中国神经精神疾病杂志
中國神經精神疾病雜誌
중국신경정신질병잡지
CHINESE JOURNAL OF NERVOUS AND MENTAL DISEASES
2007年
2期
69-72
,共4页
潘集阳%马文彬%张继辉%梁华君%马萍
潘集暘%馬文彬%張繼輝%樑華君%馬萍
반집양%마문빈%장계휘%량화군%마평
慢性失眠%睡眠质量%匹兹堡睡眠质量指数表%多导睡眠图
慢性失眠%睡眠質量%匹玆堡睡眠質量指數錶%多導睡眠圖
만성실면%수면질량%필자보수면질량지수표%다도수면도
Chronic Primary Insomnia%Sleep Quality%Pittsburgh sleep quality index%Polysomnogram
背景 慢性失眠患者由于警觉性和浅睡比例较高,常判断不清入睡与觉醒的界限,表现为对失眠特别是入睡困难和睡眠时间不足的严重程度常有夸大,即使使用药物改善睡眠后也有同样的表现,而原发性失眠患者伴有明显的心身症状.因此我们观察患者主观与客观睡眠质量的差异与焦虑症状之间的关系,初步了解影响慢性原发性失眠患者主客观睡眠差异的相关因素.方法 共收录慢性失眠患者55例,男24例,女31例.符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)原发性失眠症诊断标准,采用病程超过6个月为慢性失眠.排除患有符合DSM-Ⅳ轴Ⅰ障碍诊断标准的精神障碍者及明显躯体疾病者.收录正常对照组共15名,男8名,女7名.其中性别及年龄与患者组差异无统计学意义,排除有超过1周失眠主诉者及患有符合DSM-Ⅳ轴Ⅰ精神障碍诊断标准的精神障碍者及明显躯体疾病者.所有受试者完成匹兹堡睡眠质量指数表(Pittsburgh sleep quality index,PSQI)、状态-特质焦虑问卷(STAI)、一般情况调查表及在多导睡眠仪监测前3 d连续的睡眠日记;并在睡眠监测前晚进行一夜的预睡.结果 ①分析显示,秩和检验分析显示,慢性原发性失眠患者的无论主观或客观入睡潜伏期、睡眠时间及睡眠效率均小于正常对照组[分别是主观睡眠时间为(157.8±141.7)min v.s(423.4±42.8)min,P＜0.001;客观睡眠时间为(332.2±154.7)min v.s(418.1±47.8)min,P=0.009;主观入睡潜伏期为(80.3±73.7)min v.s.(19.2±8.6)min,P＜0.001;客观睡眠潜伏期为(23.2±25.4)min v.s.(7.7±4.7)min,P=0.017;主观睡眠效率为(0.52±0.27)v.s.(0.91±0.05),P＜0.001;客观睡眠效率为(0.67±0.28)v.s.(0.90±0.07),P＜0.001].②秩和检验分析显示,慢性失眠患者主观睡眠潜伏期大于PSG监测值[(80.3±73.7)min v.s.(23.2±25.4)min,P＜0.001],主观睡眠时间、睡眠效率低于PSG监测值[分别为(157.8±141.7)min v.s.(332.2±154.7)min,P＜0.001;(0.52±0.27)v.s.(0.67±0.28),P＜0.001];而正常对照组除在主、客观睡眠潜伏期存在差异[(19.2±8.6)min v.s.(7.7±4.7)min,P=0.019]外,其他观察值均无明显差异.③患者主观与客观睡眠潜伏期差值与STAI总分、TAI及SAI分呈正相关(r分别为0.402、0.374及0.397,P＜0.05),而与病程、性别及年龄无明显相关性;主客观睡眠效率差值与STAI各项目分及病程、性别、年龄无显著相关性.结论 慢性原发性失眠患者存在过分夸大失眠严重程度的倾向,主客观睡眠时间、睡眠效率与入睡潜伏期均有明显的差别,其主客观睡眠潜伏期的差异与患者的特质焦虑水平及状态焦虑水平呈正相关.提示焦虑症状在其主客观睡眠质量差异中起到关键的作用.
揹景 慢性失眠患者由于警覺性和淺睡比例較高,常判斷不清入睡與覺醒的界限,錶現為對失眠特彆是入睡睏難和睡眠時間不足的嚴重程度常有誇大,即使使用藥物改善睡眠後也有同樣的錶現,而原髮性失眠患者伴有明顯的心身癥狀.因此我們觀察患者主觀與客觀睡眠質量的差異與焦慮癥狀之間的關繫,初步瞭解影響慢性原髮性失眠患者主客觀睡眠差異的相關因素.方法 共收錄慢性失眠患者55例,男24例,女31例.符閤美國精神障礙診斷與統計手冊第4版(DSM-Ⅳ)原髮性失眠癥診斷標準,採用病程超過6箇月為慢性失眠.排除患有符閤DSM-Ⅳ軸Ⅰ障礙診斷標準的精神障礙者及明顯軀體疾病者.收錄正常對照組共15名,男8名,女7名.其中性彆及年齡與患者組差異無統計學意義,排除有超過1週失眠主訴者及患有符閤DSM-Ⅳ軸Ⅰ精神障礙診斷標準的精神障礙者及明顯軀體疾病者.所有受試者完成匹玆堡睡眠質量指數錶(Pittsburgh sleep quality index,PSQI)、狀態-特質焦慮問捲(STAI)、一般情況調查錶及在多導睡眠儀鑑測前3 d連續的睡眠日記;併在睡眠鑑測前晚進行一夜的預睡.結果 ①分析顯示,秩和檢驗分析顯示,慢性原髮性失眠患者的無論主觀或客觀入睡潛伏期、睡眠時間及睡眠效率均小于正常對照組[分彆是主觀睡眠時間為(157.8±141.7)min v.s(423.4±42.8)min,P＜0.001;客觀睡眠時間為(332.2±154.7)min v.s(418.1±47.8)min,P=0.009;主觀入睡潛伏期為(80.3±73.7)min v.s.(19.2±8.6)min,P＜0.001;客觀睡眠潛伏期為(23.2±25.4)min v.s.(7.7±4.7)min,P=0.017;主觀睡眠效率為(0.52±0.27)v.s.(0.91±0.05),P＜0.001;客觀睡眠效率為(0.67±0.28)v.s.(0.90±0.07),P＜0.001].②秩和檢驗分析顯示,慢性失眠患者主觀睡眠潛伏期大于PSG鑑測值[(80.3±73.7)min v.s.(23.2±25.4)min,P＜0.001],主觀睡眠時間、睡眠效率低于PSG鑑測值[分彆為(157.8±141.7)min v.s.(332.2±154.7)min,P＜0.001;(0.52±0.27)v.s.(0.67±0.28),P＜0.001];而正常對照組除在主、客觀睡眠潛伏期存在差異[(19.2±8.6)min v.s.(7.7±4.7)min,P=0.019]外,其他觀察值均無明顯差異.③患者主觀與客觀睡眠潛伏期差值與STAI總分、TAI及SAI分呈正相關(r分彆為0.402、0.374及0.397,P＜0.05),而與病程、性彆及年齡無明顯相關性;主客觀睡眠效率差值與STAI各項目分及病程、性彆、年齡無顯著相關性.結論 慢性原髮性失眠患者存在過分誇大失眠嚴重程度的傾嚮,主客觀睡眠時間、睡眠效率與入睡潛伏期均有明顯的差彆,其主客觀睡眠潛伏期的差異與患者的特質焦慮水平及狀態焦慮水平呈正相關.提示焦慮癥狀在其主客觀睡眠質量差異中起到關鍵的作用.
배경 만성실면환자유우경각성화천수비례교고,상판단불청입수여각성적계한,표현위대실면특별시입수곤난화수면시간불족적엄중정도상유과대,즉사사용약물개선수면후야유동양적표현,이원발성실면환자반유명현적심신증상.인차아문관찰환자주관여객관수면질량적차이여초필증상지간적관계,초보료해영향만성원발성실면환자주객관수면차이적상관인소.방법 공수록만성실면환자55례,남24례,녀31례.부합미국정신장애진단여통계수책제4판(DSM-Ⅳ)원발성실면증진단표준,채용병정초과6개월위만성실면.배제환유부합DSM-Ⅳ축Ⅰ장애진단표준적정신장애자급명현구체질병자.수록정상대조조공15명,남8명,녀7명.기중성별급년령여환자조차이무통계학의의,배제유초과1주실면주소자급환유부합DSM-Ⅳ축Ⅰ정신장애진단표준적정신장애자급명현구체질병자.소유수시자완성필자보수면질량지수표(Pittsburgh sleep quality index,PSQI)、상태-특질초필문권(STAI)、일반정황조사표급재다도수면의감측전3 d련속적수면일기;병재수면감측전만진행일야적예수.결과 ①분석현시,질화검험분석현시,만성원발성실면환자적무론주관혹객관입수잠복기、수면시간급수면효솔균소우정상대조조[분별시주관수면시간위(157.8±141.7)min v.s(423.4±42.8)min,P＜0.001;객관수면시간위(332.2±154.7)min v.s(418.1±47.8)min,P=0.009;주관입수잠복기위(80.3±73.7)min v.s.(19.2±8.6)min,P＜0.001;객관수면잠복기위(23.2±25.4)min v.s.(7.7±4.7)min,P=0.017;주관수면효솔위(0.52±0.27)v.s.(0.91±0.05),P＜0.001;객관수면효솔위(0.67±0.28)v.s.(0.90±0.07),P＜0.001].②질화검험분석현시,만성실면환자주관수면잠복기대우PSG감측치[(80.3±73.7)min v.s.(23.2±25.4)min,P＜0.001],주관수면시간、수면효솔저우PSG감측치[분별위(157.8±141.7)min v.s.(332.2±154.7)min,P＜0.001;(0.52±0.27)v.s.(0.67±0.28),P＜0.001];이정상대조조제재주、객관수면잠복기존재차이[(19.2±8.6)min v.s.(7.7±4.7)min,P=0.019]외,기타관찰치균무명현차이.③환자주관여객관수면잠복기차치여STAI총분、TAI급SAI분정정상관(r분별위0.402、0.374급0.397,P＜0.05),이여병정、성별급년령무명현상관성;주객관수면효솔차치여STAI각항목분급병정、성별、년령무현저상관성.결론 만성원발성실면환자존재과분과대실면엄중정도적경향,주객관수면시간、수면효솔여입수잠복기균유명현적차별,기주객관수면잠복기적차이여환자적특질초필수평급상태초필수평정정상관.제시초필증상재기주객관수면질량차이중기도관건적작용.
Background The severity of difficulty in falling asleep and the insufficiency of the sleeping time in the primary insomniacs always were overestimated, even after medication and improving the objective sleep quality. Moreover, remarkable psychosomatic symptoms were found in patients and the symptoms were significantly linked to the self-reported sleep quality. So in this study, it was designed to explore the differences between objective and subjective sleep quality and its correlative factors in chronic insomniacs.Methods A total of 55 chronic primary insomniac cases diagnosed by DSM-Ⅳ diagnostic criteria for primary insomnia and 15 normal controls were rated with Pittsburgh sleep quality index (PSQI),State-Trait Anxiety Inventory (STAI), and the Subjective General Condition Form. All cases and the controls were then examined by the whole-night polysomnography (PSG) records.Results Compared with the objective parameters of PSG, the subjective parametersiu chronic insomniacs had significantly longer sleep latency and lower total sleep time and sleep efficiency [ (80. 3± 73.7)min v.s. (23.2 ± 25.4) min, (157.8±141.7)min v.s. (332.2±154.7)min , (0.52 ±0. 27) min v.s. (0. 67 ± 0. 28) min, respectively, P ＜0. 001 ]. The difference between subjective and objective sleep latency was related to the total scores of STAI, TAI and SAI ( r = 0. 402,0. 374 and 0. 397, respectively, P ＜ 0. 05).Conclusions There were significant differences between objective and subjective estimations of sleep quality in chronic insomniacs,and they might result in the overestimation of the severity of insomnia. The differences between subjective and objective sleep quality in the chronic insomniacs were significantly correlated with the levels of anxiety.
