原發性失眠主客觀睡眠質量與日間功能損害的關系_《華西醫學》

作者：

劉紅 ¹ , 楊勁 ² ,  唐向東 ¹

1 四川大學華西醫院睡眠醫學中心（成都，610041）;2 靖邊縣婦幼保健院兒科;

關鍵詞：

原發性失眠日間功能主觀睡眠質量

DOI：

10.7507/1002-0179.20130067

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目的　探討原發性失眠患者日間功能損害及其影響因素。方法　選取2010年3月－12月符合美國《精神障礙診斷與統計手冊》第4版診斷標準的原發性失眠者62例，另選擇性別、年齡匹配的健康睡眠者53例。失眠組和對照組均采用匹茨堡睡眠質量指數量表（PSQI）評估1個月的主觀睡眠質量，多導睡眠監測（PSG）評估客觀睡眠質量，并通過“主觀睡眠時間/客觀睡眠時間×100%”計算睡眠知覺，PSG監測后受試者完成一系列日間功能評定，包括Epworth嗜睡量表（ESS）評價嗜睡程度、Flinders疲勞量表（FFS）評價疲勞程度、貝克抑郁量表（BDI）和狀態-特質焦慮量表（STAI）評估情緒狀態。結果　① 與對照組相比，失眠組主客觀睡眠質量均較差；PSQI分數更高[（14.37 ± 2.44）、（2.74 ± 1.79）分，P＜0.001）]；睡眠知覺差[（49.76 ± 33.29）、（99.36 ± 12.79）分，P＜0.001）]。② 失眠組FSS、BDI、SAI、TAI分數明顯高于對照組，ESS分數低于對照組（P值均＜0.05）。③ PSQI總分與ESS呈負相關（r=?0.17，P＜0.01），與FSS、BDI、SAI、TAI分數呈正相關（r=0.54，r=0.66，r=0.70，r=0.87）（P值均＜0.01）。客觀睡眠時間與ESS（r=?0.01，P=0.138）、FSS（r=?0.02，P=0.019）、BDI（r=?0.03，P=0.022）、SAI（r=?0.03，P=0.086）、TAI（r=?0.04，P=0.015）分數均無明顯相關性。結論　原發性失眠者主觀睡眠質量與多項日間功能損害相關，這為有效的治療失眠和改善日間癥狀提供理論依據。

引用本文： 劉紅,楊勁,唐向東. 原發性失眠主客觀睡眠質量與日間功能損害的關系. 華西醫學, 2013, 28(2): 209-213. doi: 10.7507/1002-0179.20130067 復制

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9.	Iber C, Ancoli-Israel S, Chesson A, et al. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification [M]. Westchester, Illinois: American Academy of Sleep Medicine, 2007: 17-48.
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11.	Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale[J]. Sleep, 1991, 14(6): 540-545.
12.	Chen NH, Johns MW, Li HY, et al. Validation of a Chinese version of the Epworth sleepiness scale[J]. Qual Life Res, 2002, 11(8): 817-821.
13.	Gradisar M, Lack L, Richards H, et al. The Flinders Fatigue Scale: preliminary psychometric properties and clinical sensitivity of a new scale for measuring daytime fatigue associated with insomnia[J]. J Clin Sleep Med, 2007, 3(7): 722-728.
14.	Beck AT，Ward CH，Mendelson M, et al. An inventory for measuring depression[J]. Arch Gen Psychiatry, 1961, 4(6) : 561-571.
15.	張雨新，王燕，錢銘怡. Beck 抑郁量表的信度和效度[J]. 中國心理衛生雜志, 1990, 4( 4) : 164-168.
16.	杜好瑞, 趙洪祖, 嚴宏力, 等. 失眠癥患者狀態一特質焦慮與睡眠結構的關系[J].中國心理衛生雜志, 2009，23(12): 868-871.
17.	Gooneratne NS, Bellamy SL, Pack F, et al. Case-control study of subjective and objective differences in sleep patterns in older adults with insomnia symptoms[J]. J Sleep Res, 2011, 20(3): 434-444.
18.	Manconi M, Ferri R, Sagrada C, et al. Measuring the error in sleep estimation in normal subjects and in patients with insomnia[J]. J Sleep Res, 2010, 19(3): 478-486.
19.	Shekleton JA, Rogers NL, Rajaratnam SM. Searching for the daytime impairments of primary insomnia[J]. Sleep Med Rev, 2010, 14(1): 47-60.
20.	Abe Y. Fatigue as a core symptom of insomnia[J]. Innov Clin Neurosci, 2012, 9(2): 10-11.
21.	Buysse DJ, Thompson W, Scott J, et al. Daytime symptoms in primary insomnia: a prospective analysis using ecological momentary assessment[J]. Sleep Med, 2007, 8(3): 198-208.
22.	Ustinov Y, Lichstein KL, Wal GS, et al. Association between report of insomnia and daytime functioning[J]. Sleep Med, 2010, 11(1): 65-68.
23.	Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence[J]. Sleep Med Rev, 2010, 14(1): 19-31.
24.	Harvey AG. A cognitive model of insomnia[J]. Behav Res Ther, 2002, 40(8): 869-893.
25.	Edinger JD, Fins AI, Glenn DM, et al. Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints? [J]. J Consult Clin Psychol, 2000, 68(4): 586-593.
26.	Means MK, Lichstein KL, Epperson MT, et al. Relaxation therapy for insomnia: nighttime and day time effects[J]. Behav Res Ther, 2000, 38(7): 665-678.
27.	Van Houdenhove L, Buyse B, Gabriëls L, et al. Treating primary insomnia: clinical effectiveness and predictors of outcomes on sleep, daytime function and health-related quality of life[J]. J Clin Psychol Med Settings, 2011, 18(3): 312-321.
28.	Morin CM, Benca R. Chronic insomnia[J]. Lancet, 2012, 379(9821): 1129-1141.

1. 　Diagnostic and statistical manual of mental disorders (DSM-Ⅳ) [M]. 4th ed. Washington, DC: American Psychiatric Association, 1994, 151(9): 1351–1360.
2. 　Ohayon MM. Prevalence of DSM-Ⅳ diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders[J]. J Psychiatr Res, 1997, 31(3): 333-346.
3. 　Edinger JD, Bonnet MH, Bootzin RR, et al. Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group[J]. Sleep, 2004, 27(8):1567-1596.
4. 　Alpin I, Fichten CS, Libman E, et al. How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate? [J]. J Psychosom Res, 2000, 49(5): 381-390.
5. 　McCrae CS, Rowe MA, Tierney CG, et al. Sleep complaints, subjective and objective sleep patterns, health, psychological adjustment, and daytime functioning in community-dwelling older adults[J]. J Gerontol B Psychol Sci Soc Sci, 2005, 60(4): 182-189.
6. 　Ohayon MM, Riemann D, Morin C, et al. Hierarchy of insomnia criteria based on daytime consequences[J]. Sleep Med, 2012, 13(1): 52-57.
7. 　Buysse DJ, Reynolds CF, Monk TH, et al. Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI)[J]. Sleep, 1991, 14(4): 331-338.
8. 　劉賢臣, 唐茂芹, 胡蕾, 等. 匹茲堡睡眠質量指數的信度和效度研究[J]. 中華精神科雜志, 1996, 29(2): 103-107.
9. 　Iber C, Ancoli-Israel S, Chesson A, et al. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification [M]. Westchester, Illinois: American Academy of Sleep Medicine, 2007: 17-48.
10. 　Pinto LR Jr, Pinto MC, Goulart LI, et al. Sleep perception in insomniacs, sleep-disordered breathing patients, and healthy volunteers--an important biologic parameter of sleep[J]. Sleep Med, 2009, 10(8): 865-868.
11. 　Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale[J]. Sleep, 1991, 14(6): 540-545.
12. 　Chen NH, Johns MW, Li HY, et al. Validation of a Chinese version of the Epworth sleepiness scale[J]. Qual Life Res, 2002, 11(8): 817-821.
13. 　Gradisar M, Lack L, Richards H, et al. The Flinders Fatigue Scale: preliminary psychometric properties and clinical sensitivity of a new scale for measuring daytime fatigue associated with insomnia[J]. J Clin Sleep Med, 2007, 3(7): 722-728.
14. 　Beck AT，Ward CH，Mendelson M, et al. An inventory for measuring depression[J]. Arch Gen Psychiatry, 1961, 4(6) : 561-571.
15. 　張雨新，王燕，錢銘怡. Beck 抑郁量表的信度和效度[J]. 中國心理衛生雜志, 1990, 4( 4) : 164-168.
16. 　杜好瑞, 趙洪祖, 嚴宏力, 等. 失眠癥患者狀態一特質焦慮與睡眠結構的關系[J].中國心理衛生雜志, 2009，23(12): 868-871.
17. 　Gooneratne NS, Bellamy SL, Pack F, et al. Case-control study of subjective and objective differences in sleep patterns in older adults with insomnia symptoms[J]. J Sleep Res, 2011, 20(3): 434-444.
18. 　Manconi M, Ferri R, Sagrada C, et al. Measuring the error in sleep estimation in normal subjects and in patients with insomnia[J]. J Sleep Res, 2010, 19(3): 478-486.
19. 　Shekleton JA, Rogers NL, Rajaratnam SM. Searching for the daytime impairments of primary insomnia[J]. Sleep Med Rev, 2010, 14(1): 47-60.
20. 　Abe Y. Fatigue as a core symptom of insomnia[J]. Innov Clin Neurosci, 2012, 9(2): 10-11.
21. 　Buysse DJ, Thompson W, Scott J, et al. Daytime symptoms in primary insomnia: a prospective analysis using ecological momentary assessment[J]. Sleep Med, 2007, 8(3): 198-208.
22. 　Ustinov Y, Lichstein KL, Wal GS, et al. Association between report of insomnia and daytime functioning[J]. Sleep Med, 2010, 11(1): 65-68.
23. 　Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence[J]. Sleep Med Rev, 2010, 14(1): 19-31.
24. 　Harvey AG. A cognitive model of insomnia[J]. Behav Res Ther, 2002, 40(8): 869-893.
25. 　Edinger JD, Fins AI, Glenn DM, et al. Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints? [J]. J Consult Clin Psychol, 2000, 68(4): 586-593.
26. 　Means MK, Lichstein KL, Epperson MT, et al. Relaxation therapy for insomnia: nighttime and day time effects[J]. Behav Res Ther, 2000, 38(7): 665-678.
27. 　Van Houdenhove L, Buyse B, Gabriëls L, et al. Treating primary insomnia: clinical effectiveness and predictors of outcomes on sleep, daytime function and health-related quality of life[J]. J Clin Psychol Med Settings, 2011, 18(3): 312-321.
28. 　Morin CM, Benca R. Chronic insomnia[J]. Lancet, 2012, 379(9821): 1129-1141.

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原發性失眠主客觀睡眠質量與日間功能損害的關系

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原發性失眠主客觀睡眠質量與日間功能損害的關系

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