社区卫生服务中心门诊中老年患者失眠现状及与认知功能的关系  

Relationship between insomnia and cognitive function in middle-aged and elderly patients

作　　者：胡玉坤 王苹 姜悦[4] 马力[5] 王晨[5] Hu Yukun;Wang Ping;Jiang Yue;Ma Li;Wang Chen(School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China;Dougezhuang Community Health Service Center,Beijing 100121,China;Youanmei Community Health Service Center,Beijing 100069,Chin;Division of Medical Affair,Tiantan Hospital,Capital Medical University,Beijing 100050,Chin;Department of General Practice,Tiantan Hospital,Capital Medical University,Beifing 100050,China)

机构地区：[1]首都医科大学全科医学与继续教育学院,北京100069 [2]北京市朝阳区豆各庄社区卫生服务中心,100121 [3]北京市丰台区右安门社区卫生服务中心,100069 [4]首都医科大学附属北京天坛医院医务处,100050 [5]首都医科大学附属北京天坛医院全科医疗科,100050

出　　处：《中华全科医师杂志》2018年第8期596-600,共5页Chinese Journal of General Practitioners

基　　金：北京市属医院科研培育计划项目（PX2016021）

摘　　要：目的调查社区卫生服务中心就诊的中老年患者失眠现状，研究失眠患者的认知功能损害特点及相关影响因素。方法选择北京市右安门社区卫生服务中心2016年10—12月在门诊就诊的中老年患者（年龄≥45岁），按DSM－5诊断标准分为持续性失眠组（159例），发作性失眠组（188例）和睡眠正常组（503例），采用匹兹堡睡眠质量量表（PSQI）和蒙特利尔认知评估量表（MoCA）评估3组患者的睡眠质量和认知功能，探讨两者的相关性及认知功能的相关影响因素。结果睡眠质量方面，持续性失眠组PSQI总分及各因子分均高于睡眠正常组，发作性失眠组的PSQI总分及多数因子分（催眠药物和日间功能障碍除外）高于睡眠正常组，持续性失眠组的PSQI总分及多数因子分（睡眠紊乱除外）高于发作性失眠组，差异均有统计学意义（P〈0.05）。认知功能方面，持续性失眠组的MoCA总分、命名、注意力、语言、抽象思维、延迟回忆及定向力均低于睡眠正常组，发作性失眠组的语言功能评分低于睡眠正常组，持续性失眠组的语言功能评分低于发作性失眠组，差异均有统计学意义（P〈0.05）。相关性分析结果显示，MoCA总分与PSQI总分、睡眠时间及睡眠效率因子分呈负相关（r＝－0.162、－0.131、－0.190，P〈0.05）。多因素回归分析显示，年龄为认知功能的危险因素（β＝0.038，P＝0.000），睡眠效率为保护因素（β＝0.260 ，P＝0.000）。结论社区中老年持续性失眠患者总体认知功能差，命名、注意力、语言、抽象思维、延迟回忆及定向力均下降，且与年龄及睡眠效率相关。ObjectiveTo investigate the relationship between insomnia and cognitive function in middle-aged and elderly patients.MethodsPatients aged ≥ 45 years visiting outpatient clinic of You′anmen Community Health Center from October 2016 to December 2016 were enrolled in the study. Among 850 participants there were 159 patients with persistent insomnia, 188 with paroxysmal insomnia （insomnia group） and 503 with normal sleep （normal sleep group） according to DSM-5 diagnostic criteria. The sleep quality and cognition were evaluated using Pittsburgh Sleep Quality Index（PSQI） and Montreal Cognitive Assessment（MoCA） and compared among 3 groups. Relationship between sleep quality and cognition, influencing factors of cognition were explored in this study.ResultsThe total score and all sub-scores of PSQI in persistent insomnia group were higher than those in the normal sleep group. The total score of PSQI and all sub-scores （except hypnotic drugs and daytime dysfunction） of paroxysmal insomnia group were higher than those of normal sleep group. The total PSQI score and all sub-scores （except sleep disorders） of the persistent insomnia group were higher than those of the paroxysmal insomnia group. The total score of MoCA and the sub-scores of naming, attention, language, abstract thinking, delayed recall and orientation ability of the persistent insomnia group were lower than those of the normal sleep group （P〈0.05）. The language ability of paroxysmal insomnia group was lower than that of normal sleep group （P〈0.05）. The language ability of persistent insomnia group was lower than that of paroxysmal insomnia group （P〈0.05）. The total score of MoCA was negatively correlated with the total score of PSQI and sub-scores of sleep time and sleep efficiency （r=-0.162, -0.131, -0.190; P〈0.05）. Logistic regression analysis showed that age was a risk factor for cognitive impairment （β=0.038, P=0.000） and sleep efficiency was a protective factor for cognitive function （β=0.260, P

关 键 词：社区卫生中心 失眠 认知功能 中老年 

分 类 号：R740[医药卫生—神经病学与精神病学]