冠心病患者睡眠质量及其影响因素分析

Analysis on sleeping quality and influencing factors of coronary heart disease patients

目的探讨冠心病患者的睡眠质量及其影响因素,为冠心病患者睡眠干预提供理论依据。方法该研究数据来自一项开放、单臂、多中心临床试验研究的基线数据,于2017年3月—2018年12月,选取全国8省(市)14家研究中心501例冠心病患者为研究对象,采用匹兹堡睡眠质量指数(PSQI)量表评估患者睡眠质量,以PSQI总分>5分定义为睡眠质量差,≤5分定义为睡眠质量良好。采用SAS 9.4统计软件进行χ2检验,冠心病患者睡眠质量的影响因素采用多因素非条件logistic回归进行分析,并进一步采用性别与年龄分层进行多因素非条件logistic回归分析,探讨不同亚组冠心病患者睡眠质量的影响因素。结果 501例患者PSQI总分为(5.15±3.22)分,其中,睡眠质量差者190例(37.92%)。女性,年龄≥60岁,伴有胃炎,心绞痛Ⅱ~Ⅳ级,心绞痛发作频率≥3次/月,病程≥3年,医保类型为城镇医保的冠心病患者睡眠质量差的比例更高,差异均有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析结果发现,城镇医保(OR=2.569)、女性(OR=2.071)、伴有胃炎(OR=2.573)、心绞痛Ⅱ~Ⅳ级(OR=2.392)以及病程≥3年(OR=1.537)与冠心病患者睡眠质量差呈正相关,均有统计学意义(P<0.05,P<0.01)。经性别分层分析发现,城镇医保(OR=3.022)、伴有胃炎(OR=2.429)、心绞痛Ⅱ~Ⅳ级(OR=2.454)以及病程≥3年(OR=1.725)与男性冠心病患者睡眠质量差呈正相关,房颤(OR=0.258)与男性冠心病患者睡眠质量差呈负相关;年龄≥60岁(OR=3.479)、心绞痛Ⅱ~Ⅳ级(OR=3.209)、病程≥3年(OR=3.132)与女性患者睡眠质量差呈正相关,均有统计学意义(P<0.05,P<0.01)。经年龄分层分析发现,心绞痛Ⅱ~Ⅳ级(OR=3.679)与年龄<60岁冠心病患者睡眠质量差呈正相关;女性(OR=2.822)、城镇医保(OR=2.568)、伴有胃炎(OR=2.405)、心绞痛Ⅱ~Ⅳ级(OR=2.002)与年龄≥60岁冠心病患者睡眠质量差呈正相关,均有统计学意义(P<0.01)。结论冠心病患者是睡眠质量差的高发人群,在对冠心病患者进行睡眠干预时应重点关注女性,城镇医保,伴有胃炎,心绞痛Ⅱ~Ⅳ级以及病程≥3年以上的患者。

Objective To explore the sleeping quality and influencing factors of coronary heart disease(CHD) patients,and to provide the theoretical basis for sleeping intervention of CHD patients.Methods Data of the study were from the baseline data of an open-label,single arm,multicenter clinical trial.From March 2017 to December 2018,501 CHD patients from 14 research centers in 8 provinces and cities in China were selected as the subjects.Pittsburgh Sleep Quality Index(PSQI) was used to evaluate the sleeping quality of patients,total score > 5 of PSQI served as the bad sleeping quality,total score ≤ 5 of PSQI served as the better sleeping quality.χ2 test was used to analyze the data,the influencing factors of sleeping quality in CHD patients were analyzed with multivariate non-conditional logistic regression method.The multivariate non-conditional logistic regression with age and gender stratification was performed to explore the influencing factors of sleeping quality in different sub-group of CHD patients.The used software was SAS 9.4.Results PSQI total score of 501 patients was 5.15 ±3.22,and 190(37.92%) patients experienced poor sleeping quality.The female patients,patients with age ≥60 years old,gastritis,angina pectoris grade Ⅱ-Ⅳ,angina pectoris attack frequency ≥3 times/month,disease duration ≥3 years,ubran insurance had higher proportion of poor sleeping quality,P <0.05 or P <0.01.The multivariate non-conditional logistic regression analysis showed that urban insurance(OR=2.569),female(OR=2.071),gastritis(OR=2.573),angina pectoris grade Ⅱ-Ⅳ (OR=2.392) and disease duration ≥3 years(OR=1.537) were positively correlated with poor sleeping quality of CHD patients(P<0.05,P<0.01).Gender stratification analysis showed that urban insurance(OR=3.022),gastritis(OR=2.429),angina pectoris grade Ⅱ-Ⅳ (OR=2.454) and disease duration ≥ 3 years(OR=1.725) were positively correlated with poor sleeping quality of male CHD patients,and atrial fibrillation(OR=0.258) was negatively correlated with poor sleeping quality of male CHD patients;age ≥ 60 years old(OR=3.479),angina pectoris grade Ⅱ-Ⅳ (OR=3.209) and disease duration ≥ 3 years(OR=3.132) were positively correlated with poor sleeping quality of female CHD patients(P<0.05,P<0.01).Age stratification analysis showed that angina pectoris grade Ⅱ-Ⅳ (OR=3.679) was positively correlated with poor sleeping quality of < 60 years old CHD patients;female(OR=2.822),urban insurance(OR =2.568),gastritis(OR =2.405),angina pectoris grade Ⅱ-Ⅳ (OR =2.002) were positively correlated with poor sleeping quality of ≥ 60 years old CHD patients(P<0.01).Conclusion CHD patients are at higher risk of experiencing poor sleeping quality.When performing sleeping intervention for CHD patients,it should be paid more attention to female CHD patients,CHD patients with urban insurance gastritis,angina pectoris grade Ⅱ-Ⅳ and disease duration ≥ 3 years.