失眠严重指数量表应用于工商学校学生的心理测量学特征

目的 评估失眠严重指数量表（ISI）中文版的心理测量学特征。方法 选取某工商学校 的3 969 名学生,睡眠质量采用匹兹堡睡眠质量指数（PSQI）量表评定、失眠严重程度采用ISI评定、白天 嗜睡程度采用爱泼沃斯嗜睡量表（ESS）评定、抑郁状况采用贝克抑郁量表（BDI）评定、焦虑状况采用宗 式焦虑自评量表（SAS）评定,并收集了受试者的一般资料。2 915 名（73%）学生在9 个月后完成了ISI 重 测。结果 首测ISI 分为（5.82 ±4.60）分（0～28 分）,呈现正偏态分布;其趋向于单因子结构（方差解释值 为52%）,条目载荷范围为0.62～0.80,KMO=0.87,Bartlett 球形检验的P＜ 0.001;条目与总分的相关系数 为0.63～0.79,Spearman Brown 分半信度和Chronbach''s α 系数为0.75 和0.84（均P ＜ 0.001）。首测ISI 分 与ESS 分、BDI分与SAS分存在相关性,而ISI分与PSQI分无相关性。首测和复测ISI总分和各个条目的 效应量（Cohen''s d）,除了条目5（Cohen''s d=0.361）,其他均＜ 0.1。结论 ISI（中文版）有较好的效度和信度, 适于青年失眠严重程度的评估。该青年群体的失眠发生率较高（30.2%）,而且稳定存在,需要予以关注。     

广东省乡镇青少年学生白日过度思睡状况及相关因素

目的了解广东乡镇地区11～18岁青少年学生白日过度思睡(Excessive Daytime Sleepiness,EDS)的发生情况及探讨其影响因素。方法整群抽取广东省龙门县5所中学的5003名学生,采用一般情况调查表、爱泼沃斯嗜睡量表(Epworth Sleepiness Scale,ESS)、失眠严重指数量表(Insomnia Severity Index,ISI)、贝克抑郁量表(Beck Depression Inventory,BDI)和焦虑自评量表(Self-rating Anxiety Scale,SAS)等进行问卷调查。结果青少年学生EDS(ESS10)发生率为11.1%(95%CI:10.2%～12.0%),男性高于女性(12.0%vs.10.1%,P0.05),并且在年龄、是否吸烟、身体状况、学习压力、学习兴趣、是否午睡及不同睡眠时间方面EDS的发生率存在明显差异(P0.01);EDS组的BDI、SAS和ISI总分均高于非EDS组(P0.01)。Logistic回归分析结果显示男性(OR=1.25,95%CI:1.03～1.52)、习惯性午睡(OR=1.35,95%CI:1.11～1.64)、吸烟(OR=2.02,95%CI:1.23～3.33)、学习压力大(OR=1.28,95%CI:1.07～1.54)、学习兴趣低(OR=1.38,95%CI:1.10～1.73)、有慢性疾病(OR=1.69,95%CI:1.22～2.34)、失眠(OR=3.37,95%CI:2.60～4.37)、焦虑(OR=1.95,95%CI:1.57～2.42)、抑郁(OR=1.65,95%CI:1.30～2.09)情绪是EDS的危险因素。结论广东乡镇青少年学生EDS发生率较高,男性、习惯性午睡、抽烟、学习压力大、学习兴趣低、有慢性疾病、失眠及焦虑抑郁情绪是EDS的危险因素,提示伴有EDS的青少年情绪状况和睡眠质量较差。     

血液透析患者不宁腿综合征相关影响因素分析

目的调查血液透析患者不宁腿综合征发病率并筛查其相关危险因素。方法共220例维持性血液透析患者和40例慢性肾脏病患者,采用国际不宁腿综合征研究组评价量表(IRLS)评价不宁腿综合征严重程度,Beck抑郁量表(BDI)评价抑郁症状,Epworth嗜睡量表评价白天过度嗜睡,失眠严重程度指数(ISI)评价失眠程度。采用单因素和多因素前进法Logistic回归分析筛查血液透析患者发生不宁腿综合征的相关危险因素。结果血液透析组病程(Z=-9.837,P=0.000)、血清铁蛋白(t=2.847,P=0.005)、合并不宁腿综合征比例(χ~2=10.918,P=0.001)、应用镇静催眠药比例(χ~2=7.669,P=0.006)、IRLS评分(t=2.322,P=0.020)和ISI评分(Z=4.117,P=0.001)均高于对照组。单因素和多因素前进法Logistic回归分析显示,糖尿病(OR=3.387,95%CI:1.538~7.461;P=0.002)、BDI评分9分(OR=2.643,95%CI:1.457~4.795;P=0.001)和ISI评分7分(OR=3.542,95%CI:1.939~6.468;P=0.000)是血液透析患者发生不宁腿综合征的独立危险因素。结论血液透析患者不宁腿综合征和失眠发病率较高,不宁腿综合征与失眠密切相关,抑郁症状在其中发挥重要作用。     

失眠伴抑郁与单纯失眠患者失眠认知行为治疗的疗效分析

目的分析失眠认知行为疗法(cognitive behavioral therapy on insomnia,CBT-i)对失眠伴抑郁患者以及单纯失眠患者的疗效。方法71例符合失眠症诊断的患者,根据贝克抑郁量表(Beck Depression Inventory,BDI)得分分为单纯失眠组(<14分,33例)和失眠伴抑郁组(≥14分,38例)。2组患者每天填写睡眠日记,并给予8周标准的CBT-i治疗,在治疗前(基线)、治疗第4周、治疗第8周、治疗结束后4周(第3个月)、治疗结束后16周(第6个月)采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、失眠严重程度指数(Insomnia Severity Index,ISI)、BDI、贝克焦虑量表(Beck Anxiety Inventory,BAI)、SF-36健康调查简表对2组患者睡眠质量、抑郁焦虑程度、个人健康状况等进行评估,采用独立样本t检验进行组间比较,采用重复测量方差分析进行各时间点组内比较。结果与基线时比较,单纯失眠组和失眠伴抑郁组第8周、第3个月和6个月随访时入睡潜伏期、睡眠效率、PSQI、ISI、BDI、BAI、SF-36组内比较差异均有统计学意义。失眠伴抑郁组较单纯失眠组在基线、第8周、第3个月和6个月随访时BAI(t=-6.340、-3.301、-3.511、-2.982)、SF-36(t=4.162、3.195、2.022、3.629)评分差异有统计学意义(P<0.01或0.05),2组ISI评分在第6个月随访时差异有统计学意义[(7.3±4.6)分与(4.7±3.4)分,t=-2.044,P=0.048]。2组入睡潜伏期和睡眠效率以及PSQI的评分在第8周、第3个月和6个月随访时与基线的变化量差异均无统计学意义;而2组BAI、BDI评分在第8周与第3个月和6个月随访时与基线的变化量差异有统计学意义。结论CBT-i对失眠伴抑郁患者和单纯失眠患者均有效,且可以缓解失眠伴抑郁患者的抑郁症状以及改善患者生活质量。     

睡眠医学选修课学生的选修动机和睡眠情绪特质关系

目的 了解睡眠医学选修课学生的选修动机与睡眠情绪特质的关系.方法 通过问卷星进行一般人口学资料、选修动机、睡眠症状、匹兹堡睡眠质量指数(PSQI)、焦虑(SAS)和抑郁(SDS)自评、清晨夜晚型(MEQ)、艾普沃思嗜睡(ESS)、失眠(ISI)和疲劳(FSS)严重程度收集.结果 2017年-2019年共410人报名睡眠...     

睡眠医学选修课学生的选修动机和睡眠情绪特质关系

目的 了解睡眠医学选修课学生的选修动机与睡眠情绪特质的关系.方法 通过问卷星进行一般人口学资料、选修动机、睡眠症状、匹兹堡睡眠质量指数(PSQI)、焦虑(SAS)和抑郁(SDS)自评、清晨夜晚型(MEQ)、艾普沃思嗜睡(ESS)、失眠(ISI)和疲劳(FSS)严重程度收集.结果 2017年-2019年共410人报名睡眠...     

重复经颅磁刺激治疗原发性失眠的疗效观察

目的:观察重复经颅磁刺激(r TMS)对原发性失眠的疗效。方法:80例原发性失眠患者随机分为研究组(43例,完成41例)和对照组(37例,完成34例),研究组给予右侧额叶背外侧区低频(1 Hz)r TMS治疗;对照组予假刺激(0 Hz,部位同研究组)治疗;疗程10 d,未予药物治疗。治疗前后采用匹兹堡睡眠质量指数(PSQI)和焦虑自评量表(SAS)、抑郁自评量表(SDS)评估,治疗后采用不良反应量表(TESS)评估。结果:研究组治疗有效率显著高于对照组(χ~2=7.440,P0.05),不良反应发生率显著低于对照组(χ~2=5.932,P0.05)。协方差分析结果示,研究组治疗后PSQI睡眠质量因子、入睡时间因子、睡眠时间因子、日间功能障碍因子和总分的改善、以及SAS量表减分较对照组更为显著(P均0.05)。结论:r TMS治疗原发性失眠疗效显著,对失眠伴随的焦虑症状也有较好的治疗作用。     

姑息护理对老年胃癌患者的疗效

目的分析姑息护理对老年胃癌患者心理状态、睡眠及生活质量的改善效果。方法选取在我院接受治疗的70例老年胃癌患者,随机分为姑息组(n=35)和常规组(n=35),分别给予全程姑息护理干预和常规性基础护理干预。干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)分别评估患者焦虑和抑郁程度,采用失眠严重指数量表(ISI)评分评估睡眠质量,并采用癌症患者生活质量测定量表(QLQ-C30)评估生活质量改善情况。结果两组干预前上述各项评分,组间比较差异无统计学意义(P0.05)。与干预前比较,两组干预后SAS、SDS评分、ISI评分均降低,QLQ-C30评分均升高(P0.05)。且与常规组比较,干预后姑息组SAS、SDS评分、ISI评分均明显低,QLQ-C30量表中认知功能、情绪功能及社会功能评分均显著较高(P0.05)。结论姑息护理干预可更明显改善老年胃癌患者焦虑、抑郁及失眠症状,提高生活质量,更好地减轻患者的身心痛苦。     

阻塞性睡眠呼吸暂停患者临床特征与焦虑抑郁的相关分析

目的探索阻塞性睡眠呼吸暂停(OSA)患者的临床特征及其与焦虑抑郁症状的关系,为进一步研究两者间具体的发生机制提供参考。方法选取2018年3月-9月在四川省精神卫生中心行多导睡眠监测的患者238例,根据呼吸暂停低通气指数(AHI)分为OSA组(n=130)和非OSA组(n=108)。采用自制一般资料和临床症状调查问卷、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数量表(PSQI)评定患者的临床症状和睡眠质量;采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表24项版(HAMD-24)评定患者的焦虑和抑郁症状。分析OSA组临床症状与焦虑抑郁的相关性。结果 OSA组打鼾(76.9%)、夜间憋醒(25.4%)、认知功能减退(76.9%)者均比非OSA组(分别为41.7%、13.0%、63.9%)多,且OSA组症状持续时间更长,差异均有统计学意义(P0.05或0.01)。OSA组ESS、HAMA和HAMD-24评分均高于非OSA组(P均0.01)。相关分析显示,OSA组临床症状持续时间与HAMA评分呈正相关(r=0.212,P=0.016);PSQI评分与HAMA、HAMD-24评分均呈正相关(r=0.217、0.211,P=0.014、0.017)。结论 OSA患者常伴有打鼾、夜间憋醒、认知功能减退,且症状持续时间仅与其焦虑水平有关,睡眠质量与焦虑、抑郁的关系均较密切。     

心理护理对脑外伤并发失眠患者睡眠及焦虑情绪的疗效

目的探讨心理护理改善脑外伤并发失眠患者睡眠质量及焦虑情绪的作用。方法随机选取我院2014年4月至2016年4月收治的脑外伤并发失眠患者80例,将上述患者随机分为两组,按护理方式不同分别为:常规护理组(n=40)心理护理组(n=40),对两组患者护理前后的睡眠质量及焦虑情绪进行对比分析。结果护理前两组患者的匹兹堡睡眠质量指数量表(PSQI)总分、焦虑自评量表(SAS)评分之间的差异均不显著(P0.05),护理后心理护理组患者的PSQI总分以及睡眠质量、日间功能障碍等分量表评分、SAS评分均显著低于常规护理组(P0.05),但两组患者的入睡时间、睡眠时间、睡眠效率、睡眠障碍评分之间的差异均不显著(P0.05)。结论心理护理能够更有效改善脑外伤并发失眠患者睡眠质量及焦虑情绪。     

不同睡眠障碍类型对帕金森病患者生活质量的影响

目的分析帕金森病(PD)患者不同睡眠障碍类型对其生活质量的影响,为临床干预提供依据。方法应用中文版39项帕金森病生活质量问卷(PDQ-39)评定92例PD患者生活质量。采用Epworth嗜睡评分量表、香港版REM睡眠行为异常问卷(RBDQ-HK)、PD非运动症状问卷(NMSQuest)第4项和第6项、匹兹堡睡眠质量指数量表中第10项分别评定患者白天过度嗜睡(EDS)、快速动眼睡眠行为障碍(RBD)、失眠、不宁腿综合征(RLS)、睡眠呼吸暂停(SDB)等情况。分析不同睡眠障碍类型对PD患者生活质量的影响。结果伴睡眠障碍的PD患者PDQ-39评分明显高于不伴睡眠障碍的PD患者(P0.05)。在各类睡眠障碍中,失眠为PD患者生活质量最强的预测因子(r2=0.138,P=0.000),其次是RLS(r2=0.040,P=0.000),H-Y分级亦有预测作用,3者对PDQ-39总分的影响占决定作用的52%。RBD、EDS、SDB对PD患者生活质量的影响不明显。结论睡眠障碍可明显降低PD患者生活质量,其中失眠影响最显著,RLS次之。     

Sleepiness and sleep quality in patients with HIV infection

ObjectivesPatients with HIV infection frequently complain of sleep disturbances and daytime sleepiness. Only few data on these problems evaluated by standardized measures is available.MethodsA sample of 180 consecutive patients with HIV infection referred to the internal and to the neurological HIV clinics at the University of Münster was enrolled in this study. The data were compared to a sample of 120 age- and sex-matched control subjects. We used the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Beck's Depression Inventory (BDI). In addition, the clinical and immunological data of the patients were registered.ResultsAll scores of the ESS, the PSQI, and the BDI were significantly increased in the HIV infected patients as compared to the control group. There were no significant correlations between any of the immune parameters and the scores. Only a higher BDI score was correlated with both the ESS score and the PSQI score.ConclusionsPatients with HIV infection and not using evavirenz show an increased daytime sleepiness and a decreased quality of sleep. These findings could not be related to the immunological state of the patients. The only specific factor influencing daytime sleepiness in HIV infected patients is probably treatment with HAART. The most important factor determining sleepiness and sleep quality in HIV infected patients is depression which was found to be independent from the immunological state and HAART of the patients.     

北京市350名职业人员睡眠质量和情绪调节的认知策略调查

目的 了解受过高等教育职员的睡眠质量及其所采用的情绪调节认知策略.方法 采用匹兹堡睡眠质量指数(PSQI)问卷、失眠严重指数(ISI)问卷、简式简明心境问卷(POMS-SF)和认知情绪调节问卷(CERQ),对采取整群随机抽样法抽取的北京市6所单位的350名大专以上在职人员的睡眠质量与情绪调节策略进行调查.结果 (1)98例(28%)存在睡眠质量问题(PSQI≥7分),146例(41.7%)日常状态受失眠影响(ISI＞7分);(2)遭遇负性生活事件后,在所有受访人员中使用频率最高的3种情绪调节策略依次为积极重新评价、重新关注计划、积极重新关注;(3)在情绪调节认知策略的灾难化维度上,主观不失眠组(ISI≤7分)得分(34.21±12.85)分,低于轻度失眠组(7分＜ISI≤14分)[(39.62±15.02)分]与中重度失眠组(ISI≥15分)[(41.48±11.25)分],差异有统计学意义(t=3.466,P=0.001;t=2.625,P=0.009);在沉浸维度上,主观不失眠组得分(46.43±12.78)分,低于轻度失眠组[(49.92±13.55)分]与中重度失眠组[(51.67±11.44)分],差异有统计学意义(t=2.332,P=0.020;t=1.974,P=0.049).结论 受访职员睡眠质量问题及主观失眠现象较多见,多能运用积极认知策略调节情绪;主观失眠组职员有更多灾难化、沉浸的消极认知策略的运用.     

Quetiapine for insomnia in Parkinson disease: results from an open-label trial

Quetiapine is an atypical antipsychotic with sedative properties frequently used to treat hallucinations and psychosis in Parkinson disease (PD). The objective of this trial is to evaluate quetiapine for insomnia in nonpsychotic PD patients. Fourteen consecutive PD patients with frequent insomnia and without psychotic symptoms were treated openly for 12 weeks with a single evening dose of quetiapine. The dose was adjusted according to clinical improvement and tolerance. The severity of insomnia was assessed using the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness was evaluated with the Epworth Sleep Scale (ESS), and motor performance was evaluated using the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). All evaluations were done before and 1, 2, and 3 months after initiation of treatment. Total PSQI basal scores were 13.6 +/- 3.7 points. The PSQI score improved in 11 patients and was reduced by 3.8 +/- 3.9 points by the end of the study (P < 0.01). The ESS score was reduced by 4.3 +/- 3.7 points (P < 0.01). The mean quetiapine dose was 31.9 mg/day. No significant change was observed in the motor scale. Two patients were discontinued due to nonserious adverse effects. These results suggest that quetiapine may be a safe and effective treatment of insomnia in PD patients. Double-blind studies will probably confirm these findings.     

失眠职业人群的情绪障碍与其人格特征及防御方式的相关性研究

目的探讨职业失眠人群的情绪障碍与其人格特征及防御方式的相关性。方法使用匹兹堡睡眠质量指数问卷（PSQI）、艾森克人格问卷（EPQ）、防御方式问卷（CSQ）、状态焦虑特质问卷（STAI）、抑郁自评问卷（BDI）,随机抽取500名职业人群进行抽样问卷调查。结果500名职业人群中PSQI评分大于7分者有159人,睡眠障碍的发生率为31.8%。在159人当中存在焦虑障碍者95人,存在抑郁障碍者84人,发生率分别为59.75%、52.83%。焦虑障碍评分和抑郁障碍评分与EPQ中内外向（E）评分呈显著负相关（r=-0.607,r=-0.473）,而与EPQ中的情绪稳定性（N）评分呈显著正相关（r=0.591,r=0.829）,与防御方式中不成熟防御机制（F1）评分呈正相关（r=0.245,r=0.288）。结论职业人群失眠状况仍较严重,而且其伴发的情绪障碍与其不良的人格特征和不成熟防御机制的使用密切相关。     

Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study

ObjectiveTo identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.MethodsSleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire – Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.ResultsAs expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.ConclusionThese preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.     

Quality of sleep in primary focal dystonia: a case–control study

Background: Sleep disturbances are common in patients with movement disorders. Evaluating quality of sleep is of primary importance because of the effect that nocturnal and daytime sleep abnormalities exert on general health status. However, quality of sleep has never been addressed in detail in patients with dystonia. The aim of this case–control study was to analyse quality of sleep in patients with the two most common forms of primary focal dystonia, blepharospasm (BSP) and cervical dystonia (CD). Methods: We evaluated quality of sleep (Pittsburgh Sleep Quality Index, PSQI) and excessive daytime sleepiness (Epworth Sleepiness Scale, ESS) in 98 patients with focal adult‐onset dystonia (52 with BSP; 46 with CD) and in a group of 56 age‐and gender‐matched healthy subjects. The Beck Depression Inventory (BDI) was used for the evaluation of depressive symptomatology. Results: Quality of sleep was impaired (significantly higher PSQI scores) in both groups of patients. However, differences in PSQI scores between patients with CD and control subjects were partly confounded by BDI scores, whereas differences in PSQI scores between patients with BSP and control subjects were not influenced by BDI. Excessive daytime sleepiness was not significantly more frequent than in control subjects in either patients with BSP or patients with CD. Conclusions: This study suggests that the assessment and treatment of insomnia‐related complaints should be considered in global management plans of patients with focal dystonia, particularly in those affected by BSP.     

经颅重复磁刺激辅助治疗老年焦虑症继发睡眠障碍的效果观察

目的 探讨米氮平合用经颅重复磁刺激法治疗伴睡眠障碍的老年焦虑症的疗效.方法 将100例符合“老年焦虑症”诊断标准并伴有失眠的患者随机分为研究组（米氮平合并经颅重复磁刺激法）和对照组（单用米氮平）各50例.观察8周.治疗前及治疗后第2,4,8周采用汉密尔顿焦虑量表（HAMA）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评定焦虑和抑郁症状;治疗前及治疗第8周采用多导睡眠监测技术（PSG）和匹兹堡睡眠质量指数量表（PSQI）评定睡眠状况.结果 （1）两组临床疗效有效率分别为87.23％和68.89％,两组比较差异有统计学意义（x2=4.55,P＜0.05）;（2）治疗后4、8周后,研究组HAMA、SAS及SDS分值量表分值与对照组比较较低,且差异有统计学意义（t分别为3.997 3,4.937 7,3.359 9;P＜0.05）;（3）治疗后研究组实际睡眠总时间、睡眠潜伏期、REM潜伏期、REM睡眠比例、夜间觉醒次数、觉醒总时间评分结果与对照组比较差异有统计学意义（t分别为3.565 6,3.105 7,2.705 7,2.699 1,3.614 9,19.898 8;P＜0.05）;（4）治疗后研究组PSQI评分低于对照组,两组比较差异有统计学意义（t=3.327 8,P＜ 0.05）;（5）两组不良反应的发生率分别为10.64％和17.78％,经比较差异无统计学意义（x2=0.97,P＞0.05）.结论 米氮平合用经颅重复磁刺激法治疗老年焦虑症伴发的睡眠障碍有较好的效果.