社区人群失眠合并睡眠呼吸障碍的患病率及疾病特征

Prevalence and characteristics of comorbid insomnia and sleep apnea in community population

目的分析社区人群失眠合并睡眠呼吸障碍(SDB)的患病率及疾病特征。方法本研究为横断面研究。于2021年4—5月,在汕头和梅州整群抽取社区常住居民,完成居民一般信息采集、睡眠相关健康调查和睡眠监测。失眠严重程度指数(ISI)≥8定义为失眠。睡眠监测采用Ⅳ型可穿戴式智能监测设备。同时符合失眠和SDB诊断,定义为失眠合并SDB。通过SPSS25软件,分析单纯失眠、单纯SDB和失眠合并SDB的患病率及特征;通过logistic回归分析睡眠障碍与睡不解乏、糖代谢异常、高脂血症、心血管疾病的关系。结果共完成3730例城乡居民调查,中位年龄55.0(46.0,63.0)岁,单纯失眠、单纯SDB、失眠合并SDB的患病率分别为26.0%、20.2%、10.4%。经年龄、性别、体重指数、吸烟、饮酒、糖代谢异常、高脂血症校正后,单纯失眠睡不解乏发生率是无失眠无SDB者的2.900倍(P<0.001),失眠合并SDB睡不解乏发生率为3.777倍(P<0.001);单纯失眠、单纯SDB、失眠合并SDB患者高脂血症风险均增加(OR=1.553、1.415、1.868,均P<0.05);单纯SDB心血管疾病风险增加40.8%(P=0.001),失眠合并SDB心血管风险增加42.1%(P=0.007)。分层分析结果显示,年轻(<60岁)、体重指数正常(<25 kg/m^(2))的女性失眠合并SDB患者心血管疾病风险增高。体重指数正常的女性单纯失眠或失眠合并SDB患者的高脂血症风险升高。结论社区居民有高的失眠合并SDB患病率;失眠合并SDB患者睡不解乏症状明显,与高脂血症、心血管疾病风险增高相关。

Objective To analysis the prevalence and characteristics of comorbid insomnia and sleep disordered breathing(SDB)in community population.Methods This is a cross-sectional study.Cluster sampling was applied.Community residents in Shantou and Meizhou were investigated during April to May,2021.Essential information collection,sleep related health investigation,and sleep study were conducted.Insomnia was defined as the insomnia severity index(ISI)≥8.A typeⅣwearable intelligent sleep monitor was applied for sleep study.Comorbid insomnia and SDB was defined as both diagnosis of insomnia and SDB.Statistical analysis was conducted by SPSS 25.Prevalence and characteristics of insomnia only,SDB only and comorbid insomnia and SDB were analyzed.Logistic regression was conducted to analyze the relationship between sleep disorders and unrestored sleep,abnormal glucose metabolism,hyperlipidemia,and cardiovascular disease.Results There were 3730 residents completed the investigation.The median age was 55.0(46.0,63.0)years.The prevalence of insomnia only,SDB only,and comorbid insomnia and SDB were 26.0%,20.2%,and 10.4%respectively.The incidence of unrestored sleep in insomnia only and comorbid insomnia and SDB were 2.900 times and 3.777 times of that in no insomnia or SDB(both P<0.001);the risk of hyperlipidemia was elevated in insomnia only,SDB only and comorbid insomnia and SDB(OR=1.553,1.415,and 1.868;all P<0.05);the risk of cardiovascular disease increased 40.8%in SDB only(P=0.001),and 42.1%in comorbid insomnia and SDB(P=0.007),after adjusted by age,sex,body mass index(BMI),smoking,drinking,abnormal glucose metabolism,and hyperlipidemia.Stratified analysis revealed that young female(age<60 years)with normal BMI(<25 kg/m^(2))and comorbid insomnia and SDB were associated with higher risk of cardiovascular disease.Female with normal body weight and insomnia only or comorbid insomnia and SDB were associated with higher risk of hyperlipidemia.Conclusions The prevalence of comorbid insomnia and SDB is high in community population.Patients with comorbid insomnia and SDB present with more significant unrestored sleep,and are correlated with higher risk of hyperlipidemia and cardiovascular diseases.