电磁环境下应激性失眠的影响因素及中医证候分析

Analysis of the Influencing Factors and Traditional Chinese Medicine Syndromes of Stress-induced Insomnia Under Electromagnetic Environment

目的 了解电磁环境下参训人员的睡眠状况,分析应激性失眠的影响因素和中医证候特征。方法 2023-08-01/2023-08-03日采用整群抽样方法,随机抽取某电磁辐射单位300名男性参训人员进行横断面调查,收回有效问卷297份,以匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分>7分为应激性失眠的诊断标准,分为应激性失眠组(n=133)和正常对照组(n=164)。采集两组参训人员的一般资料。将福特应激失眠反应量表(Ford insomnia response to stress test,FIRST)评分以中位数(M=13)进行分割,将297例参训人员分为高风险人群(n=142)和低风险人群(n=155),分析失眠高、低风险人群的PSQI评分。按健康调查简表(MOS 36-item short form health survey,SF-36)、疲劳量表14(fatigue scale 14,FS-14)测评两组参训人员的生活质量和疲劳程度,采用失眠中医证候调查表进行中医证候分析。结果 电磁环境下参训人员应激性失眠的发生率为44.78%(133/297)。FIRST得分高风险人群在PSQI总分、入睡时间、睡眠时间、睡眠效率、日间功能障碍评分上均显著高于低风险人群(P均<0.01)。应激性失眠组参训人员中饮酒人数比例、本科及以上人数比例明显高于正常对照组(P均<0.01);与正常对照组比较,应激性失眠组参训人员生理健康(physical component summary,PCS)和心理健康(mental component summary,MCS)两个领域的健康程度更低,一般健康(general health,GH)、生理功能(physical functioning,PF)、生理职能(role physical,RP)、躯体疼痛(bodily pain,BP)、情感职能(role emotional,RE)、社会功能(social functioning,SF)、精力(vitality,VT)、精神健康(mental health,MH)方面评分更低(P均<0.01)。多元线性回归分析结果显示,饮酒史、FIRST、PCS和躯体疲劳程度是应激性失眠的影响因素(P<0.05)。中医证候分析显示,应激性失眠组、正常对照组参训人员的中医证候积分为23.00(11.50,36.00)分、1.89(0.00,8.75)分,应激性失眠组的中医证候积分明显高于正常对照组(Z=10.900,P<0.01);失眠主要涉及的病位有肝(22例)、心(31例)、肾(19例)、脾胃(40例),证候因素包括气虚(29例)、阴虚(18例)、气滞(8例)、痰湿(16例)、火热(51例)。结论 电磁环境下应激性失眠患者病位主要在脾胃,火热为最常见的证候要素。失眠易感性、生理健康水平和躯体疲劳程度是应激性失眠的影响因素,辨别应激性失眠的危险因素对改善参训人员睡眠质量至关重要。

Objective To find out the sleep condition of participants under electromagnetic environment,and to analyze the influencing factors of stress-induced insomnia and the characteristics of traditional Chinese medicine syndromes.Methods A cross-sectional survey of 300 male participants in an electromagnetic radiation unit was conducted using the cluster sampling method from August 1st,2023 to August 3rd,2023,a total of 297 valid questionnaires were collected,the Pittsburgh sleep quality index(PSQI) score >7 was used as the diagnostic criterion for stress-induced insomnia,and the participants were divided into stress-induced insomnia group(n=133) and normal control group(n=164).The general data of the two groups were collected.According to the median of the the Ford insomnia response to stress test(FIRST) scores(M=13),the 297 respondents were divided into high-risk(n=142) and low-risk population(n=155),and their PSQI scores were analyzed.The quality of life and fatigue levels of the participants in the two groups were assessed using MOS 36-item short form health survey(SF-36) and fatigue scale 14(FS-14),and their traditional Chinese medicine syndrome were analyzed using the insomnia traditional Chinese medicine syndrome questionnaire.Results The prevalence of stress-induced insomnia among participants in the electromagnetic environment was 44.78%(133/297).FIRST in a high-risk population in total scores of PSQI score,sleep latency,sleep time,sleep efficiency,daytime dysfunction scores were significantly higher than that of low-risk population(all P<0.01).The proportion of having history of alcohol consumption and undergraduate or above in the stress-induced insomnia group were significantly higher than those in the normal control group(all P<0.01);compared with the normal control group,the stress-induced insomnia group had a lower degree of health in both physical component summary(PCS) and mental component summary(MCS) domains,the scores of general health(GH),physical functioning(PF),role physical(RP),bodily pain(BP),role emotional(RE),social functioning(SF),vitality(VT) and mental healith(MH) were lower(all P<0.01).Multiple linear regression analysis results showed that the history of alcohol consumption,FIRST,PCS and body fatigue were influencing factors of stress-induced insomnia(P<0.05).The traditional Chinese medicine syndrome analysis showed that the traditional Chinese medicine syndrome scores were 23.00(11.50,36.00) and 1.89(0.00,8.75) in stress-induced insomnia group and normal control group,traditional Chinese medicine syndrome scores in stress-induced insomnia group were significantly higher than those in normal control group(Z=10.900,P<0.01);the main locations of disease related to insomnia were liver(22 cases),heart(31 cases),kidney(19 cases),spleen and stomach(40 cases),symptomatic factors included Qi deficiency(29 cases),Yin deficiency(18 cases),Qi stagnation(8 cases),phlegm and dampness(16 cases) and excessive fire(51 cases).Conclusion The locations of disease involved in stress-induced insomnia patients in the electromagnetic environment are mainly spleen and stomach,with excessive fire as the most common symptomatic element.Insomnia susceptivity,level of physical fitness and somatic fatigue are influencing factors in stress-induced insomnia,and identifying risk factors for stress-induced insomnia is of paramount importance to enhance sleep quality among participants.