients had significantly greater scores of FFS,BDI,and STAI.However,PI patients experienced lower score of ESS compared with GSC.These differences were all statistically significant（P0.05）.The total PSQI score was negatively correlated with ESS（r=–0.17,P0.01）,and positively correlated with FSS,BDI,SAI,and TAI（r=0.54,r=0.66,r=0.70,r=0.87）（P0.01）.Objective sleep time was not obviously correlated with ESS（r=-0.01,P=0.138）,FSS（r=-0.02,P=0.019）,BDI（r=-0.03,P=0.022）,SAI（r=-0.03,P=0.086）,TAI（r=-0.04,P=0.015）.Conclusion Individual subjective sleep quality is related to various daytime functioning impairments,which provides a theoretical basis for the treatment of insomnia and improvement of daytime symptoms.