妊娠期女性睡眠质量的横断面调查

A cross-sectional study on sleep quality of pregnant women

目的了解妊娠期妇女睡眠状况及其影响因素。方法于2019年10月至11月对在安徽医科大学第一附属医院和第二附属医院做产科检查及住院的孕妇进行问卷调查,收集孕妇的一般资料、妊娠情况,结合主观症状描述和匹兹堡睡眠质量指数(PSQI)、阿森斯失眠量表(AIS)、不宁腿综合征量表(RLS-S)和Epworth嗜睡量表(ESS)评估睡眠质量,运用抑郁自评量表(SDS)和焦虑自评量表(SAS)评估孕妇情绪状况。共发放300份量表,回收有效量表212份。将孕妇分为早孕组、中孕组及晚孕组;以PSQI=7分为界点,PSQI≥7分的孕妇为睡眠障碍组,PSQI<7分为睡眠正常组。了解各组孕妇的睡眠及情绪状况并分析影响因素。结果有1种及以上睡眠障碍的孕妇145例(68.4%),报告最常见的前8种睡眠障碍是思睡、打鼾、睡前肢体不适、夜尿增多、梦呓、多汗、失眠、噩梦。早孕组、中孕组及晚孕组间尿频(χ^(2)=45.076)、梦呓的发生率(χ^(2)=9.050)及RLS-S量表评分(Z=6.971)比较差异均有统计学意义(均P<0.05)。与早孕组比较,中孕组孕妇的思睡症状发生率较低(χ^(2)=5.250,P<0.05),晚孕组尿频发生率高(χ^(2)=6.466,P<0.05)、RLS-S评分较高(Z=2.441,P<0.05);与中孕组比较,晚孕组孕妇的梦呓发生率较低(χ^(2)=9.060,P<0.05)、尿频发生率高(χ^(2)=4.174,P<0.05)、ESS评分较低(Z=1.229,P<0.05)。与睡眠正常组比较(PSQI<7分),睡眠障碍组(PSQI≥7分)孕妇AIS、RLS-S、ESS、SDS、SAS得分显著增高(Z/t值分别为8.083、4.191、2.347、3.638、4.625,均P<0.05)。控制年龄后的偏相关分析结果显示PSQI、AIS分别与SDS、SAS呈正相关(r=0.318~0.565),RLS-S与SAS、孕周呈正相关(r分别为0.394、0.201,均P<0.05),ESS与PSQI、AIS、RLS-S呈正相关(r分别为0.334、0.312、0.260,均P<0.05)。结论妊娠期妇女睡眠障碍发生率高。随着孕周的增加,尿频、肢体不适症状明显,情绪与睡眠质量、思睡程度相互影响。

Objective To investigate the sleep status of pregnant women and its influencing factors.Methods A questionnaire survey was conducted among pregnant women who underwent obstetric examination and were hospitalized in the First and Second Affiliated Hospital of Anhui Medical University from October to November,2019.The general information and pregnancy status were collected.And the sleep quality was assessed by subjective symptom descriptions and scales evaluation,including Pittsburgh Sleep Quality Index(PSQI),Athens Insomnia Scale(AIS),Restless Legs Syndrome Scale(RLS-S)and Epworth Sleepiness Scale(ESS),while the emotional status was assessed by Self-Rating Depression Scale(SDS)and Self-Rating Anxiety Scale Table(SAS).A total of 300 scales were issued,and 212 valid scales were recovered.The pregnant women were divided into early pregnancy group,middle pregnancy group and late pregnancy group,or divided into sleep disorder group(PSQI≥7)and normal sleep group(PSQI<7)by PSQI=7.Finally,the sleep and emotional status of pregnant women in each group were analyzed.Results There were 145 pregnant women with one or more sleep disorders(68.4%).The top 8 most common syndromes were sleepiness,snoring,physical discomfort before going to bed,increased nocturnal urination,somniloquism,sweating easily,insomnia and nightmares.There were significant differences in nocturia frequency(χ^(2)=45.076),the incidence of somniloquism(χ^(2)=9.050)and RLS-S scores(Z=6.971)among the early pregnancy group,the middle pregnancy group and the late pregnancy group(all P<0.05).Compared to the early pregnancy group,the middle pregnancy women had lower incidence of sleepiness symptom(χ^(2)=5.250,P<0.05),and the late pregnancy women had higher incidence of nocturia frequency(χ^(2)=6.466,P<0.05)and higher RLS-S scores(Z=2.441,P<0.05).Compared to the middle pregnancy group,the late pregnancy women had lower somniloquism syndrome(χ^(2)=9.060,P<0.05)and lower ESS score(Z=1.229,P<0.05),and higher frequency night urination(χ^(2)=4.174,P<0.05).Compared to the normal sleep group(PSQI<7),the scores of AIS,RLS-S,ESS,SDS and SAS in the sleep disorder group(PSQI≥7)were significantly higher(Z=8.083,4.191,2.347,t=3.638,4.625,all P<0.05).After controlling‘age’,the partial correlation analysis showed that the scores of PSQI and AIS were positively correlated with SDS and SAS,respectively(r values ranged from 0.318 to 0.565),and the RLS-S score was positively correlated with SAS and gestational week(r=0.394 and 0.201,respectively,both P<0.05),the ESS score was positively correlated with PSQI,AIS and RLS-S scores(r=0.260,0.312 and 0.334,all P<0.05).Conclusion Pregnant women have a high incidence of sleep disorders.With the increase of gestational weeks,frequent urination,physical discomfort symptoms are obvious,and mood,sleep quality,and sleepiness affect each other.