Analysis of sleep characteristics in elderly patients with insomnia and mild cognitive impairment
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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。 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. -
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 1.197a 0.236 性别[例(%)] 1.083b 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 0.929a 0.357 高血压[例(%)] 9(30.0) 10(38.5) 0.039b 0.844 糖尿病[例(%)] 7(23.3) 6(23.1) 0.001b 0.982 冠心病[例(%)] 7(23.3) 8(30.8) 0.386b 0.535 脑卒中[例(%)] 5(16.7) 4(15.4) 0.055b 0.815 吸烟史[例(%)] 7(23.3) 6(23.1) 0.001b 0.982 饮酒史[例(%)] 5(16.7) 6(23.1) 0.256b 0.551 MoCA得分(x±s，分) 26.20±0.53 22.16±1.26 16.019a ＜0.001 SAS得分(x±s，分) 26.19±5.42 38.22±3.31 9.833a ＜0.001 注：a为t值，b为χ2值。 
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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
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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
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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
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