社区轻中度慢性阻塞性肺疾病患者睡眠质量与急性加重风险关联的前瞻性研究

Association between sleep quality and risk of acute exacerbation of mild and moderate chronic obstructive pulmonary disease:a community-based prospective study

【目的】研究上海市浦东新区社区轻中度慢性阻塞性肺疾病(COPD)患者睡眠质量与病情急性加重风险之间的关联。【方法】采用随机整群抽样的方法,选取浦东新区10个社区的轻中度COPD患者进行基线及前瞻性随访,通过问卷调查收集患者人口学特征、疾病信息、睡眠质量(匹兹堡睡眠质量指数量表)及病情急性加重发生情况等信息。采用多因素负二项回归估计睡眠质量与急性加重风险的关系。【结果】212名研究对象参与基线调查并完成随访,轻度COPD患者占95.8%。女性略多于男性,65岁以上患者占54.2%,睡眠质量较差的患者约占32.9%。18.9%的患者在随访时自报过去1年间发生过急性加重。负二项回归结果表明,随着睡眠质量下降,急性加重风险增加,调整后RR值为1.12(95%CI:1.02~1.24),其中,睡眠效率低的患者发生急性加重风险升高,其调整后RR值为1.66(95%CI:1.17~5.43)。【结论】社区轻中度COPD患者的急性加重风险受睡眠质量影响显著,尤其存在睡眠效率低的患者。提示对睡眠质量应在社区及患者自我管理中加以关注,以提升患者的健康状态。

[Objective]To investigate the association between sleep quality and the risk of acute exacerbation in mild and moderate chronic obstructive pulmonary disease(COPD)patients in Pudong New Area of Shanghai.[Methods]This was a prospective study involving eligible mild and moderate COPD patients from 10 communities randomly selected in Pudong New District of Shanghai.A structured questionnaire was used to collect demographic characteristics,clinical information and information on acute exacerbation.Sleep quality was assessed using the Pittsburgh Sleep Quality Index(PSQI)in Chinese.Multiple negative binomial regression was used to estimate the association between sleep quality and risk of exacerbation.[Results]Altogether 212 mild/moderate COPD patients participated and completed the entire survey,of whom the majority(95.8%)were mild COPD patients,110 persons female and over half(54.2%)over 65 years old.32.9%of the patients had poorer sleep quality at baseline.18.9%of the patients reported exacerbation over the past year during follow-ups.Multiple negative binomial regression suggested that increased PSQI was related to higher risk of exacerbation(RRad=1.12,95%CI:1.02-1.24),and patients with poorer sleep efficiency had a higher risk of exacerbation(RRad=1.66,95%CI:1.17-5.43).[Conclusion]Poorer sleep quality is associated with a higher risk of exacerbation in community mild/moderate COPD patients,especially in those with problem of sleep efficiency.More attention to sleep disorders is warranted in community management or self-management of patients with COPD.