失眠伴轻度认知功能障碍老年患者的睡眠分析

孙奕; 郑慧芬

doi:10.16766/j.cnki.issn.1674-4152.003188

失眠伴轻度认知功能障碍老年患者的睡眠分析

doi: 10.16766/j.cnki.issn.1674-4152.003188

孙奕¹,
郑慧芬^2, ,

1.
江苏卫生健康职业学院临床学院，江苏南京 210029
2.
江苏省老年病医院神经内科，江苏南京 210024

基金项目:

江苏省卫生健康委科研项目 H2019052

详细信息

通讯作者:
郑慧芬，E-mail：zhenghuifen@163.com

中图分类号: R749.16
计量
- 文章访问数: 143
- HTML全文浏览量: 65
- PDF下载量: 43
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-04
- 网络出版日期: 2023-11-23

Analysis of sleep characteristics in elderly patients with insomnia and mild cognitive impairment

SUN Yi¹,
ZHENG Huifen^{2
, ,}

1.
Clinical School, Jiangsu Health Vocational College, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的观察失眠伴轻度认知障碍(MCI)老年患者的睡眠特征以及行为认知疗法干预的治疗效果。方法选取2020年1月—2021年12月在江苏省老年病医院神经内科住院部及门诊就诊的失眠患者56例，失眠认知正常组30例，失眠合并MCI组26例，比较2组患者匹兹堡睡眠指数(PSQI)量表、焦虑自评量表(SAS)和多导睡眠图监测(PSG)情况，对失眠合并MCI患者进行为期4周的短程行为认知疗法干预，观察治疗效果。结果失眠合并MCI组MoCA得分低于失眠认知正常组[(22.16±1.26)分 vs. (26.20±0.53)分，t=16.019，P＜0.001]，SAS得分高于失眠认知正常组[(38.22±3.31)分 vs. (26.19±5.42)分，t=9.833，P＜0.001]。失眠合并MCI组PSQI总分、睡眠质量、入睡时间、睡眠时间、睡眠效率的得分高于失眠认知正常组，差异有统计学意义(均P＜0.05)；PSG结果显示，失眠合并MCI组睡眠潜伏期明显延长，总睡眠时间较失眠认知正常组有所减少，非快速眼动睡眠(NREM)浅睡眠百分比较高，差异有统计学意义(均P＜0.05)，但觉醒次数、睡眠效率与失眠认知正常组比较差异无统计学意义(均P＞0.05)。干预治疗后，失眠合并MCI组部分患者MoCA得分有所好转，SAS得分较干预前下降，差异有统计学意义；PSQI总分较干预前下降，差异无统计学意义，睡眠质量、入睡时间、睡眠效率3个分项得分与干预前相比显著改善(均P＜0.05)。结论失眠合并MCI的患者睡眠潜伏期、NREM浅睡眠时间明显延长，睡眠质量主观感觉较差，总体睡眠效率更低；认知行为干预治疗效果较好。
- 轻度认知功能障碍 /
- 匹兹堡睡眠指数量表 /
- 多导睡眠图
Abstract: Objective To observe the sleep characteristics of elderly patients with insomnia combined with mild cognitive impairment (MCI) and the effect of behavioral cognitive impairment. Methods A total of 56 insomnia patients were selected from the Inpatient Department and Outpatient Department of the Department of Neurology of Jiangsu Geriatrics Hospital from January 2020 to December 2021, including 30 insomnia of normal cognition patients and 26 insomnia patients combined with MCI. The Pittsburgh Sleepiness Quotient Index (PSQI) scale, Self-Assessment Scale for Anxiety (SAS) scale and polysomnography (PSG) monitoring were compared between the two groups. The insomnia combined with MCI group were treated with short-range behavioral cognitive therapy for 4 weeks, and then to observe the therapeutic effect. Results The MoCA score of insomnia combined with MCI group was lower than that of insomnia of normal cognition group [(22.16±1.26) points vs. (26.20±0.53) points, t=16.019, P < 0.001], and the SAS score was higher than insomnia of normal cognition group [(38.22±3.31) points vs. (26.19±5.42) points, t=9.833, P < 0.001]. The scores of PSQI, sleep quality, fall asleep time, sleep time and sleep efficiency of insomnia combined with MCI group were higher than those of insomnia of normal cognition group, and the differences were statistically significant (all P < 0.05). The PSG results showed that the sleep latency was significantly prolonged in the insomnia combined with MCI group, the total sleep time was reduced compared with the insomnia of normal cognition group, and the percentage of NREM light sleep was higher, with statistical significance (all P < 0.05), but the number of awakenings and sleep efficiency were not significantly different compared with the insomnia of normal cognition group (all P>0.05). After intervention, MoCA score of some patients in the insomnia combined with MCI group improved, and SAS scores decreased, the difference was statistically significant. The total score of PSQI decreased compared with that before intervention, and the difference was not statistically significant, but three sub-items of sleep quality, falling asleep time and sleep efficiency were significantly improved compared with that before intervention, and the difference was statistically significant (all P < 0.05). Conclusion Patients with insomnia combined with MCI have significantly longer sleep latency, NREM shallow sleep time, poor subjective perception of sleep quality, and lower overall sleep efficiency. Cognitive behavioral intervention therapy has a good effect.
- Mild cognitive impairment /
- Pittsburgh steep quality index /
- Polysomnography

HTML全文

表 1 2组失眠患者一般资料比较

Table 1. Comparative analysis of general information between two groups of insomnia patients

项目	失眠认知正常组(30例)	失眠合并MCI组(26例)	统计量	P值
年龄(x±s，岁)	74.07±6.31	72.15±5.53	1.197^a	0.236
性别[例(%)]			1.083^b	0.298
男性	12(40.0)	10(38.5)
女性	18(60.0)	16(61.5)
受教育年限(x±s，年)	11.5±1.3	11.9±1.9	0.929^a	0.357
高血压[例(%)]	9(30.0)	10(38.5)	0.039^b	0.844
糖尿病[例(%)]	7(23.3)	6(23.1)	0.001^b	0.982
冠心病[例(%)]	7(23.3)	8(30.8)	0.386^b	0.535
脑卒中[例(%)]	5(16.7)	4(15.4)	0.055^b	0.815
吸烟史[例(%)]	7(23.3)	6(23.1)	0.001^b	0.982
饮酒史[例(%)]	5(16.7)	6(23.1)	0.256^b	0.551
MoCA得分(x±s，分)	26.20±0.53	22.16±1.26	16.019^a	＜0.001
SAS得分(x±s，分)	26.19±5.42	38.22±3.31	9.833^a	＜0.001
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 2组失眠患者PSQI得分比较(x±s，分)

Table 2. Comparison of PSQI scores between two groups of insomnia patients (x±s, points)

项目	失眠认知正常组(30例)	失眠合并MCI组(26例)	t值	P值
PSQI总分	9.26±3.12	10.89±1.66	2.385	0.021
睡眠质量	1.92±0.47	2.31±0.54	2.962	0.004
入睡时间	1.89±0.30	2.67±1.90	2.220	0.031
睡眠时间	2.02±0.45	2.88±0.62	5.994	＜0.001
睡眠效率	1.98±0.24	2.79±0.33	10.599	＜0.001
睡眠障碍	1.95±0.59	2.20±0.45	1.719	0.091
催眠药物	1.14±0.19	1.25±0.32	1.588	0.118
日间功能障碍	2.56±0.59	2.71±0.26	1.091	0.280

下载: 导出CSV

表 3 2组失眠患者PSG各项指标比较(x±s)

Table 3. Comparison of PSG parameters between two groups (x±s)

项目	失眠认知正常组(30例)	失眠合并MCI组(26例)	t值	P值
总描记时间(min)	489.26±23.47	492.13±31.66	0.389	0.699
睡眠潜伏期(min)	20.09±9.82	32.63±9.52	4.834	＜0.001
总睡眠时间(min)	386.76±39.74	356.19±34.35	3.055	0.003
觉醒次数(次)	4.13±0.32	4.28±0.29	1.823	0.073
睡眠效率(%)	75.87±6.34	73.46±10.38	1.064	0.292
NREM浅睡眠百分比(%)	66.23±13.21	75.32±10.34	2.835	0.006

下载: 导出CSV

表 4 失眠合并MCI组患者认知行为干预前后各项量表得分比较(x±s)

Table 4. Comparison of scale scores before and after cognitive-behavioral intervention in insomnia-patients with comorbid MCI (x±s)

指标	干预前	干预后	t值	P值
MoCA得分	22.16±1.26	23.29±3.25	-1.865	0.193
SAS得分	38.22±3.31	33.34±3.82	9.662	＜0.001
PSQI总分	10.89±1.66	9.89±1.75	3.686	0.097
睡眠质量	2.31±0.54	1.29±0.47	11.575	＜0.001
入睡时间	2.67±1.90	1.87±0.92	6.692	＜0.001
睡眠时间	2.88±0.62	2.65±0.54	2.322	0.126
睡眠效率	2.79±0.33	2.11±0.18	1.562	0.026
睡眠障碍	2.28±0.45	2.06±0.37	1.246	0.224
催眠药物	1.25±0.32	1.03±0.27	3.459	0.068
日间功能障碍	2.71±0.26	2.52±0.19	1.793	0.085

下载: 导出CSV

参考文献(18)

[1]	中国睡眠研究会. 中国失眠症诊断和治疗指南[J]. 中华医学杂志, 2017, 97(24): 1844-1856. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-OGSF201908001012.htm
[2]	LI S B, DAMONTE V M, CHEN C, et al. Hyperexcitable arousal circuits drive sleep instability during aging[J]. Science, 2022, 375(6583): eabh3021. DOI: 10.1126/science.abh3021.
[3]	赵翠, 霍静, 王淼, 等. 老年综合征与老年人睡眠障碍的相关性分析[J]. 中华老年医学杂志, 2020, 39(12): 1430-1433.
[4]	KITAMURA T, MIYAZAKI S, SULAIMAN H B, et al. Insomnia and obstructive sleep apnea as potential triggers of dementia: is personalized prediction and prevention of the pathological cascade applicable?[J]. EPMA J, 2020, 11(3): 355-365. doi: 10.1007/s13167-020-00219-w
[5]	DELRSOOS L M, MOGAVERO M P, FERRI R. Restless sleep disorder, restless legs syndrome, and periodic limb movement disorder-Sleep in motion![J]. Pediatr Pulmonol, 2021, 57(8): 1879-1886.
[6]	HONG J J, CHEN J, KAN J M, et al. Effects of acupuncture treatment in reducing sleep disorder and gut microbiota alterations in PCPA induced insomnia mice[J]. Evid Based Complement Alternat Med, 2020, 2020: 3626120. DOI: 10.1155/2020/3626120.
[7]	XUE J, LI J R, LIANG J M, et al. The Prevalence of mild cognitive impairment in China: a systematic review[J]. Aging Dis, 2018, 9(4): 706-715. doi: 10.14336/AD.2017.0928
[8]	PACHIKIAN B D, COPINE S, SUCHATRAU M, et al. Effects of saffron extract on sleep quality: a randomized double-blind controlled clinical trial[J]. Nutrients, 2021, 13(5): 1473. doi: 10.3390/nu13051473
[9]	刘贤臣, 唐茂芹, 胡蕾, 等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996, 29(2): 103-107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHMA199602018.htm
[10]	FENG G Y, HAN M, LI X, et al. The clinical effectiveness of cognitive behavioral therapy for patients with insomnia and depression: a systematic review and meta-analysis[J]. Evid Based Complement Alternat Med, 2020, 2020: 807-821.
[11]	何静文, 屠志浩, 苏彤, 等. 失眠症患者认知功能损害的特点及其机制[J]. 第二军医大学学报, 2019, 40(9): 1015-1019. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201909012.htm
[12]	ARGYROPOULOS G P D, BUTLER C R. Does hippocampal atrophy explain anterograde and retrograde amnesia following autoimmune limbic encephalitis?[J]. Hippocampus, 2020, 30(9): 1013-1017. doi: 10.1002/hipo.23208
[13]	BUBU O, BRANNICK M, MORTIMER J, et al. Sleep, cognitive impairment and Alzheimer' s disease: a systematic review and meta analysis[J]. Sleep, 2016, 10(26): 173-199.
[14]	TARASOFF-CONWAY J M, CARARE R O, OSORIO R S, et al. Clearance systems in the brain-implications for Alzheimer disease[J]. Nat Rev Neurol, 2015, 11(8): 457-470.
[15]	陈寿林, 朱生芝, 于畅, 等. 老年抑郁症患者血清指标与认知功能的相关性研究[J]. 中华全科医学, 2022, 20(3): 450-453. doi: 10.16766/j.cnki.issn.1674-4152.002375
[16]	于逢春, 周正宏. 睡眠障碍与认知功能障碍研究进展[J]. 中国卒中杂志, 2016, 11(11): 966-972. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUZH201611015.htm
[17]	PICTON J D, MARINO A B, NEALY K L. Benzodiazepine use and cognitive decline in the elderly[J]. Am J Health Syst Pharm, 2018, 75(1): e6-e12.
[18]	CHAPOUTOT M, PETER-DEREX L, BASTUJI H, et al. Cognitive behavioral therapy and acceptance and commitment therpy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders[J]. Int J Environ Res Public Health, 2021, 18(19): 10-22.