睡眠质量、生活事件与新发脑梗死关系的研究

doi:10.3969/j.issn.1673-5765.2016.11.005

摘要/Abstract

摘要：

目的探讨生活事件刺激及睡眠质量对脑梗死发病的影响，并进一步研究其对脑梗死严重程度及卒中后情绪障碍的影响。方法入组新发脑梗死患者与非脑梗死患者（对照组），比较两组的一般临床资料，分析脑梗死的危险因素，采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index，PSQI）量表进行病前1个月睡眠质量评价，生活事件量表（Life Event Scale，LES）进行病前生活事件刺激量评估，并在患者住院第一周内采用汉密尔顿抑郁量表、汉密尔顿焦虑量表评价情绪障碍，美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）、日常生活能力量表（Activity of Daily Living Scale， ADL）评价发病严重情况。结果共纳入脑梗死组95例，对照组85例。单因素分析结果显示，脑梗死组的生活事件量表得分显著高于对照组[6.00（14.00）vs 0.00（6.25），P <0.001]，其中负性生活事件得分显著高于对照组 [6.00（16.00）vs 0.00（3.25），P <0.001]；PSQI总得分脑梗死组高于对照组[8.50（7.00）vs 6.00（6.5），（P =0.007）]，其中有5项睡眠质量因子分别为主观睡眠质量（P =0.021）、睡眠潜伏期（P =0.034）、睡眠持续性（P =0.002）、睡眠紊乱（P =0.023）、白天功能紊乱（P =0.012）的得分均显著高于对照组；非条件性Logistic回归分析提示负性事件[比值比（odds ratio，OR）1.054，95%可信区间（confidence interval，CI）1.003～1.108，P =0.038）、睡眠持续性（OR 1.601，95%CI 1.133～2.264，P =0.008）及舒张压（OR 1.037，95%CI 1.006～1.069，P =0.019）是脑梗死的危险因素。另外，在脑梗死患者中，病前睡眠障碍患者汉密尔顿抑郁量表得分较无睡眠障碍者显著增高[9.00（15.00）vs 0.00（8.00）， P =0.047]。结论生活事件、睡眠障碍均对脑梗死发病率有影响，其中负性生活事件、睡眠持续性、舒张压高是脑梗死的独立危险因素，病前睡眠障碍有可能引起更严重的卒中后抑郁症状。

文章导读： 本文对急性脑梗死患者的基线和临床特点进行了多因素分析，证实负性生活事件、睡眠持续性均可导致脑梗死的风险升高。

关键词: 脑梗死; 睡眠质量; 生活事件; 抑郁

Abstract:

Objective To explore the impact of life event stimulation and sleep quality on the incidence of cerebral infarction, and to further study its impact on the severity of cerebral infarction and poststroke mood disorder. Methods The patients with cerebral infarction and subjects without cerebral infarction were enrolled into the study. The general clinical data of two groups were compared to analyze the risk factors of cerebral infarction. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the 1-month sleep quality before cerebral infarction and life event stimulation assessment was performed by using Life Event Scale (LES). The Hamilton Depression Scale and the Hamilton Anxiety Scale were used in the first week of hospitalization to evaluate the emotional disorder. National Institutes of Health Stroke Scale (NIHSS), and Activity of Daily Living Scale (ADL) were used to evaluate the severity of the illness.

Results A total of 95 patients were enrolled in the cerebral infarction group and 85 patients were enrolled in the control group. Univariate analysis showed that the scores of LES in the cerebral infarction group were significantly higher than those in the control group [6.00 (14.00) vs 0.00 (6.25), P <0.001] and cerebral infarction group scored significantly higher than those in the control group on negative life event [6.00 (16.00) vs 0.00 (3.25), P <0.001]. The cerebral infarction group scored significantly higher than those in the control group on the total scores of PSQI [8.50 (7.00) vs 6.00 (6.5), (P =0.007)] and five factors of sleep quality, which were subjective sleep quality (P =0.021), sleep latency (P =0.034), sleep duration (P =0.002), sleep disturbances (P =0.023) and daytime dysfunction (P =0.012); Unconditional logistic regression analysis showed negative life event (odds ratio [OR] 1.054, 95% confidence interval [CI ] 1.003-1.108, P =0.038), sleep duration (OR 1.601, 95%CI 1.33-2.264, P =0.008) and diastolic blood pressure (OR 1.037, 95%CI 1.006-1.069, P =0.019) were the risk factors of cerebral infarction. In addition, the Hamilton Depression Scale score was significantly higher in patients with sleep disorders than in those without sleep disorders [9.00 (15.00) vs 0.00 (8.00), P =0.047]. Conclusion Life event and poor sleep quality have impact on the incidence of cerebral infarction. Negative life event, sleep duration and diastolic blood pressure are the independent risk factors of cerebral infarction. Sleep disorders before the onset of cerebral infarction may lead to more severe symptoms of post-stroke depression.

Key words: Cerebral infarction; Sleep quality; Life event; Depression

曾思琳，郭毅，蔡智立，杨焱，梁宇彬，常鑫. 睡眠质量、生活事件与新发脑梗死关系的研究[J]. 中国卒中杂志, 2016, 11(11): 923-929.

ZENG Si-Lin, GUO Yi,CAI Zhi-Li, et al.. Correlation of Sleep Quality, Life Event with Cerebral Infarction[J]. Chinese Journal of Stroke, 2016, 11(11): 923-929.

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