社区脑卒中及其高危人群失眠与阻塞性睡眠呼吸暂停筛查及相关因素分析

Related factors of insomnia and obstructive sleep apnea in community population at high risk of ischemic stroke

目的观察社区脑卒中及其高危人群失眠与阻塞性睡眠呼吸暂停(OSA)高风险的发生率并对其影响因素进行分析。方法 2015年2月对天津市大张庄村和劝业场社区3500例本市户籍常住居民进行横断面调查,选择脑卒中及其高危人群信息完整者作为研究对象,根据阿森斯失眠量表测评标准将研究对象分为失眠组241例和无失眠组380例。采用Stop-Bang量表测评将研究对象又分为OSA高风险组410例和OSA低风险组211例。结果筛查结果显示,失眠组焦虑自评量表(SAS)评分[(37.40±9.14)分vs(29.38±4.45)分,P=0.000]、抑郁自评量表(SDS)评分[(38.32±10.95)分vs(30.07±6.18)分,P=0.000]显著高于无失眠组。社区脑卒中及其高危人群失眠发生率为38.8%,OSA高风险率为66.0%。logistic分析短暂性脑缺血发作、饮酒,SDS评分、SAS评分是影响失眠的独立危险因素;男性、体质量指数、颈围、高血压、心脏病是影响OSA高风险的独立危险因素(P<0.05,P<0.01)。结论社区脑卒中及其高危人群中,短暂性脑缺血发作、饮酒及焦虑抑郁状态对失眠的发生产生显著影响,而男性、肥胖、颈围、高血压及心脏病与OSA高风险相关,对社区脑卒中及其高危人群早期进行上述因素的筛查,有助于脑卒中一、二级预防。

Objective To analyze the influencing factors of insomnia and obstructive sleep apnea（OSA）in community population at high risk of ischemic stroke.Methods The influencing factors of insomnia and OSA were investigated in 3500 permantent residents of Dazhangahuang Villige and Quanyechang Community of Tianjin.Residends with complete information of ischemic stroke selected were divided into insomnia group（n=241）and insomnia-free group（n=380）according to the Athens Insomnia Scale and into high OSA risk group（n=410）and low OSA risk group（n=211）according to the Stop-Bang Scale.Results The incidence of ischemic stroke and insomnia was 38.8%and that of OSA was 66.0%.Univariate and multivariate logistic regression analysis showed that transient ischemic attack,alcohol consumption,SDS and SAS score were the independent risk factors for insomnia while male,BMI,neck circumference,hypertension and heart disease were the independent risk factors for OSA（P〈0.05,P〈0.01）.Conclusion Transient ischemic attack,alcohol consumption,anxiety and depression are the risk factors for insomnia whereas male,obesity,neck circumference,hypertension and heart disease are the risk factors for OSA in cummunity population at high risk of ischemic stroke.Detection of such factors contributes to grade one or grade two prevention of ischemic srtoke.