慢性原发性失眠患者主客观睡眠质量差异及相关因素

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3d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)minv.s(423.4±42.8)min,P<0.001;客观睡眠时间为(332.2±154.7)minv.s(418.1±47.8)min,P=0.009;主观入睡潜伏期为(80.3±73.7)minv.s.(19.2±8.6)min,P<0.001;客观睡眠潜伏期为(23.2±25.4)minv.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)minv.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)minv.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)minv.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。

Differences between objective and subjective sleep quality in chronic primary insomniacs and the correlated factors

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.