睡眠时长和睡眠质量与卒中后抑郁状态的关系研究

Correlation between Sleep Duration,Sleep Quality and Post-Stroke Depression

目的探讨睡眠时长和睡眠质量与卒中后抑郁状态的关系。方法前瞻性连续纳入2017年7月-2019年5月在天津医科大学总医院神经内科住院的卒中患者为研究对象,根据抑郁自评量表(sel f-rating depression scale,SDS)和17项汉密尔顿抑郁量表(Hamilton depression scale-17,HAMD-17)评分将患者分为抑郁状态组和非抑郁状态组。睡眠时长和睡眠质量采用研究人员问询和受试者主观自评方式评估,按睡眠时长分为<7 h、7~<8 h、8~<9 h、9~<10 h和≥10 h组,睡眠质量分为好、一般和差3个等级。采用自制问卷收集患者的人口学、生活方式[吸烟、酗酒和国际体力活动问卷(international physical activity questionnaire,IPAQ)]、BMI、疾病史等信息。结果共入组836例卒中患者,抑郁状态组453例(54.2%),非抑郁状态组383例(45.8%)。抑郁状态组的睡眠质量较非抑郁状态组差(P<0.001),但两组的睡眠时长差异无统计学意义;抑郁状态组的I PAQ评分更低(P<0.001),女性比例更高(P=0.034),有疾病史者比例更高(P=0.006)。logistic回归分析显示,与睡眠质量好相比,睡眠质量一般(OR 1.729,95%CI 1.232~2.428,P=0.002)和睡眠质量差(OR 1.817,95%CI 1.250~2.640,P=0.002)均增加卒中后抑郁状态的风险;睡眠时长对卒中后抑郁状态的影响不显著。结论卒中患者抑郁状态的发生率较高,睡眠质量是卒中后抑郁状态的独立预测因素。

Objective To investigate the correlation between sleep duration,sleep quality and post-stroke depression.Methods This prospective study consecutively enrolled stroke inpatients in the Department of Neurology,General Hospital of Tianjin Medical University from July 2017 to May 2019.The patients were divided into depression group and non-depression group according to self-rating depression scale(SDS)and Hamilton depression scale-17(HAMD-17)scores.Sleep duration and sleep quality were assessed based on a self-report.According to the sleep duration,the patients were divided into 5 groups(<7 h,7-<8 h,8-<9 h,9-<10 h and≥10 h).The sleep quality was divided into 3 grades(good,average and poor).The demographic,lifestyle,BMI,disease history and other information of the patients were collected by self-designed questionnaire.Results A total of 836 stroke patients were enrolled,including 453(54.2%)in depression group and 383(45.8%)in non-depression group.The sleep quality of depression group was worse than that of non-depression group(P<0.001),but there was no statistical difference in sleep duration between the two groups. In addition, the international physical activity questionnaire (IPAQ) scorewas lower (P <0.001), the proportion of female was higher (P =0.034), and the proportion of patientswith chronic disease history was higher (P =0.006) in depression group than that in non-depressiongroup. Logistic regression analysis showed that general sleep quality (OR 1.729, 95%CI 1.232-2.428,P =0.002) and poor sleep quality (OR 1.817, 95%CI 1.250-2.640, P =0.002) increased the risk ofdepression, compared with good sleep quality;sleep duration had no significant effect on depression.Conclusions Stroke patients are a high risk group of depression, and sleep quality is anindependent predictor of post-stroke depression.