精神分裂症共病失眠患者睡眠认知特征及相关因素研究

Cognitive characteristics of sleep and related factors in patients with schizophrenia comorbid with insomnia

目的探讨精神分裂症共病失眠患者的睡眠认知特征及影响因素。方法按照DSM—IV诊断标准入组61名共病失眠的精神分裂症患者，62名原发性失眠患者及64名正常睡眠者，采用睡眠功能失调信念与态度量表（DBAS）、匹兹堡睡眠质量指数量表（PSQI）对三组被试进行评估，用阳性和阴性症状量表（PANSS）评估精神分裂症患者的精神症状。结果精神分裂症失眠组PQSI日间功能因子分[（1．72±0．92）分]高于原发性失眠组[（1．32±0．99）分]，入睡时问因子上，原发性失眠组得分[（2．45±0．71）分]高于精神分裂症失眠组[（2．11±0．97）分，P〈0．05]；除“改善睡眠方法的错误信念”因子外，正常组的DBAS总分[（79．44±10．53）分]及各凶子分均高于精神分裂症失眠组[（68．26±11．76）分]和原发性失眠组[（67．85±11．39）分，P〈0．01]；精神分裂症共病失眠患者中，DBAS因子“对睡眠的期望”（β=-0．425，P=0．009）和“对睡眠药物的看法”（β=-0．239，P=0．048）是睡眠质量的影响因素，原发性失眠者中，DBAS因子“对失眠后果的灾难化解释”（β=0．279，P=0．001）、“对睡眠的控制与预测”（β=-0．291，P=0．017）及年龄（β=0．078，P=0．020）因素影响睡眠质量。结论精神分裂症失眠患者与原发性失眠患者比正常睡眠者存在更多的错误睡眠认知，其错误信念会较大地影响睡眠质量。

Objective To explore cognitive characteristics of sleep and analyze its influencing fac- tors in patients with schizophrenia comorbid insomnia. Methods 61 patients with schizophrenia comorbid with insomnia, 62 patients with primary insomnia and 64 normal sleepers were recruited according to DSM-IV.The subjects in the three groups were measured by Dysfunctional Beliefs and Attitudes about Sleep Scale（DBAS） and Pittsburgh Sleep Quality Index（PSQI） .Patients with schizophrenia were also measured by the Positive And Negative Symptom Scale（PANSS）. Results The day function factor of PQSI for the schiz- ophrenic patients（1.72±0.92） was significantly higher than that for the primary insomniacs（1.32±0.99） （P〈 0.05） .The time to fall asleep factor of PQSI for the primary insomniacs （2.45±0.71） was significantly higher than that in the patients with schizophrenia （2.11 ±0.97）. In addition to the false beliefs about improving sleep factor, the total and all factor scores of DBAS for the normal sleepers（79.44± 10.53） were higher than that in schizophrenic group（ 68.26± 11.76） and primary insomnia group（ 67.85±11.39） （all P〈0.01 ）.The ex- pectations on sleep factor （β = - 0.425, P = 0.009） and the attitudes towards sleep medications factor （β = -0.239,P= 0.048）were the influencing factors on sleep quality in schizophrenic patients comorbid with in- somnia.The estimation of the consequences of insomnia （β=-0.279, P= 0.001 ）, predictive and control of sleep（β=-0.291 ,P=0.017）as well as age factors（β= 0.078,P= 0.020） were the influencing factors on in primary insomnia patients. Conclusion Patients with schizophrenia comorbid with insomnia and patients with primary insomnia have more distorted cognitions towards sleep, and their cognitions can greatly affect thequality of sleep.