CAJ | 학술논문

目的分析2型糖尿病(T2DM)患者的睡眠质量对血糖控制达标的影响及相关因素.方法选取2011年6月至2012年2月在中日友好医院内分泌科住院的T2DM患者200例为研究对象,采用匹兹堡睡眠质量指数(PSQI)量表调查T2DM患者的睡眠质量.以糖化血红蛋白(HbA1c)＜7.0％作为血糖控制达标；以Zung氏抑郁自评量表(SDS)了解患者精神状况,SDS≥50分为抑郁状态；以PSQI ≥7分为睡眠障碍,将患者分为无睡眠障碍组(88例)和睡眠障碍组(112例)；并结合临床资料进行分析和比较.计量资料采用独立样本t检验,计数资料采用卡方检验,与睡眠障碍、血糖达标的相关性分析采用多元logistic回归分析.结果与无睡眠障碍组相比,睡眠障碍组年龄、HbA1c、血糖(空腹、0.5h、2h)、总胆固醇、甘油三酯、PSQI评分、SDS评分、抑郁发生率明显升高(t=-19.49～-1.99,x2 =9.931,均P＜0.05)；C肽(空腹、0.5h)、体质指数(BMI)明显偏低(t=2.07、2.14、2.35,均P＜0.05).PSQI评分＜5分组、5～7分组、7～9分组和≥9分组的血糖达标率分别为27.9％、19.6％、10.0％和8.6％,随着PSQI评分升高,血糖达标率呈逐渐下降的趋势.多元logistic回归分析结果显示:睡眠障碍与年龄、男性、HbA1c≥7.0％及抑郁呈正相关,与BMI负相关(OR=1.04、2.38、2.98、2.14、0.89,均P＜0.05).HbA1c≥7.0％与睡眠障碍及2h血糖呈正相关,与胰岛素治疗呈负相关(OR =2.81、1.21、0.33,均P＜0.05).结论 T2DM患者普遍存在睡眠障碍,其与高血糖存在着交互影响,并造成心理健康问题.应重视对T2DM患者的睡眠质量管理和血糖控制,以改善睡眠和有效提高血糖达标率.
목적 분석2형당뇨병(T2DM)환자적수면질량대혈당공제체표적영향급상관인소.방법 선취2011년6월지2012년2월재중일우호의원내분비과주원적T2DM환자200례위연구대상,채용필자보수면질량지수(PSQI)량표조사T2DM환자적수면질량.이당화혈홍단백(HbA1c)＜7.0％작위혈당공제체표；이Zung씨억욱자평량표(SDS)료해환자정신상황,SDS≥50분위억욱상태；이PSQI ≥7분위수면장애,장환자분위무수면장애조(88례)화수면장애조(112례)；병결합림상자료진행분석화비교.계량자료채용독립양본t검험,계수자료채용잡방검험,여수면장애、혈당체표적상관성분석채용다원logistic회귀분석.결과 여무수면장애조상비,수면장애조년령、HbA1c、혈당(공복、0.5h、2h)、총담고순、감유삼지、PSQI평분、SDS평분、억욱발생솔명현승고(t=-19.49～-1.99,x2 =9.931,균P＜0.05)；C태(공복、0.5h)、체질지수(BMI)명현편저(t=2.07、2.14、2.35,균P＜0.05).PSQI평분＜5분조、5～7분조、7～9분조화≥9분조적혈당체표솔분별위27.9％、19.6％、10.0％화8.6％,수착PSQI평분승고,혈당체표솔정축점하강적추세.다원logistic회귀분석결과현시:수면장애여년령、남성、HbA1c≥7.0％급억욱정정상관,여BMI부상관(OR=1.04、2.38、2.98、2.14、0.89,균P＜0.05).HbA1c≥7.0％여수면장애급2h혈당정정상관,여이도소치료정부상관(OR =2.81、1.21、0.33,균P＜0.05).결론 T2DM환자보편존재수면장애,기여고혈당존재착교호영향,병조성심리건강문제.응중시대T2DM환자적수면질량관리화혈당공제,이개선수면화유효제고혈당체표솔.
Objective To investigate the effect of sleep quality on glycemic control and relevant factors involved in subjects with type 2 diabetic mellitus(T2DM).Methods A total of 200 inpatients with T2DM were enrolled in this study.Each patient completed Pittsburg Sleep Quality Index (PSQI) questionnaire.The glycemic control target was ＜ 7％.All patients were evaluated by Zung Self-rating Depression Scale (SDS) for the mental status,the score of SDS ≥ 50 was defined as a depressive state.Patients were divided into two groups:non-sleep disorder group (n =88) and sleep disorder group (n =112) according to PSQI score ≥7 which was defined as the sleep disorder.The clinical characteristics of two groups were compared and analyzed.Results The incidence of sleep disorder was 56％ in the overall population.In the sleep disorders group,Age,hemoglobin A,glycosylated (HbA1c),fasting plasma glucose,0.5-hour as well as 2-hour postprandial plasma glucose,fasting serum total cholesterol,triglycerides,the score of SDS and the incidence of depression were significantly greater (t =-19.49--1.99,x2 =9.931,all P ＜ 0.05),whereas fasting C-peptide,0.5-hour postprandial C-peptide and body mass index (BMI) were significantly lower (t =2.07,2.14,2.35,all P ＜ 0.05) than those of the non-sleep disorder group.Glycemic control target rate of PSQI ＜ 5 group,PSQI≥5 to 7 group,PSQI ≥7 to 9 group and PSQI≥9 group was 27.9％,19.6％,10.0％ and 8.6％,respectively.Patients with a higher score of PSQI were less likely to reach glycemic targets (P ＜ 0.05).Multiple logistic regression analysis indicated that sleep disorders was positively correlated with increased age,male,HbA1c and depression,however,sleep disorders was negatively related to BMI (OR =1.04,2.38,2.98,2.14,0.89,respectively,all P ＜0.05).There was a positive association between sleep disorders,2-hour postprandial plasma glucose and HbA1c≥7％,however,HbA1c ≥7％ was inversely associated with insulin therapy (OR =2.81,1.21,0.33,all P ＜ 0.05).Conclusion Sleep disorders are prevalent in patients with T2DM.Hyperglycemia and sleep disorders interact with each other.Sleep disorders probably cause psychological health problems.Management of sleep quality and glucose control in patients with T2DM should be an effective approach for sleep and higher glycemic control target rate.