孤独感在心房颤动患者述情障碍与睡眠质量间的中介效应

姚雨霏; 孙国珍; 郦明芳; 鲍志鹏; 王琳

doi:10.16766/j.cnki.issn.1674-4152.004480

孤独感在心房颤动患者述情障碍与睡眠质量间的中介效应

doi: 10.16766/j.cnki.issn.1674-4152.004480

南京医科大学第一附属医院心血管内科，江苏南京 210000

基金项目:

国家自然科学基金面上项目 82270329

南京医科大学第一附属医院国家自然科学基金青年基金培育计划 PY2022002

详细信息

通讯作者:
王琳，E-mail: wl1356@163.com

中图分类号: R541.75
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- 文章访问数: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2025-11-10
- 网络出版日期: 2026-10-23

The mediating effect of loneliness on the relationship between alexithymia and sleep quality in patients with atrial fibrillation

Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China

摘要

摘要: 目的探讨述情障碍对心房颤动患者睡眠质量的影响，以及孤独感在其间的中介作用，以期为心房颤动患者的睡眠管理提供参考。方法采用便利抽样法，选取2024年1—9月在南京医科大学第一附属医院就诊的300例心房颤动患者作为研究对象。使用一般资料调查表、多伦多述情障碍量表（TAS-20）、6条目孤独感量表（ULS-6）和匹兹堡睡眠质量量表（PSQI）进行问卷调查。运用PROCESS宏程序，Bootstrap方法进行中介效应分析。结果心房颤动患者睡眠质量较差[7.00(5.00, 11.00)分]、处于述情障碍临界状态[55.00(48.00, 61.00）分]和轻度孤独感水平[13.00(12.00, 15.00)分]，年龄较大、文化程度较低患者睡眠质量较差。中介效应分析显示，总效应值为0.076，述情障碍对睡眠质量有直接负面影响（effect=0.051），孤独感部分介导述情障碍对睡眠质量的影响（effect=0.025），以上结果均有统计学意义（P＜0.05）。结论述情障碍直接影响心房颤动患者的睡眠质量，孤独感在述情障碍与睡眠质量之间起到部分中介作用，提示在针对心房颤动患者述情障碍临床干预的同时还应考虑如何减轻患者孤独感，促进睡眠质量的提升。
- 心房颤动 /
- 述情障碍 /
- 孤独感 /
- 睡眠质量 /
- 中介效应
Abstract: Objective To explore the impact of alexithymia on the sleep quality of patients with atrial fibrillation and the mediating role of loneliness in it, with the hope of providing a reference for the sleep management of patients with atrial fibrillation. Methods This study employed a convenience sampling method, selecting 300 patients with atrial fibrillation who visited the First Affiliated Hospital of Nanjing Medical University from January to September 2024. A general information questionnaire, the Toronto alexithymia scale-20 (TAS-20), the 6-item loneliness scale (ULS-6), and the Pittsburgh sleep quality index (PSQI) were used for assessment. The PROCESS macro program and the Bootstrap method were utilized for mediating effect analysis. Results The study found that patients with atrial fibrillation had poor sleep quality [7.00 (5.00, 11.00) points], were at the borderline level of alexithymia [55.00 (48.00, 61.00) points], and had a mild level of loneliness [13.00 (12.00, 15.00) points]. Patients who were older or of a lower education level had poorer sleep quality. Mediation effect analysis showed that the total effect size was 0.076, with alexithymia having a direct negative impact on sleep quality (effect=0.051), and loneliness partially mediating the impact of alexithymia on sleep quality (effect=0.025). All results were statistically significant (P < 0.05). Conclusion Alexithymia is a direct risk factor for sleep quality in patients with atrial fibrillation, and loneliness plays a partial mediating role between alexithymia and sleep quality. Therefore, clinical interventions for patients with atrial fibrillation and alexithymia should consider reducing loneliness to effectively improve sleep quality.
- Atrial fibrillation /
- Alexithymia /
- Loneliness /
- Sleep quality /
- Mediating effect

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图 1 房颤患者孤独感在述情障碍及睡眠质量间的中介效应

Figure 1. Mediation effect of loneliness between alexithymia and sleep quality in patients with atrial fibrillation

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表 1 不同特征房颤患者睡眠质量比较[M(P₂₅, P₇₅)，分]

Table 1. Comparison of sleep quality among patients with different types of atrial fibrillation [M(P₂₅, P₇₅), points]

项目	例数	睡眠质量	统计量	P值
性别			-0.211^a	0.833
男性	188	8.0(5.0, 11.0)
女性	112	7.0(6.0, 10.0)
居住地			-1.150^a	0.250
城镇	247	7.0(5.0, 10.0)
农村	53	8.0(6.0, 12.0)
文化			9.581^b	0.008
小学及以下	34	6.5(5.0, 8.3)
中学/中专	149	7.0(5.0, 10.0)
本科/大专以上	117	8.0(6.0, 12.0)
月收入(元)			0.111^b	0.946
＜3 000	64	7.5(5.0, 12.0)
3 000~6 000	104	7.0(5.3, 10.0)
>6 000	132	7.5(5.0, 10.8)
患病时长			0.097^b	0.953
1年以内	131	7.0(5.0, 11.0)
1~3年	73	7.0(5.0, 10.0)
3年以上	96	8.0(6.0, 10.0)
房颤类型			-0.661^a	0.509
阵发性房颤	246	7.0(5.0, 10.3)
持续性房颤	54	8.0(5.0, 11.0)
导管消融治疗史			-0.482^a	0.630
否	247	7.0(5.0, 11.0)
是	53	7.0(5.0, 10.5)
高血压			-1.475^a	0.140
无	202	7.0(5.0, 10.0)
有	98	8.5(5.0, 11.3)
糖尿病			-1.036^a	0.300
无	266	7.0(5.0, 11.0)
有	34	9.0(5.8, 11.3)
吸烟习惯			-0.438^a	0.661
无	235	7.0(5.0, 11.0)
有	65	7.0(5.0, 10.0)
饮酒习惯			-1.801^a	0.072
无	224	8.0(6.0, 11.0)
有	76	7.0(5.0, 9.0)
注：^a为Z值，^b为H值。

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表 2 房颤患者特征因素及其与睡眠质量的相关性分析

Table 2. Correlation analysis between characteristic factors and sleep quality in patients with atrial fibrillation

项目	睡眠质量 (分)	年龄 (岁)	LADD (mm)	LVEF (%)
睡眠质量(分)	1
年龄(岁)	0.257^a	1
LADD(mm)	-0.001	0.083	1
LVEF(%)	0.010	-0.063	-0.251^a	1
注：^aP < 0.01。

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表 3 房颤患者特征变量回归分析

Table 3. Regression analysis of characteristic variables in patients with atrial fibrillation

结果变量	预测变量	R	R²	F值	β	t值	P值
孤独感得分		0.352	0.124	42.210
	述情障碍得分				0.120	6.497	＜0.001
睡眠得分		0.239	0.057	9.020
	述情障碍得分				0.051	2.018	0.045
	孤独感得分				0.207	2.787	0.006

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表 4 房颤患者孤独感在述情障碍及睡眠质量间的中介效应分析

Table 4. Mediation effect analysis of loneliness between alexithymia and sleep quality in patients with atrial fibrillation

中介路径	效应值	SE	Bootstrap 95% CI	中介效应占比(%)
总效应	0.076	0.024	0.029~0.123	100.00
述情障碍→睡眠质量	0.051	0.025	0.013~0.101	67.11
述情障碍→孤独感→睡眠质量	0.025	0.010	0.007~0.045	32.89

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