2型糖尿病患者恐惧疾病进展对睡眠质量的影响:执行功能的作用路径

Effect of fear of disease progression on sleep quality in patients with type 2 diabetes mellitus:the pathway of executive function

背景 2型糖尿病患病率较高,给患者家庭和社会带来沉重负担。睡眠障碍是糖尿病发病的危险因素。睡眠障碍可通过神经-内分泌-代谢通路影响糖尿病的发生发展。关注糖尿病患者睡眠质量的影响因素,对改善其睡眠质量至关重要。目的 探讨2型糖尿病患者恐惧疾病进展、执行功能及睡眠质量之间的关系,为改善2型糖尿病患者的睡眠质量提供参考。方法 连续选取2023年1月—5月空军军医大学第二附属医院内分泌科收治的、符合《中国2型糖尿病防治指南(2020年版)》诊断标准的2型糖尿病患者197例。采用恐惧疾病进展简化量表(FoP-Q-SF)、执行功能行为评定量表成人版(BRIEF-A)和匹兹堡睡眠质量指数量表(PSQI)评定对疾病进展的恐惧程度、执行功能及睡眠质量。采用SPSS宏程序Process中的model 4和Bootstrap法进行中介效应检验。结果 (1)检出75例(38.07%)2型糖尿病患者存在睡眠问题。(2)2型糖尿病患者PSQI评分与FoP-Q-SF评分和BRIEF-A评分均呈正相关(r=0.159、0.287,P均<0.01)。(3)执行功能是恐惧疾病进展与睡眠质量之间的作用路径,间接效应值为0.076(95%CI:0.022~0.146),占总效应的39.58%。结论 2型糖尿病患者睡眠问题较严重。执行功能可能是恐惧疾病进展与睡眠质量之间的作用路径。

Background Type 2 diabetes mellitus is one of the most prevalent diseases,which imposes a heavy burden on patients′families and the society.Sleep disorders are recognized as risk factors for the development of diabetes,which may affect the onset and development of diabetes through neuro-endocrino-metabolic pathways,so identifying the factors responsible for the sleep quality of diabetic patients is of great importance in improving their sleep quality.Objective To investigate the relationship among fear of disease progression,executive function and sleep quality in patients with type 2 diabetes mellitus,so as to provide references for improvement of sleep quality in patients with type 2 diabetes mellitus.Methods A sample of 197 patients with type 2 diabetes mellitus who were admitted to the Endocrinology Department of the Second Affiliated Hospital of the Air Force Military Medical University from January to May 2023 and met the criteria defined in the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China(2020 edition)were consecutively selected.All subjects were assessed using Fear of Progression Questionnaire-Short Form(FoP-Q-SF),Behavior Rating Inventory of Executive Function-Adult version(BRIEF-A)and Pittsburgh Sleep Quality Index(PSQI).Then the Process macro for SPSS(Model 4)and Bootstrap technique were applied to examine the mediating effect of executive function on the relationship between fear of disease progression and sleep quality in patients with type 2 diabetes mellitus.Results①75 patients(38.07%)with type 2 diabetes mellitus were found to have sleep problems.②PSQI score in patients with type 2 diabetes mellitus was positively correlated with FoP-Q-SF score and BRIEF-A score(r=0.159,0.287,P<0.01).③Executive function mediated the relationship between fear of disease progression and sleep quality,the indirect value was 0.076(95%CI:0.022~0.146),accounting for 39.58%of the total effect.Conclusion Sleep disorders are common in patients with type 2 diabetes mellitus,and executive function may play a medicating role in the relationship between fear of disease progression and sleep quality.