音乐放松疗法对脑卒中失眠患者的影响

目的分析音乐放松疗法对脑卒中患者失眠的影响,用以指导临床护理。方法65例脑卒中失眠患者随机分为治疗组和对照组,对照组给予常规护理,治疗组除给予常规护理外加用音乐放松疗法;结果对两组患者干预前后进行睡眠总时间、早醒、睡眠中断情况、入睡时间的评估,治疗组治疗前后比较有显著意义(P<0.05);组间比较有显著意义(P<0.05)。结论可采取音乐疗法来改善脑卒中失眠患者睡眠状况,提高患者生活质量。     

耳穴压豆治疗脑卒中患者失眠90例临床观察

目的:观察耳穴压豆治疗脑卒中患者失眠的疗效。方法:90例脑卒中失眠患者选取耳穴:皮质下、交感、内分泌、神门、心、肾、肝、脾等穴位,王不留行籽压法治疗1个月。采用自身对照方法观察治疗前后入睡及睡眠时间、醒觉次数、睡眠质量评价。结果:各项指标均有明显改善,治疗前后比较有显著性差异(P<0.01)。结论:耳穴压豆治疗脑卒中患者失眠疗效较好。     

CT引导下微创治疗老年慢性硬膜下血肿48例护理配合

对40例脑卒中失眠患者采取访谈式睡眠调查法进行失眠原因调查,并给予有针对性的护理对策。结果显示入睡困难和早醒是失眠最常见的症状,引起失眠的原因依次为心理因素、肢体痛、环境因素、病理生理因素、药物因素等。认为医护人员应根据脑卒中患者失眠的不同原因及症状实施有目的、有计划的护理措施,可减少镇静催眠药的使用,提高患者的睡眠质量和生活质量。     

脑卒中患者失眠40例原因分析及护理对策

对40例脑卒中失眠患者采取访谈式睡眠调查法进行失眠原因调查,并给予有针对性的护理对策.结果显示入睡困难和早醒是失眠最常见的症状,引起失眠的原因依次为心理因素、肢体痛、环境因素、病理生理因素、药物因素等.认为医护人员应根据脑卒中患者失眠的不同原因及症状实施有目的、有计划的护理措施,可减少镇静催眠药的使用,提高患者的睡眠质量和生活质量.     

音乐放松疗法对脑卒中失眠患者的影响

目的：分析音乐放松疗法对脑卒中患者失眠的影响，用以指导临床护理。方法：65例脑卒中失眠患者随机分为治疗组和对照组，对照组给予常规护理，治疗组除给予常规护理外加用音乐放松疗法；结果：对两组患者干预前后进行睡眠总时间、早醒、睡眠中断情况、入睡时间的评估，治疗组治疗前后比较有显著意义(P&;lt;0．05)；组间比较有显著意义(P&;lt;0．05)。结论：可采取音乐疗法来改善脑卒中失眠患者睡眠状况，提高患者生活质量。     

脑卒中后失眠病人睡眠障碍与认知功能的相关性研究

[目的]了解脑卒中病人失眠现状,探讨其睡眠障碍与卒中后认知功能的相关性。[方法]采用匹兹堡睡眠质量指数(PSQI)量表和简易智能精神状态检查(MMSE)量表对197例脑卒中后失眠病人进行便利抽样调查,并对调查结果进行分析。[结果]不同时期和不同类型的脑卒中病人失眠发生率比较差异均有统计学意义,急性期缺血性脑卒中病人失眠发生率较高;不同程度认知功能障碍脑卒中失眠病人的PSQI总分比较差异有统计学意义;除了日间功能方面,不同程度认知障碍病人的PSQI各维度得分比较差异均有统计学意义,尤其在睡眠质量和睡眠时间两个维度差异比较明显;脑卒中后失眠病人睡眠质量与认知功能两者间呈显著正相关。[结论]脑卒中病人失眠发生率较高,存在认知功能障碍的病人更容易发生失眠现象,脑卒中后失眠与认知功能互为影响。医护人员在诊治和护理工作中应及早重视对睡眠及认知情况的评估和管理,采取预防及治疗性措施,促进脑卒中病人康复。     

心理护理在脑卒中失眠患者康复中的作用

目的：探讨心理护理对脑卒中失眠患者睡眠质量和生存质量的影响。方法：对60例脑卒中失眠患者实施认知疗法，精神支持，行为疗法等心理护理，比较心理护理前后PSQI和QOL评分。结果：通过心理护理纠正了患者不良的情绪，提高了自信，改善了睡眠，PSQI和QOL评分心理护理后优于心理护理前，差异显著（P〈0．05）。结论：心理护理可提高脑卒中失眠患者对治疗及康复的依从性，改善睡眠质量和生活质量。     

低能量氦——氖激光血管内照射治疗脑卒中失眠的疗效观察

目的探讨低能量氦—氖激光血管内照射（ＩＬＩＢ）疗法对脑卒中失眠的疗效。方法经ＩＬＩＢ治疗的脑卒中失眠患者１２６例，激光波长０６３２８μｍ，平均功率１５ｍｗ，每天１次，每次治疗时间６０分钟，１０天为１个疗程。结果治疗组总有效率９２７％，对照组６７８％，差异有显著意义（Ｐ＜０．０１）。结论ＩＬＩＢ治疗脑卒中失眠，具有见效快、疗效可靠，且方法简便，无痛苦，患者乐于接受，值得推广应用     

成人脑卒中后失眠国内外临床登记试验的分类汇总与分析评价

失眠是成人脑卒中后常见的睡眠问题。本文通过检索ClinicalTrials.gov成人脑卒中后失眠相关临床登记试验,评价了最近5年内各登记试验研究方法及设计的先进性与科学性,分析了不同分期脑卒中后失眠的研究特点及核心,并考察了世界范围内睡眠脑电监测的新进展及应用。指出在世界范围内,成人脑卒中后失眠方面的研究尚存在很大发展空间,需要专业人员和科技的支持,为成人脑卒中后失眠的临床评估及精准诊治提供具体客观详细的数据资料,以促进成人脑卒中患者的预后。     

康复护理干预联合重复经颅磁对脑卒中后失眠患者的临床观察

目的:观察康复护理干预联合重复经颅磁对脑卒中后失眠治疗的临床疗效。方法:选取2016年11月至2017年9月武汉市汉口医院康复科收治的脑卒中后失眠患者90例作为研究对象,随机分为观察组和对照组,每组45例。对照组采用常规护理配合重复经颅磁治疗。观察组进行康复护理干预配合重复经颅磁治疗。结果:观察组总有效率93%,对照组总有效率86%,观察组明显优于对照组,差异有统计学意义(P<0.05)。结论:采用康复护理干预联合重复经颅磁治疗脑卒中后失眠患者有较好的临床疗效,患者生命质量提高,可行性和安全性较高。     

初发脑梗死后失眠患病率及相关因素分析

目的：探讨初发脑梗死后失眠的发病情况及相关影响因素。方法：纳入脑梗死患者150例,采用匹兹堡睡眠质量指数（PSQI）、改良Barthel指数（MBI）、神经功能缺损程度评分（NDS）、汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）进行测评,并以PSQI量表总分〉7分作为判断失眠的标准。分析卒中患者失眠的类型及特点;分析失眠在不同类型人群中发生率的差异,筛选影响因素;分析失眠患者与非失眠患者各量表评分的差异。结果：150例患者中,73例（48.67%）发生失眠,失眠的形式以入睡困难、早醒、睡眠维持困难为主。失眠的发生率与性别、卒中部位、临床神经功能缺损程度、日常生活能力、精神状态关系密切。失眠患者在神经功能缺损程度、焦虑和抑郁程度方面较非失眠患者严重（P〈0.05）,日常生活能力较低（P〈0.05）。结论：初发缺血性脑卒中患者失眠的发生率较高,影响因素有性别、卒中的部位、生活能力、神经功能缺损程度及精神状态。     

延髓梗死与急性期失眠相关性分析

目的探讨缺血性卒中患者中延髓梗死与急性期失眠的相关性。方法连续纳入急性缺血性卒中患者,收集临床资料,包括患者影像学、人口学及相关量表等。根据影像结果登记梗死部位;根据相关睡眠障碍标准定义失眠。二分类logisti回归模型分析延髓粳死对失眠的影响。结果321例缺血性卒中患者,急性期失眠135例(42.1%),脑干梗死77例(24.0%),延髓梗死21例(6.5%)。与非失眠患者比较,急性期失眠患者脑干粳死及延髓梗死比例更高;Logisic回归分析表明,延髓梗死患者发生急性期失眠风险比非失眠者高4.325倍(P=0.021,OR=5.325,95%CI 1.282-22.121)。结论约40%急性缺血性卒中患者发生急性期失眠延髓梗死可能增加急性期失眠发生风险。     

失眠相关的心理因素研究

目的:探讨失眠与睡眠的过度要求、对睡眠的控制、失眠的外归因以及睡眠依赖等心理因素的关系。方法:用汪氏失眠综合问卷(WIIQ)对150例失眠患者以及150例正常睡眠者进行横断性的问卷调查,用SPSS 22.0进行分析。结果:失眠症组心理因素总分及各分量表分相较于对照组更高(P0.01)。心理因素总分以及每个分量表的总分与WIIQ的失眠严重性指数之间有显著相关性(P0.01),相关系数在0.571与0.746之间。在对照组中,曾经有过失眠的受试者的心理因素比从未失眠的受试者更多(P0.01)。临床试验患者中,治疗后比治疗前心理因素更少(P0.01);心理因素总分与匹兹堡睡眠质量指数治疗前后差值之间有显著的相关性(P0.01),相关系数为0.461。结论:失眠与睡眠的过度要求、对睡眠的控制、失眠的外归因以及睡眠依赖等不良的认知和行为相关,因素越多失眠越严重。失眠与相关的心理因素的因果关系可能是双向,即失眠带来心理因素,心理因素维持、加重失眠。通过心理治疗可以减少这些心理因素,进而缓解失眠。     

舒适护理对脑梗死患者减轻失眠的效果观察

目的 探讨舒适护理对减轻脑梗死患者失眠的效果,促进脑梗死患者身心全面康复.方法 随机选择2005年1-12月入住的231例神志较为清醒的脑梗死患者,按急性期、稳定期、恢复期分别实施相应的舒适护理措施,对患者入院时、人院后2周的失眠情况进行评估比较.结果 患者入院后2周时失眠状况较入院时显著改善,差异有统计学意义,P<0.01.结论 舒适护理对改善脑梗死患者睡眠质量有很大作用,减少了并发症的发生,提升了护理服务水平,应予重视和推广.     

Prevalencia de trastornos del sueño y factores asociados en pacientes hospitalizados

ObjectiveTo determine the prevalence of insomnia in inpatient in an Internal Medicine Department and to identify risk factors of sleep disorders.MethodA cross-sectional observational study was designed. Inpatients over eighteen years old hospitalized for acute medical conditions were recruited. Insomnia was assessed by the Athens insomnia scale. A nurse administered a questionnaire on risk factors including socio-demographic factors, reason for admission, comorbidities, current medications, functional status, nocturnal symptoms, and environmental factors.ResultsA total of 299 patients were recruited with a mean age of 73.7 years (SD 14.2). Overall prevalence of insomnia was 42.1%, slightly higher in women (48.2%) than in men (37.0%) (P = .052). In those less than 65 years the prevalence was 33.8%, and in patients aged 65 or over it was 44.9% (P = .093). The main factors associated with insomnia were a history of anxiety, depression and stroke, heartburn, pain, fear, and poor functional capacity at admission. Environmental factors such as noise, the sensation of cold or heat, and changing habits involved in hospitalization did not reach statistical significance. In patients 65 years or older, the use of beta-blockers was associated with insomnia. The multivariate analysis showed stroke, heartburn, and pain as independent risk factors for insomnia.ConclusionsInsomnia is highly prevalent among inpatient, and is associated with some treatable or modifiable factors.     

Insomnia

Insomnia is a common problem that is chronic for many individuals. Multiple processes, including psychologic, physiologic, and environmental factors, can influence insomnia, and their effects can shift over time. Accordingly, the evaluation of patients who have insomnia should be broad in scope. Insomnia represents a clinical problem with significant daytime consequences, associations, and comorbidities. Several nosologies categorize insomnia into specific diagnoses. Useful minimal criteria for an insomnia disorder include persistent nighttime symptoms with daytime distress or impairment. Specific treatments, addressing particular underlying causes,and general pharmacologic and nonpharmacologic strategies may play valuable roles in the management of insomnia patients. The effective treatment of insomnia can have further benefits in decreasing the likelihood of future psychiatric symptoms.     

Is insomnia associated with suicidality in stroke?

Tang W-K, Lu J-Y, Liang H, Chan T-T, Mok V, Ungvari GS, Wong K-S. Is insomnia associated with suicidality in stroke?

Objective

To evaluate the relationship between insomnia and suicidality (SI) in Chinese patients with first or recurrent stroke.

Design

Cross-sectional survey.

Setting

Acute stroke unit of a general hospital.

Participants

Patients (N=787) with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong.

Interventions

Not applicable.

Main Outcome Measures

Suicidality (SI) was assessed with the Geriatric Mental State Examination at 3 months after subjects' index stroke. Insomnia symptoms were evaluated with a standard insomnia questionnaire. The association between insomnia symptoms and SI was examined and adjusted for potential confounders, including age, sex, marital status, previous stroke, depression, fatigue, Mini-Mental State Examination score, and neurologic deficits measured with the National Institutes of Health Stroke Scale.

Results

Eighty-seven patients (11.1%) were found to have SI (SI group). Frequent awakening was significantly more common in the SI group than in the non-SI group and remained a significant predictor of SI in forward logistic regression analysis (odds ratio, 1.7) after adjusting for possible confounders.

Conclusions

These findings should alert clinicians to the potential danger of insomnia and the importance of its early identification and treatment in stroke patients.     

门诊失眠患者焦虑、抑郁情况及影响因素分析

目的分析门诊患者失眠、焦虑及抑郁的影响因素。方法采用一般资料及阿森斯失眠量表、焦虑与抑郁自评量表的调查问卷,对257例失眠患者进行调查分析。结果失眠平均得分(13.63±4.03)分,失眠得分18分以下者占86.0%。失眠合并焦虑或抑郁者分别占37.7%和34.6%。失眠合并抑郁及焦虑者占24.9%,失眠与焦虑、抑郁呈正相关(P<0.01)。受教育程度为失眠的影响因素,体质量指数、生活习惯为焦虑的影响因素,体质量指数为抑郁的影响因素。结论失眠与焦虑、抑郁相互影响,受教育程度低者失眠得分较高,低体质量指数为焦虑、抑郁的影响因素,不规律的生活习惯是焦虑的影响因素。     

Insomnia

Because sleep needs vary from person to person, insomnia is defined as the chronic inability to obtain the amount of sleep needed for optimal functioning and well-being. Insomnia, which is a symptom rather than a disease, can be classified into three main etiologic groups: insomnias related to other mental disorders (for example, depression and anxiety), insomnias related to known organic factors (for example, sleep apnea and "nonrestorative" sleep), and primary insomnia (for example, learned psychophysiologic insomnias and insomnia complaints without objective findings). The treatment for insomnia often involves a combination of pharmacotherapy, behavioral and short-term psychotherapy, and sleep hygiene guidelines. Sleep disorders centers can provide specialized knowledge and techniques for patients with severe chronic insomnia.     

Advances in treating insomnia

Too often, insomnia is treated as a symptom without investigation of the cause. Insomnia may be a condition unto itself (primary insomnia), or it may be associated with a medical or psychiatric condition (comorbid insomnia), and it may be acute or chronic. Inadequate treatment often leads to significant frustration and lost productivity. We review the classification, pathophysiology, and treatment of insomnia and discuss how we can minimize its adverse consequences.