心血管疾病患者内感觉意识、焦虑敏感性与失眠症状的关系研究

背景　睡眠障碍会引起心血管疾病，而失眠是常见的睡眠障碍之一。失眠受焦虑、抑郁等多种心理因素的影响。焦虑敏感性是焦虑影响失眠的重要桥梁，其与内感觉障碍也有重要联系。目前针对内感觉意识、焦虑敏感性与失眠症状关系的研究较少。了解更多有关失眠症状的影响因素可能会为这些领域制定干预措施提供依据。目的　调查成年心血管疾病患者内感觉意识、焦虑敏感性与失眠症状之间的关系，分析失眠症状的预测因素，为实施失眠症状的干预提供理论依据。方法　采用横断面调查法，2019年10-12月在某市一家三级甲等医院，采用方便抽样法，抽取170例成年心血管疾病患者，采用一般资料调查表、内感觉意识问卷（IAQ）、焦虑敏感指数量表-3（ASI-3）、失眠严重程度指数量表（ISI）进行调查。结果　共回收有效问卷160份，有效回收率为94.1%。78.8%（126/160）的参与者经历失眠，其中，轻度失眠者63例（50.0%），中度失眠者53例（42.1%），严重失眠者10例（7.9%）。160例心血管疾病患者IAQ评分为（55.39±11.58）分，ASI-3评分为（34.76±16.35）分，ISI评分为（12.36±6.38）分。不同性别、疾病类型心血管疾病患者ISI评分比较，差异有统计学意义（P<0.05）。Pearson相关分析显示，内感觉意识、焦虑敏感性与失眠症状两两呈线性正相关（r=0.406~0.554，P<0.05）。多元线性回归分析显示，控制了性别、疾病类型，焦虑敏感性（b=0.216，P<0.001）与内感觉意识（b=0.224，P<0.001）是心血管疾病患者失眠症状的影响因素，两者共同解释失眠症状总方差的46.3%。结论　内感觉意识和焦虑敏感性是心血管疾病患者失眠症状的重要预测指标。使用多模式的身心综合行为干预可能是未来的研究方向。

Relationships of Insomnia Symptoms with Interoceptive Awareness and Anxiety Sensitivity in Adults with Cardiovascular Disease

Background　Sleep disorders can cause cardiovascular diseases（CVD），among which insomnia is one of the most frequently seen. Insomnia is often affected by anxiety，depression and other psychological factors. To be specific，anxiety influences insomnia via anxiety sensitivity，an important intermediary. Moreover，abnormal interoceptive awareness is also closely related to insomnia. To develop interventions for insomnia symptoms based on interoceptive awareness and anxiety sensitivity，besides the evidence from very limited available studies about the correlations of the three factors，studying the associated factors of insomnia symptoms may be used as an additional theoretical assistance. Objective　To investigate the relationship of interoceptive awareness and anxiety sensitivity with insomnia symptoms in adult patients with CVD，and based on this，to analyze the predictive value of the former two for the latter，to provide a theoretical basis for the delivery of intervention of insomnia symptoms. Methods　A cross-sectional survey was conducted in a grade A tertiary hospital in a city of China. 170 adult patients with CVD were selected by convenient sampling from October to December 2019. The General Information Questionnaire developed by our research group，Interoceptive Awareness Questionnaire（IAQ），Anxiety Sensitivity Index-3（ASI-3） and Insomnia Severity Index（ISI） were used to investigate. Results　A total of 160 valid questionnaires were collected, with an effective recovery rate of 94.1%. 78.8%（126/160） of the participants experienced insomnia，among whom 63（50.0%） had mild insomnia，53（42.1%） had moderate insomnia and 10（7.9%） had severe insomnia. The average scores of IAQ，ASI-3 and ISI for the participants were（55.39±11.58），（34.76±16.35），and（12.36±6.38），respectively. The ISI score changed significantly according to gender and types of CVD（P<0.05）. Pearson correlation analysis showed that the severity of insomnia symptoms was linear positively correlated with the levels of interoceptive awareness and anxiety sensitivity（r=0.406-0.554，P<0.05）. Multiple linear regression analysis showed that anxiety sensitivity（b=0.216，P<0.001） and interoceptive awareness（b=0.224，P<0.001） were important influencing factors of insomnia symptoms after controlling gender and disease type，explaining 46.3% of the total variance of insomnia symptoms. Conclusion　Interoceptive awareness and anxiety sensitivity are important predictors of insomnia in patients with CVD. The use of multimodal psychosomatic intervention may be a future research direction.