双相情感障碍患者睡眠状况及影响因素分析

尉建红; 冯虹

doi:10.16766/j.cnki.issn.1674-4152.003466

双相情感障碍患者睡眠状况及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003466

尉建红^1, ,,
冯虹²

1.
绍兴市第七人民医院(绍兴文理学院医学院附属精神卫生中心)神经内科，浙江绍兴 312000
2.
绍兴市第七人民医院(绍兴文理学院医学院附属精神卫生中心)心身障碍科

基金项目:

浙江省医药卫生科技计划项目 2022RC279

详细信息

通讯作者:
尉建红，E-mail：weijc1979@163.com

中图分类号: R749.41
计量
- 文章访问数: 220
- HTML全文浏览量: 330
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-13
- 网络出版日期: 2024-05-29

Sleep patterns and factors influencing sleep in patients with bipolar disorder

WEI Jianhong^{1
, ,},
FENG Hong²

1.
Department of Neurology, Shaoxing Seventh People' s Hospital (Mental Health Center Affiliated to School of Medicine, Shaoxing University of Arts and Sciences), Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的探讨双相情感障碍患者睡眠状况，并分析影响双相情感障碍患者睡眠状况的相关因素，为双相情感障碍患者睡眠的管理提供理论依据。方法选择2018年4月—2022年5月绍兴市第七人民医院住院的149例双相情感障碍患者为研究对象。根据匹兹堡睡眠质量指数量表(PSQI)评分将所有研究对象分为睡眠障碍组和无睡眠障碍组，分析2组患者一般资料和实验室检查结果，采用logistic回归分析研究影响双相情感障碍患者睡眠状况的因素。结果共计发放149份问卷，回收有效问卷142份。其中PSQI评分≥8分为睡眠障碍组(24例)，PSQI评分 < 8分为无睡眠障碍组(118例)；142例双相情感障碍患者PSQI总分为(12.09±3.89)分，睡眠质量处于较低水平；睡眠障碍组褪黑素(MLT)、促肾上腺皮质激素(ACTH)均低于无睡眠障碍组，同型半胱氨酸(Hcy)、皮质醇(COR)以及汉密尔顿抑郁量表(HADA)、汉密尔顿焦虑量表(HAMA)评分均高于无睡眠障碍组(P < 0.05)；高COR(OR=1.444, 95% CI: 1.127~1.850)、高Hcy(OR=1.875, 95% CI: 1.154~3.047) 均为睡眠障碍发生的危险因素; 低ACTH (OR=0.758, 95% CI: 0.609~0.943)、低MLT(OR=0.794, 95% CI: 0.700~0.900)均为睡眠障碍发生的保护因素(P < 0.05)。结论双相情感障碍均伴有不同程度的睡眠障碍，且MLT、ACTH以及Hcy、COR均为影响患者睡眠状况的相关因素。
- 双相情感障碍 /
- 睡眠 /
- 褪黑素 /
- 影响因素
Abstract: Objective This study aims to explore the sleep status of patients with bipolar disorder and analyze the related factors affecting the sleep status of patients with bipolar disorder, and to analyze the related factors, and to provide theoretical basis for the sleep management of patients with bipolar disorder. Methods A total of 149 hospitalized patients with bipolar disorder from April 2018 to May 2022 at Shaoxing Seventh People' s Hospital were enrolled in this study. According to their Pittsburgh sleep quality index (PSQI) score, the subjects were divided into two groups: sleep disorder group and non-sleep disorder group. The general data and laboratory test results of both groups were analyzed. Additionally, multivariate stepwise logistic regression with binary variables was conducted to identify factors infulencing the sleep status of patients with bipolar disorder were analyzed by. Results Out of the 149 distributed questionnaires, 142 valid questionnaires were collected. Among them, 24 participants with a PSQI score ≥8 were divided into the sleep disorder group, while 118 participants with a PSQI score < 8 were classified into the non-sleep disorder group. The overall PSQI score for the 142 patients with bipolar disorder was (12.09±3.89) points, indicating a low level of sleep quality. In the sleep disorder group, the levels of melatonin (MLT) and adrenocorticotropic hormone (ACTH) were lower than that of the non-sleep disorder group. Conversely, the levels of homocysteine (Hcy) and cortisol (COR), as well as the scores of Hamilton depression scale (HADA) and Hamilton anxiety scale (HAMA), were higher in the non-sleep disorder group (P < 0.05). Multivariate logistic regression analysis showed that high COR (OR=1.444, 95% CI: 1.127-1.850) and high Hcy (OR=1.875, 95% CI: 1.154-3.047) were risk factors for sleep disorders. Low ACTH (OR=0.758, 95% CI: 0.609-0.943) and low MLT (OR=0.794, 95% CI: 0.700-0.900) were all protective factors for sleep disorders (P < 0.05). Conclusion Sleep disorders are commonly observed in individuals with bipolar disorder, and several factors including MLT, ACTH, Hcy, and COR are associated with the sleep status of these patients.
- Bipolar disorder /
- Sleep /
- Melatonin /
- Influencing factor

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表 1 142例双相情感障碍患者睡眠质量得分情况(x±s, 分)

Table 1. Sleep quality score of 142 patients with bipolar disorder(x±s, points)

项目	得分
PSQI总分	12.09±3.89
睡眠质量	2.28±0.64
入睡时间	2.25±0.59
睡眠时间	1.98±0.54
睡眠效率	1.78±0.54
睡眠障碍	1.61±0.48
催眠药物	1.75±0.59
日间功能障碍	2.34±0.51

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表 2 2组双相情感障碍患者一般资料比较

Table 2. Comparison of general data between patients with sleep disorder and patients without sleep disorder

项目	睡眠障碍组 (n=118)	无睡眠障碍组 (n=24)	统计量	P值
性别[例(%)]			1.608^a	0.205
女性	57(48.30)	15(62.50)
男性	61(51.70)	9(37.50)
年龄(x±s, 岁)	31.46±8.26	29.48±5.03	1.550^b	0.127
BMI(x±s)	22.97±2.01	23.13±2.27	0.321^b	0.751
生活区域[例(%)]			0.463^a	0.496
农村	75(63.56)	17(70.83)
城市	43(36.44)	7(29.17)
学历[例(%)]			1.490^c	1.361
小学	36(30.51)	12(50.00)
初中	44(37.29)	6(25.00)
初中及以上	38(32.20)	6(25.00)
疾病分型[例(%)]			0.572^a	0.450
双相Ⅰ型障碍	74(62.71)	17(70.83)
双相Ⅱ型障碍	44(37.29)	7(29.17)
HAMA(x±s, 分)	12.47±3.54	2.95±1.01	24.687^b	< 0.001
HAMD(x±s, 分)	22.58±6.87	3.74±1.12	28.015^b	< 0.001
YMRS(x±s, 分)	17.64±3.64	3.25±0.53	40.867^b	< 0.001
Hcy(x±s, μmol/L)	15.10±2.18	10.03±1.09	16.921^b	< 0.001
COR(x±s, mmol/L)	15.05±4.72	10.08±1.27	9.823^b	< 0.001
ACTH(x±s, μmol/L)	22.17±2.16	27.15±4.51	8.223^b	< 0.001
MLT(x±s，ng/L)	25.51±1.22	31.48±2.23	18.890^b	< 0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 3 双相情感障碍患者睡眠情况影响因素的多因素logistic回归分析

Table 3. Multi-factor logistic regression analysis on sleep status of patients with bipolar disorder

变量	B	SE	Waldχ²	P值	OR值	95% CI
COR	0.367	0.127	8.421	0.004	1.444	1.127~1.850
ACTH	-0.277	0.111	6.175	0.013	0.758	0.609~0.943
MLT	-0.231	0.064	12.943	< 0.001	0.794	0.700~0.900
Hcy	0.629	0.248	6.446	0.011	1.875	1.154~3.047
HAMA	0.042	0.070	0.430	0.499	1.050	0.919~1.189
HAMD	0.367	0.197	3.482	0.062	1.442	0.980~2.120
YMRS	0.102	0.077	1.749	0.186	1.112	0.950~1.290

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