主观性失眠与脑血管病慢性期功能预后的关系研究:基于多中心前瞻性研究的事后分析

The Relationship between Subjective Insomnia and Functional Prognosis in the Chronic Phase of Cerebrovascular Disease:A Post-Hoc Analysis Based on a Multicenter Prospective Study

目的 探索脑血管病患者主观性失眠与慢性期功能预后的关系。方法 本研究是对多中心、大型前瞻性研究--中国卒中后抑郁发生及其结局的前瞻性队列研究(prospective cohort study on the incidence and outcome of patients with post-stroke depression in China,PRIOD)的事后分析。选取PRIOD中入组患者人数较多的15个中心,对入组的脑血管病患者进行发病5年后的电话随访。收集患者的一般资料、临床特点。根据《精神障碍诊断与统计手册》(第五版)中失眠的诊断标准编制调查问卷,收集失眠及相关睡眠问题,评估患者是否存在主观性失眠以及睡眠时间。采用mRS评估患者的功能预后。采用多因素logistic回归分析脑血管病患者主观性失眠与功能预后的关系。结果 本研究共纳入698例患者,其中319例(45.70%)为主观性失眠患者,仅17.55%(56/319)服用助眠药物。logistic回归分析显示,主观性失眠与脑血管病患者功能预后存在显著关联:校正协变量后,与无失眠患者相比,主观性失眠患者功能残疾风险较高(OR 1.64,95%CI 1.11~2.42,P=0.013);亚组分析显示,在基线为首次脑血管病发作患者中,与无失眠患者相比,主观性失眠患者功能残疾的风险较高(OR 1.74,95%CI 1.13~2.68,P=0.013)。结论 主观性失眠是导致脑血管病慢性期功能残疾的危险因素。

Objective To explore the relationship between subjective insomnia and functional prognosis in the chronic phase of patients with cerebrovascular disease.Methods This study is a post-hoc analysis of the multicenter,large-scale prospective study—prospective cohort study on the incidence and outcome of patients with post-stroke depression in China(PRIOD).Fifteen centers with a high number of patients enrolled in the PRIOD were selected,and the patients were followed up by telephone 5 years after the onset of cerebrovascular disease.General information and clinical characteristics were collected.According to the diagnostic criteria of insomnia in the Diagnostic&Statistical Manual of Mental Disorders(Fifth Edition),a questionnaire was compiled to collect data on insomnia and related sleep issues,and to assess the presence of subjective insomnia and sleep duration.The functional prognosis was evaluated by mRS.Multivariate logistic regression was used to analyze the relationship between subjective insomnia and functional prognosis in cerebrovascular disease patients.Results A total of 698 patients were included,of which 319(45.70%)had subjective insomnia.Only 17.55%(56/319)were taking sleep aids.Logistic regression analysis revealed a significant association between subjective insomnia and functional prognosis in cerebrovascular disease patients:after adjusting for covariates,subjective insomnia patients had a higher risk of functional disability compared to those without insomnia(OR 1.64,95%CI 1.11-2.42,P=0.013).Subgroup analysis showed that among patients experiencing their first cerebrovascular event at baseline,those with subjective insomnia had a higher risk of functional disability compared to those without insomnia(OR 1.74,95%CI 1.13-2.68,P=0.013).Conclusions Subjective insomnia is a risk factor for functional disability in the chronic phase of patients with cerebrovascular disease.