唾液皮质醇水平的睡眠障碍诊断价值研究

The diagnostic value of salivary cortisol level for sleep disorders

目的分析唾液皮质醇对睡眠障碍的诊断价值。方法纳入杭州市571名正常成年人为研究对象,采用化学发光免疫法测定唾液皮质醇浓度,采用匹兹堡睡眠质量指数(PSQI)量表调查睡眠质量,分析唾液皮质醇浓度与睡眠障碍的关系以及唾液皮质醇检测对睡眠障碍的诊断价值。结果共调查571人,患睡眠障碍267例,占46.76%。Logistic回归分析显示,唾液皮质醇浓度与睡眠障碍患病有关(OR=1.870, 95%CI:1.691～2.068);男性(OR=0.628, 95%CI:0.401～0.983)患睡眠障碍的风险低于女性。ROC曲线分析显示,分别以唾液皮质醇浓度6.55 nmol/L (男)、 7.40nmol/L (女)为诊断的最佳阳性临界点,其对应的AUC值分别为0.873 (95%CI:0.839～0.911)、 0.885 (95%CI:0.841～0.929),灵敏度分别为78.5%、 68.3%,特异度分别为84.0%、 87.8%。结论唾液皮质醇浓度与睡眠障碍患病存在正性关联,唾液皮质醇检测可辅助诊断睡眠障碍,建议男、女性诊断阳性临界点浓度分别为6.55、 7.40 nmol/L。

Objective To evaluate the diagnostic value of salivary cortisol for sleep disorders.Methods A total of 571 normal adults in Hangzhou were included,the concentration of saliva was determined by chemiluminescence immunoassay.The sleep quality was investigated by the Pittsburgh Sleep Quality Index(PSQI)scale.The relationship between salivary cortisol concentration and the diagnostic value of salivary cortisol derection for sleep disorders were analyzed.Results A total of 571 people were investigated and 267 cases of sleep disorders were found,accounting for 46.76%.Logistic regression analysis showed that salivary cortisol concentration was associated with sleep disorders(OR=1.870,95%CI:1.691-2.068),male(OR=0.628,95%CI:0.401-0.983)had a lower risk of sleep disorders than female.The ROC curve analysis showed that the salivary cortisol concentration of 6.55 nmol/L(male)and 7.40 nmol/L(female)were the best positive critical points for the screening test,with the corresponding AUC being 0.873(95%CI:0.839-0.911)and 0.885(95%CI:0.841-0.929),sensitivity being 78.5%and 68.3%,and specificity being 84.0%and 87.8%.Conclusion There was a positive correlation between salivary cortisol concentration and sleep disorders;saliva cortisol test can be auxiliary diagnosis of sleep disorders.It was recommended that the positive critical point of male and female diagnosis were 6.55 and 7.40 nmol/L,respectively.