云南省德宏州HIV感染者抗病毒治疗后睡眠障碍发生率及其影响因素研究

Incidence and risk factors of sleep disturbances in HIV/AIDS patients receiving antiretroviral therapy in Dehong prefecture,Yunnan province

目的探索德宏州成人接受艾滋病抗病毒治疗者中发生睡眠障碍的情况及影响因素。方法采用回顾性队列研究,对德宏州2004年7月1日至2016年6月30日接受国家抗病毒治疗的成人艾滋病病毒(HIV)感染者,摘取人口学、抗病毒治疗基线基本数据以及随访期间睡眠障碍发生情况。采用多因素Logistic回归分析睡眠障碍发生的影响因素。结果至2016年6月,德宏州成人HIV感染者接受抗病毒治疗共9 625例,其中自我报告出现过睡眠障碍的共计211例,占2.2%。多因素Logistic回归分析显示,开始治疗年龄在30~39岁和≥50岁者发生睡眠障碍的风险分别是<30岁者的1.60倍[比值比(OR)=1.60,95%可信区间(CI):1.09~2.35]和1.93倍(OR=1.93,95%CI:1.09~3.42);抗病毒治疗5~9年者和>10年者发生睡眠障碍的风险分别是治疗1年以下者的5.65倍(OR=5.65,95%CI:2.13~14.99)和17.85倍(OR=17.85,95%CI:6.52~84.84)。傣族较汉族发生睡眠障碍风险降低(OR=0.65,95%CI:0.44~0.96);经性传播途径感染者较经注射毒品途径感染者发生睡眠障碍的风险降低(OR=0.45,95%CI:0.31~0.64);性别、文化程度、婚姻状况、基线CD4+T淋巴细胞计数和基线治疗是否含齐多夫定/依非韦伦等与睡眠障碍的发生之间无显著关联。结论德宏州成年HIV感染者接受抗病毒治疗后出现睡眠障碍的比例较低。年龄较大、治疗时间长、汉族、静脉注射吸毒途径感染HIV接受治疗后睡眠障碍发生率相对较高,需进一步研究验证。

Objective To investigate the incidence and risk factors of sleep disturbances in adult HIV/AIDS patients receiving antiretroviral therapy(ART)in Dehong prefecture,Yunnan province.Methods A retrospective cohort study was conducted based on the data of the patients who initiated ART between July 2004 and June 2016 including their demographic characteristics and baseline information from local AIDS information system.Adjusted odds ratios(aORs)of sleep disturbances were estimated by multivariate logistic regression analysis.Results 9 625 HIV-infected patients were included,in which 211(2.2%)cases reported during follow-up visits to have sleep disturbances.Multivariable logistic analysis showed that the risk of self-reported sleep disturbances in patients who started ART at the age of 30-39 and≥50 years were 1.60(OR=1.60,95%CI:1.09-2.35)and 1.93(OR=1.93,95%CI:1.09-3.42)times higher than those under 30 years old.The risk was 5.65 times(OR=5.65,95%CI:2.13-14.99)and 17.85 times(OR=17.85,95%CI:6.52-84.84)respectively,for those receiving ART for 5-9 years and for>10 years.Dai Chinese(OR=0.65,95%CI:0.44-0.96)and infected HIV by sexual transmission(OR=0.45,95%CI:0.31-0.64)showed lower risk of self-reported sleep disturbances.Gender,educational level,marital status,baseline CD4 count,and usage of AZT/EFV at baseline showed no significant associations(P>0.05).Conclusion The occurrence of self-reported sleep disturbances among adult HIV infected individuals initiating ART is at a low level in Dehong prefecture.Patients of older age,Han Chinese,being on treatment for a long time,and infected HIV by injecting drug use are more likely to report sleep disturbances after treatment,which requires further investigation.