住院心房颤动患者睡眠状况调查及相关因素分析

Investigation of sleep status and correlative factors in hospitalized patients with atrial fibrillation

目的了解住院心房颤动(房颤)患者睡眠质量并探讨其影响因素。方法对2019年10月至12月在中国医学科学院阜外医院心律失常中心住院的房颤患者进行回顾性分析, 采用匹兹堡睡眠质量指数(PSQI)测评睡眠质量, 以PSQI总分>7分定义为睡眠障碍, 依据PSQI评分将患者分为无睡眠障碍组及睡眠障碍组。采用单因素分析及多因素Logistic回归分析患者睡眠质量影响因素, 以P<0.05为差异有统计学意义。采用多因素Logistic回归分析评价不同心理状态患者(单独合并焦虑、单独合并抑郁、同时合并焦虑及抑郁)睡眠障碍发生风险。结果入选332例房颤患者, 年龄(58.60±10.47)岁, 其中男225例(67.8%, 225/332)。PSQI评分为6.0(6.0)分, 睡眠障碍发生率为34.0%(113/332)。单因素分析显示性别(χ^(2)=8.24, P=0.004)、年龄(χ^(2)=5.05, P=0.025)、焦虑(χ^(2)=14.00, P<0.001)、抑郁(χ^(2)=16.35, P<0.001)可能为睡眠质量的影响因素。多因素Logistic回归分析显示年龄(OR=1.77, 95%CI 1.05~2.98, P=0.033)、抑郁(OR=2.06, 95%CI 1.19~3.55, P=0.010)对房颤患者睡眠质量有显著影响, 差异有统计学意义;性别(OR=1.63, 95%CI 0.99~2.70, P=0.057)、焦虑(OR=1.83, 95%CI 0.99~3.41, P=0.055)对房颤患者睡眠质量的影响差异无统计学意义。以既无焦虑亦无抑郁组作为对照, 经年龄、性别校正, 单独合并焦虑组患者睡眠障碍风险与对照组相比差异无统计学意义(OR=2.06, 95%CI 0.72~5.94, P=0.180);单独合并抑郁组与同时合并焦虑及抑郁组患者睡眠障碍风险分别约为对照组的2.14倍(OR=2.14, 95%CI 1.16~3.96, P=0.016)、3.69倍(OR=3.69, 95%CI 1.94~7.01, P<0.001), 差异有统计学意义。结论住院房颤患者睡眠障碍发生率较高, 与高龄、抑郁密切相关, 女性、焦虑可能亦为危险因素, 其中同时合并焦虑及抑郁患者睡眠障碍风险最高。

Objective To investigate the sleep quality and related factors among atrial fibrillation(AF)inpatients.Methods The AF inpatients From October 2019 to December 2019 in Center of Arrhythmia of Fuwai Hospital were retrospectively included and analyzed.The sleep quality was assessed using the Pittsburgh sleep quality index(PSQI),and the total score of PSQI>7 was defined as sleep disorder.Univariate analysis and multivariate Logistic regression were used to identify potential influencing factors of sleep quality,and differences were considered statistically significant at the 5%level(P<0.05).Multivariate Logistic regression analysis was used to evaluate the risk of sleep disorders in patients with different psychological states(anxiety alone,depression alone,both anxiety and depression).Results Three hundred and thirty-two patients were involved in the study with an average age of(58.60±10.47)years,and 225(67.8%,225/332)were male.The median(inter-quartile range)score of PSQI was 6.0(6.0),and 34.0%(113/332)had sleep disorders.Univariate analysis indicated that gender(χ^(2)=8.24,P=0.004),age(χ^(2)=5.05,P=0.025),anxiety(χ^(2)=14.00,P<0.001),depression(χ^(2)=16.35,P<0.001)may be the influencing factors of sleep quality.Multivariable Logistic regression analysis showed that sleep quality was statistically significantly associated with age(OR=1.77,95%CI 1.05-2.98,P=0.033)and depression(OR=2.06,95%CI 1.19-3.55,P=0.010);while not statistically significantly associated with gender(OR=1.63,95%CI 0.99-2.70,P=0.057)and anxiety(OR=1.83,95%CI 0.99-3.41,P=0.055).Taking patients who had neither depression nor anxiety as a control group,the adjusted odds ratio of having poor sleep quality was 2.06-fold higher in patients with anxiety alone(OR=2.06,95%CI 0.72-5.94,P=0.180),2.14-fold higher in patients with depression alone(OR=2.14,95%CI 1.16-3.96,P=0.016),and 3.69-fold higher in patients who had both depression and anxiety(OR=3.69,95%CI 1.94-7.01,P<0.001).Conclusion The prevalence of sleep disorders in AF inpatients was higher than that in the general population.It is closely related to advanced age and depression,female and anxiety may also be risk factors.Patients with both anxiety and depression have the highest risk of sleep disorder.