急性冠状动脉综合征患者失眠现况及影响因素分析  

An analysis of insomnia and its influencing factors in patients with acute coronary syndrome

作　　者：孔悦 丁荣晶[2] 雷莎[1] 王历[1] 夏昆[3] 姜红岩 张丽晶 姚道阔[6] 马文林[7] 胡大一[2] Kong Yue;Ding Rongjing;Lei Sha;Wang Li;Xia Kun;Jiang Hongyan;Zhang Lijing;Yao Daokuo;Ma Wenlin;Hu Dayi(Department of Cardiovascular Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Cardiology Center,People′s Hospital of Peking University,Beijing100044,China;Department of Cardiology,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China;Department of Cardiology,Beijing First Hospital of Integrated Traditional Chinese And Western Medicine,Beijing 100026,China;Department of Cardiology,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine,Beijing 100700,China;Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Cardiology,Tongji Hospital,Tongji University,Shanghai 200065,China)

机构地区：[1]重庆医科大学附属第一医院心内科,400016 [2]北京大学人民医院心脏中心,100044 [3]首都医科大学附属北京朝阳医院心内科,100020 [4]北京市第一中西医结合医院心内科,100026 [5]北京中医药大学东直门医院心内科,100700 [6]首都医科大学附属北京友谊医院心脏中心,100050 [7]同济大学附属同济医院心内科,上海200065

出　　处：《中华内科杂志》2021年第4期331-337,共7页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金(81772446);北京市自然科学基金(7132199)。

摘　　要：目的了解急性冠状动脉综合征(ACS)患者失眠现况,分析导致ACS患者失眠的影响因素,为制定针对ACS患者的失眠策略提供依据。方法本研究为一项多中心、前瞻性、观察性队列研究。筛选纳入2013年3月至2015年6月符合标准的ACS住院患者771例,入院7d内病情稳定后完成基线社会人口信息学资料、睡眠质量问卷、广泛性焦虑量表(GAD7)、患者健康问卷9项(PHQ9)、生活质量量表12(SF12)以及社会支持调查量表(ESSI),采用logistic回归分析影响ACS患者失眠的因素。结果共收回741例患者的有效问卷,741例患者中男510例(68.8%),女231例(31.2%)。487例(65.7%)存在至少一种失眠症状,其中308例(41.6%)存在入睡困难,369例(49.8%)存在夜间易醒,116例(15.7%)存在早醒,74例(10.0%)同时存在早醒和入睡困难,53例(7.2%)同时存在早醒、夜间易醒和入睡困难。Logistic回归分析显示,入院前体力活动情况(OR=0.636,95%CI 0.411~0.984)、抑郁(OR=1.908,95%CI 1.101~3.305)和低社会支持(OR=0.278,95%CI 1.198~3.301)是ACS患者存在失眠的独立影响因素。结论接近2/3的ACS患者存在失眠症状,入睡困难和夜间易醒是最常见的表现;体力活动情况、抑郁和社会支持与发生失眠独立相关。Objective To investigate the current situation of insomnia in patients with acute coronary syndrome(ACS),and analyze the influencing factors of insomnia in the ACS patients,so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients.Methods This is a multicenter and prospective observational study.A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015.The baseline social demographic information,sleep quality questionnaire,general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9),short-form 12 health survey questionnaire(SF-12),and enhancing recovery in coronary heart disease patients social inventory(ESSI)were completed within 7 days after admission.Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients.Results A total of 741 subjects with valid questionnaires were collected,including 510 males(68.8%)and 231 females(31.2%).Among them,487(65.7%)subjects had at least one insomnia symptom:308(41.6%)subjects had difficulty in falling asleep,369(49.8%)subjects were easy to wake at night,116(15.7%)subjects woke up earlier than they expected,74(10.0%)subjects experienced both woke up earlier and difficulty in falling asleep,and 53(7.2%)subjects woke up earlier,woke up at night and had difficulty in falling asleep at the same time.Logistic regression analyses showed that before admission physical activity(OR=0.636,95%CI 0.411-0.984),depression(OR=1.908,95%CI 1.101-3.305)and low social support(OR=0.278,95%CI 1.198-3.301)were independent factors of insomnia in ACS patients.Conclusions Nearly 2/3 ACS patients have symptoms of insomnia.Difficulty in falling asleep and easy to wake up at night are the most common manifestations.Physical activity,depression and social support independently are associated with insomnia.

关 键 词：急性冠状动脉综合征 失眠 抑郁 预后 

分 类 号：R740[医药卫生—神经病学与精神病学] R541.4[医药卫生—临床医学]