老年慢性失眠患者血清下丘脑-垂体-肾上腺轴激素水平变化及其与睡眠质量和认知功能的相关性

Changes of serum levels of hypothalamic-pituitary-adrenal axis hormones and its correlation with sleep quality and cognitive function in elderly patients with chronic insomnia

目的 探讨老年慢性失眠患者血清下丘脑-垂体-肾上腺轴(HPA)激素[促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)、皮质醇(COR)]水平变化及其与睡眠质量和认知功能的相关性。方法 选取2019年6月至2021年6月在中国人民解放军联勤保障部队第九〇一医院(以下简称“我院”)就诊的老年慢性失眠患者88例作为观察组,另选择我院同期80名健康体检者作为对照组。比较两组血清HPA激素指标(CRH、ACTH、COR)、光电容积脉搏波描记法监测指标(总睡眠时间、睡眠潜伏期、睡眠效率、觉醒次数)及睡眠认知相关量表[匹兹堡睡眠质量指数(PSQI)、失眠严重指数(ISI)、简易精神状况检查(MMSE)、蒙特利尔认知评估量表(MoCA)]评分的差异,并分析老年慢性失眠患者血清HPA激素指标与睡眠、认知指标间的相关性。结果 观察组血清CRH、COR、睡眠潜伏期、觉醒次数、PSQI、ISI高于对照组,总睡眠时间、睡眠效率及MMSE、Mo CA评分低于对照组,差异有统计学意义(P<0.05)。相关性分析结果显示,老年慢性失眠患者血清CRH、COR水平与睡眠潜伏期、觉醒次数、PSQI、ISI评分呈正相关(r>0,P<0.05),与总睡眠时间、睡眠效率及MMSE、Mo CA评分呈负相关(r<0,P<0.05)。结论 老年慢性失眠患者血清CRH、COR水平升高,与其睡眠质量下降和认知功能损害关系密切。

Objective To investigate the changes of serum levels of hypothalamic-pituitary-adrenal axis(HPA) hormones(corticotropin-releasing hormone [CRH],adrenocorticotropic hormone [ACTH],cortisol [COR]) and its correlation with sleep quality and cognitive function in elderly patients with chronic insomnia.Methods A total of 88 elderly patients with chronic insomnia in the 901th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army(hereinafter referred to as “our hospital”) from June 2019 to June 2021 were selected as the observation group,and 80 healthy subjects in our hospital during the same period were selected as the control group.Serological HPA hormones indicators(CRH,ACTH,COR),photoplethysmography monitoring indicators(total sleep time,sleep latency,sleep efficiency,arousal times),and sleep and cognition related scales(Pittsburgh sleep quality index [PSQI],insomnia severity index [ISI],mini-mental state examination [MMSE],and Montreal cognitive assessment [Mo CA]) scores were compared between the two groups,the correlation between serological indexes and sleep and cognitive indexes in elderly patients with chronic insomnia was analyzed.Results The serum levels of CRH,COR,sleep latency,arousal times,PSQI,and ISI in the observation group were higher than those in the control group,the total sleep time,sleep efficiency,and scores of MMSE,Mo CA in the observation group were lower than those in the control group,the differences were statistically significant(P0,P<0.05),and negatively correlated with total sleep time,sleep efficiency,and scores of MMSE,Mo CA(r<0,P <0.05).Conclusion The increase of serum CRH and COR levels in elderly patients with chronic insomnia is closely related to the decline of sleep quality and cognitive impairment.