心境障碍青少年主客观睡眠质量的一致性分析  

Agreement analysis of subjective and objective sleep quality in adolescents with mood disorders

作　　者：陈腾伟 牛璐 朱佳鑫 邱丹 张成成 陈月东 张宏会 侯筱菲[2] 陶好娟[3] 陈夕圆 马亚荣 林康广[6,7] 周亮 CHEN Tengwei;NIU Lu;ZHU Jiaxin;QIU Dan;ZHANG Chengcheng;CHEN Yuedong;ZHANG Honghui;HOU Xiaofei;TAO Haojuan;CHEN Xiyuan;MA Yarong;LIN Kangguang;ZHOU Liang(Department of Social Medicine and Health Management,Xiangya School of Public Health,Central South University,Changsha 410013;Department of Community Prevention,Tianjin Anding Hospital,Tianjin 300222;Department of Psychiatry,Second Xiangya Hospital,Central South University,National Clinical Research Center on Mental Disorders,Changsha 410011;Department of Community Psychiatry,Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370;Department of Psychosomatic Medicine,Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370;Department of Mood Disorders,Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370;School of Health and Life Sciences,University of Health and Rehabilitation Sciences,Qingdao Shandong 266113,China)

机构地区：[1]中南大学湘雅公共卫生学院社会医学与卫生事业管理学系,长沙410013 [2]天津市安定医院社区预防科,天津300222 [3]中南大学湘雅二医院精神科,国家精神心理疾病临床医学研究中心,长沙410011 [4]广州医科大学附属脑科医院社区精神科,广州510370 [5]广州医科大学附属脑科医院心身医学科,广州510370 [6]广州医科大学附属脑科医院情感障碍科,广州510370 [7]康复大学生命科学与健康学院,山东青岛266113

出　　处：《中南大学学报(医学版)》2024年第10期1566-1575,共10页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2023JJ40796);美国中华医学基金会(21-425)。

摘　　要：目的:科学、准确地评估睡眠质量对于理解睡眠问题及其对健康的影响具有重要意义。本研究分析心境障碍青少年主观睡眠评估与客观睡眠监测结果的一致性,以期为相关研究提供可靠的方法学基础。方法:在国内3家医院的精神科门诊招募心境障碍青少年患者,采用共识睡眠日记和活动记录仪(运动手环)进行14 d的睡眠监测。采用Wilcoxon符号秩和检验比较主客观测量数据的差异,Bland-Altman图和组内相关系数(intra-class correlation coefficient,ICC)对二者的一致性进行描述,Spearman秩相关系数描述二者的相关性,混合效应模型分析主客观测量数据差异的影响因素。结果:入睡后觉醒次数(number of awakenings during sleep,NWAK)、入睡后清醒时间(waking after sleep onset,WASO)、总睡眠时间(total sleep time,TST)、醒来时刻的主观和客观测量值之间的差异均有统计学意义(均P<0.001);而入睡时刻的主观和客观测量值的差异无统计学意义(P=0.283)。入睡时刻(ICC=0.821,r=0.838)、醒来时刻(ICC=0.821,r=0.836)的主观和客观测量值有良好的一致性和相关性;TST表现出中等的一致性(ICC=0.640)和相关性(r=0.682);NWAK(ICC=0.210,r=0.276)和WASO(ICC=0.358,r=0.365)则表现出较差的一致性和相关性。在Bland-Altman图中,入睡时刻、醒来时刻、TST的散点大多数均匀分布在95%一致性界限(limits of agreement,LoA)之间,WASO、NAWK的主客观测量差值随着主客观均值的增加而变大,但是以上指标的主客观测量差值95%LoA均超过相应指标的可接受范围,表明一致性差。基线抑郁水平与NWAK(β=0.034,P<0.05)、TST(β=2.617,P<0.01)和入睡时刻(β=1.454,P<0.05)的主客观测量差值大小有关,睡眠质量评分与WASO的主客观测量差值大小有关(β=0.051,P<0.01)。结论:主观睡眠日记和活动记录仪(运动手环)睡眠监测数据仍存在较大差异,后续应进一步探索影响主客观测量差异的因素,并优化测量�Objective:Accurate assessment of sleep quality is crucial for understanding sleep problems and their impact on health.This study analyzed the agreement between subjective sleep assessments and objective sleep monitoring in adolescents with mood disorders,aiming to provide a reliable methodological foundation for related research.Methods:Adolescents with mood disorders were recruited from psychiatric outpatient clinics of three domestic hospitals.A consensus sleep diary and an actigraph(activity tracker)were used to monitor sleep for 14 days.The differences between subjective and objective measurements were compared using the Wilcoxon signed-rank test,while Bland-Altman plots and intraclass correlation coefficients(ICC),described their agreement.Spearman’s rank correlation coefficients were used to assess their correlation,and mixed-effects models analyzed factors influencing the differences between subjective and objective measurements.Results:Significant differences were observed between subjective and objective measures for the number of awakenings after sleep onset(NWAK),waking after sleep onset(WASO),total sleep time(TST),and wake-up time(P<0.001);however,the difference in sleep onset time was not statistically significant(P=0.283).Subjective and objective measurements of sleep onset(ICC=0.821,r=0.838)and wake-up time(ICC=0.821,r=0.836)demonstrated good agreement and correlation;TST showed moderate agreement(ICC=0.640)and correlation(r=0.682);NWAK(ICC=0.210,r=0.276)and WASO(ICC=0.358,r=0.365)exhibited poor and correlation.In the Bland-Altman plots,most data points for sleep onset,wake-up time,and TST were uniformly distributed within the 95%limits of agreement(LoA).The differences between subjective and objective measurements for WASO and NWAK increased with higher average values.However,the 95%LoA of the differences between subjective and objective measurements of all the above indicators exceeded the acceptable ranges of the corresponding indicators,indicating poor agreement.Baseline depression levels wer

关 键 词：心境障碍 睡眠日记 活动记录仪 一致性 相关性 影响因素 青少年 

分 类 号：R74[医药卫生—神经病学与精神病学]