2型糖尿病患者的睡眠质量对血糖控制达标的影响

目的分析2型糖尿病（T2DM）患者的睡眠质量对血糖控制达标的影响及相关因素。方法选取2011年6月至2012年2月在中日友好医院内分泌科住院的T2DM患者200例为研究对象，采用匹兹堡睡眠质量指数（PSQI）量表调查T2DM患者的睡眠质量。以糖化血红蛋白（HbAlc）〈7．0％作为血糖控制达标；以Zung氏抑郁自评量表（SDS）了解患者精神状况，SDS≥50分为抑郁状态；以PSQI≥7分为睡眠障碍，将患者分为无睡眠障碍组（88例）和睡眠障碍组（112例）；并结合临床资料进行分析和比较。计量资料采用独立样本t检验，计数资料采用卡方检验，与睡眠障碍、血糖达标的相关性分析采用多元logistic回归分析。结果与无睡眠障碍组相比，睡眠障碍组年龄、HbAlc、血糖（空腹、0．5h,2h）、总胆固醇、甘油三酯、PSQI评分、SDS评分、抑郁发生率明显升高（t=-19．49～-1．99，，=9．931，均P〈0．05）；C肽（空腹、0．5h）、体质指数（BMI）明显偏低（t=2．07、2．14、2．35，均P〈0．05）。PSQI评分〈5分组、5～7分组、7—9分组和≥9分组的血糖达标率分别为27．9％、19．6％、10．0％和8．6％，随着PSQI评分升高，血糖达标率呈逐渐下降的趋势。多元logistic回归分析结果显示：睡眠障碍与年龄、男性、HbAlc≥7．0％及抑郁呈正相关，与BMI负相关（OR=1．04、2．38、2．98、2．14、0．89，均P〈0．05）。HbAlct〉7．0％与睡眠障碍及2h血糖呈正相关，与胰岛素治疗呈负相关（OR=2．81、1．21、0．33，均P〈0．05）。结论T2DM患者普遍存在睡眠障碍，其与高血糖存在着交互影响，并造成心理健康问题。应重视对T2DM患者的睡眠质量管理和血糖控制，以改善睡眠和有效提高血糖达标率。

Effects of sleep quality on glycemic control in patients with type 2 diabetes

Objective To investigate the effect of sleep quality on glycemic control and relevant factors involved in subjects with type 2 diabetic mellitus（T2DM）. Methods A total of 200 inpatients with T2DM were enrolled in this study. Each patient completed Pittsburg Sleep Quality Index （PSQI） questionnaire. The glycemic control target was 〈 7%. All patients were evaluated by Zung Self-rating Depression Scale （SDS） for the mental status, the score of SDS ≥ 50 was defined as a depressive state. Patients were divided into two groups ： non-sleep disorder group （ n = 88 ） and sleep disorder group （ n = 112） according to PSQI score ≥7 which was defined as the sleep disorder. The clinical characteristics of two groups were compared and analyzed. Results The incidence of sleep disorder was 56% in the overall population. In the sleep disorders group, Age, hemoglobin A, glycosylated （HbAlc）, fasting plasma glucose, 0. 5-hour as well as 2-hour postprandial plasma glucose, fasting serum total cholesterol, triglycerides,the score of SDS and the incidence of depression were significantly greater （t = -19.49 - - 1.99, X2 = 9. 931, all P 〈 0.05 ）, whereas fasting C-peptide, 0. 5-hour postprandial C-peptide and body mass index （BMI） were significantly lower （t =2.07,2. 14,2. 35,all P 〈0. 05） than those of the non-sleep disorder group. Glycemic control target rate of PSQI 〈 5 group, PSQI I〉 5 to 7 group, PSQI ≥ 7 to 9 group and PSQI~〉9 group was 27. 9%, 19. 6%, 10. 0% and 8. 6%, respectively. Patients with a higher score ofPSQI were less likely to reach glycemic targets （ P 〈 0.05 ）. Multiple logistic regression analysis indicated that sleep disorders was positively correlated with increased age, male, HbAlc and depression, however, sleep disorders was negatively related to BMI （ OR = 1.04, 2. 38, 2. 98, 2. 14, 0. 89, respectively, all P 〈 0. 05）. There was a positive association between sleep disorders, 2-hour postprandial plasma glucose and HbAle≥7%, however, HbAlc≥7% was inversely associated with insulin therapy （ OR = 2. 81, 1.21, 0. 33, all P 〈 0. 05）. Conclusion Sleep disorders are prevalent in patients with T2DM. Hyperglycemia and sleep disorders interact with each other. Sleep disorders probably cause psychological health problems. Management of sleep quality and glucose control in patients with T2DM should be an effective approach for sleep and higher glycemic control target rate.