珠三角地区创伤患者睡眠障碍与PTSD关系

Correlation between PTSD and sleep disorder: a research among patients from 8 hospitals in Pearl River Delta

目的 了解珠江三角洲地区创伤住院患者创伤后应激障碍（PTSD）与睡眠障碍的发生情况及二者关系,并分析创伤后应激障碍患者睡眠障碍的影响因素。方法 采用目的抽样法抽取珠江三角洲地区708名创伤患者,使用PTSD平民版筛查问卷（PCL-C）、匹兹堡睡眠质量指数量表（PSQI）及自编影响因素调查表进行问卷调查。结果 珠江三角洲地区708名创伤患者PTSD发生率为27.5%,其中,轻或中度症状者占68.2%（133/195）,重度症状者占31.8%（62/195）;睡眠障碍的总发生率为37.9%,其中,无症状、轻度或中度、重度PTSD症状患者睡眠障碍发生率分别为27.9%（143/513）、57.9%（77/133）、77.4%（48/62）;无PTSD症状的513人中,PSQI均分为（6.79±3.78）分,睡眠障碍143人;轻度或中度PTSD症状的133人中,PSQI均分为（6.62±3.69）分,睡眠障碍77人;重度PTSD症状的62人中,PSQI均分为（7.26±3.72）分,睡眠障碍48人;PTSD自评量表PCL-C得分与PSQI得分呈正相关（r=0.480,P〈0.05）;不同程度的PTSD患者的睡眠总体情况及7个睡眠因子差异均有统计学意义（P〈0.001）;多因素分析表明,PTSD患者睡眠障碍的主要影响因素为距事故发生时间（OR=1.303,95%CI=1.129~1.503）、脊柱受伤（OR=1.991,95%CI=1.219~3.251）和生活自理程度（OR=1.684,95%CI=1.286~2.206）。结论PTSD患者的睡眠障碍随PTSD加剧而加重,不同程度的PTSD患者的睡眠障碍表现不同,主要受距事故发生时间,脊柱受伤与否及生活自理程度的影响。

Objective To explore the correlation between post-traumatic stress disorder（PTSD） and sleep disorder among 708 patients from 8 hospitals in Pear1 River Delta, and to analyze influence factors of sleep quality among PTSD patients. Methods With target sampling,708 patients were chosen from 8 grade two hospitals in Pearl River Delta for a self-administrated anonymous questionnaire survey with PTSD Checklist-Civilian Version（PCL-C） and Pittsburgh Sleep Quality Index （PSQI） under the help of investigators. Results Among the patients, the overall prevalence of PTSD symptoms was 27. 5% ,with the proportion of 31.8% （62/195） for severe symptoms and 68.2% （133/195） for mild to moderate symptoms. The prevalences of sleeping problem were 37.9% for all the patients,27.9% （ 143/513 ） for the pa- tients without PTSD symptoms, and 57.9% （77/133） and 77.4% （48/62）for the patients with mild or moderate and se- vere PTSD symptoms, respectively. The average PSQI score was 6.79 ± 3.78 among the 513 patients without PTSD symptoms,with 143 patients having sleeping disorder; whereas,the score was 6. 62± 3.69 and 7.26 ± 3.72 among 133 patients with mild or moderate PTSD symptoms（77 having sleeping disorder） and 62 patients with severe PTSD symptoms（48 having sleeping disorder）. There was a positive correlation between PCL-C and PSQI （r = 0. 480, P 〈 0. 05 ）. There were significant differences in the general sleeping status and the 7 sleeping-related factors among the patients with different severity of PTSD symptoms. Multi-factor analyses showed that the main influence factors of sleep disorder for PTSD patients were the duration from the time of the accident（ odds ratiol OR] = 1. 303,95% confidence interval[95% CI] = 1.129 - 1. 503 ; P = 1. 303 ）, spinal injury （ OR = 1.991,95 % CI = 1.219 - 3.251 ; P = 0. 006 ） and ability of self- care （ OR = 1. 684,95 % CI = 1. 286 - 2. 206 ; P = 0. 000）. Conclusion PTSD and sleep disorder have a positive correlation. Patients with different severity of PTSD could have different performance in term of sleep disorder and the duration from the time of the accident, spine injury, and ability of self-care were main influencing factors for sleep disorder in PTSD patients.