北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (6): 1063-1068. doi: 10.19723/j.issn.1671-167X.2020.06.012

• 论著 • 上一篇    下一篇

原发性干燥综合征患者睡眠障碍的相关影响因素

王一帆1,范稹2,成姚斌1,金月波1,霍阳3,何菁1,()   

  1. 1. 北京大学人民医院风湿免疫科,北京 100044
    2. 湖北省荆门市第一人民医院风湿免疫科,湖北荆门 448000
    3. 北京大学人民医院神经内科,北京 100044
  • 收稿日期:2020-07-13 出版日期:2020-12-18 发布日期:2020-12-13
  • 通讯作者: 何菁 E-mail:hejing1105@126.com
  • 基金资助:
    国家自然科学基金(31870879);国家自然科学基金(81701607)

Investigation of sleep disturbance and related factors in patients with primary Sjögren’s syndrome

Yi-fan WANG1,Zhen FAN2,Yao-bin CHENG1,Yue-bo JIN1,Yang HUO3,Jing HE1,()   

  1. 1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Rheumatology and Immunology, Jinmen NO.1 People’s Hospital, Jingmen 448000, Hubei, China
    3. Department of Neurology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2020-07-13 Online:2020-12-18 Published:2020-12-13
  • Contact: Jing HE E-mail:hejing1105@126.com
  • Supported by:
    National Natural Science Foundation of China(31870879);National Natural Science Foundation of China(81701607)

摘要:

目的:探讨原发性干燥综合征(primary Sj?gren’s syndrome,pSS)患者中睡眠障碍的发生率及其相关的影响因素。方法:选取就诊于北京大学人民医院符合纳入及排除标准的186例pSS患者作为研究对象进行回顾性研究,采用匹兹堡睡眠质量量表(the Pittsburgh sleep quality index, PSQI)、抑郁症筛查量表(patient health questionnaire-9, PHQ-9)、广泛性焦虑量表(generalized anxiety disorder-7,GAD-7)进行调查,收集一般资料及临床数据,以欧洲抗风湿病联盟干燥综合征疾病活动度评分(the European League Against Rheumatism Sj?gren’s syndrome disease activity index,ESSDAI)评估疾病活动度。以pSS患者的PSQI分值>7分为界,分为152例睡眠障碍组和34例睡眠正常组。采用Mann-Whitney U秩和检验、卡方检验、t检验,Spearman相关分析以及Logistic回归进行统计学处理。结果:pSS患者中睡眠障碍的发生率为81.7%(152/186), 其中52.7%(98/186)的pSS患者存在中重度睡眠障碍。睡眠障碍组pSS患者的PSQI平均得分为(12.29±3.30)分,睡眠正常组PSQI平均得分为(5.50±1.20)分。睡眠障碍组患者的PSQI评分、PHQ-9评分及GAD-7评分均明显高于睡眠正常组患者,并且差异均具有统计学意义,P值分别为0.000、0.035、0.031。睡眠障碍组的PSQI量表评分在睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物使用及日间功能障碍等七个方面均明显高于睡眠正常组,并且两组间的差异均具有统计学意义(P<0.05)。疾病病程、焦虑程度、抑郁评分与PSQI评分呈正相关(r值分别为0.151、0.240、0.421,P <0.05),而补体C3、C4与PSQI评分呈负相关(r值分别为-0.021、-0.235,P <0.05)。二元Logistic回归分析显示病程、PHQ-9评分为pSS患者睡眠障碍的预测指标,其中病程OR=2.809, 95%CI: 1.21~6.52;PHQ-9评分,OR=1.422, 95%CI: 1.04~1.94(P <0.05)。结论:pSS患者睡眠障碍的发生率较高,且与疾病病程、抑郁、焦虑情绪等因素密切相关。

关键词: 原发性干燥综合征, 睡眠障碍, 焦虑, 抑郁, 危险因素

Abstract:

Objective: To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of primary Sj?gren’s syndrome (pSS) patients. Methods: One hundred and eighty-six pSS patients were included in the study, who were admitted to Peking University People’s Hospital and met the criteria of inclusion and exclusion. Sleep quality was assessed using the Pittsburgh sleep quality index(PSQI).Depression, anxiety were evaluated by patient health questionnaire (PHQ)-9,generalized anxiety disorder(GAD)-7, respectively. The demographic and clinical data were also recorded.Disease activity and damage were evaluated with the European League Against Rheumatism Sj?gren’s syndrome disease activity index (ESSDAI). According to the PSQI score>7, the pSS patients were divided into 152 cases of sleep disorder group and 34 cases of normal sleep group. Mann-Whitney U test, Chi-square test or Fisher’s exact test, independent samples t test, Spearman correlation analysis and Logistic regression were used for statistical analysis. Results: The prevalence of sleep disturbance (PSQI>7) was 81.7% (152 / 186) in the pSS patients, and 52.7% (98/186) had moderate or severe sleep disorders (PSQI≥11). The mean PSQI score of sleep disordered group was (12.29±3.30), while the normal sleep group PSQI score was (5.50±1.20). The PSQI score, PHQ-9 score and GAD-7 score in the sleep-disordered group were significantly higher than those in the normal sleep group (P=0.000, 0.035, 0.031). The PSQI score in the sleep disordered group were significantly higher than those in the normal sleep group in seven aspects: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disorders, hypnotic drug use and daytime dysfunction. All of them had statistical significance. According to the results of Spearman correlation analysis, PSQI had significantly positive correlation with course of disease, anxiety, depression score (r=0.151, 0.240, 0.421, P<0.05), but negatively correlated with C3,C4 (r=-0.021, -0.235, P<0.05). Logistic analysis identified the course of disease(OR=2.809, 95%CI: 1.21-6.52)and PHQ-9 score(OR=1.422, 95%CI: 1.04-1.94)as predictors of sleep disorders. Conclusion: The incidence of sleep disorder in the pSS patients was higher, which was closely related to the course of disease, anxiety, depression and other factors. It is critical to assess and manage comprehensively the disease.

Key words: Sj?gren's syndrome, Sleep disorders, Anxiety, Depression, Risk factors

中图分类号: 

  • R783.2

表1

pSS患者睡眠障碍组和睡眠正常组基本资料比较"

Items Sleep-disordered group Normal sleep group P value
Total cases, n 152 34
Female/% 96.1 100 0.538
Age/years, M (P25, P75) 59.5 (54.25,65) 64.0 (54.5,67) 0.456
Disease duration/ years, M (P25, P75) 7.5 (3,7.5) 3 (3,7.5) 0.024*
BMI/(kg/m2), M (P25, P75) 21.8 (20.1,23) 23.4 (22,25.3) 0.061

表2

pSS患者睡眠障碍组和睡眠正常组临床资料比较"

Items Sleep-disordered group Normal sleep group P value
WBC/(×109/L), M (P25, P75) 5.0 (4.6,5.4) 4.9 (4.5,5.4) 0.351
HGB/(g/L), x-±s 127±19.9 130±11.8 0.366
PLT/(×1012/L), M (P25, P75) 194 (180,208) 196 (168,227) 0.846
ESR/(mm/h), M (P25, P75) 21.2 (17.0,25.4) 21.7 (12.5,30.8) 0.727
CRP/(mg/L), M (P25, P75) 5.0 (0.9,9.0) 1.6 (0.3,3.5) 0.016*
α-fodrin/(RU/mL), M (P25, P75) 18.1 (13.3,23.1) 15.7 (5.9,25.5) 0.082
RF /(IU/mL), M (P25, P75) 171 (13.8,329) 101 (19.0,184) 0.144
IgA/(g/L), x-±s 3.8±4.1 2.9±1.7 0.213
IgG/(g/L), M (P25, P75) 14.6 (13.1,16.1) 16.6 (14.1,19.2) 0.211
IgM/(g/L), M (P25, P75) 1.3 (1.1,1.5) 1.2 (0.9,1.6) 0.714
C3/(g/L), x-±s 0.9±0.2 0.9±0.1 0.925
C4/(g/L), x-±s 0.2±0.1 0.3±0.3 0.171
γ globulin/%, M (P25, P75) 20.6 (19.1,22.1) 21.7 (19.1,24.3) 0.103
RBP/(mg/L), x-±s 1.12±3.1 0.3±0.1 0.085
β2-MG/(μg/L), M (P25, P75) 695 (63.0,1327) 262 (87.8,437) 0.781
NAG(U/L), M (P25, P75) 10.2 (8.7,11.7) 14.8 (9.0,20.5) 0.989

表3

pSS患者睡眠障碍组和睡眠正常组PSQI评分比较"

Items Sleep-disordered group Normal sleep group P value
Total cases, n 152 34
Subjective sleep quality, M (P25, P75) 1 (1,2) 1 (0,1) <0.001*
Sleep latency, M (P25, P75) 2 (2,3) 1 (1,1) <0.001*
Sleep duration, M (P25, P75) 1.5 (1,2) 1 (0,1) 0.004*
Sleep efficiency, M (P25, P75) 3 (2,3) 1 (0,1) <0.001*
Sleep disturbance, M (P25, P75) 1 (1,1) 1 (1,1) 0.027*
Hypnotic drug use, M (P25, P75) 1 (1,2) 1 (0,1) <0.001*
Daytime dysfunction, M (P25, P75) 2 (2,3) 1 (1,2) 0.001*
PSQI global, x-±s 12.29±3.30 5.50±1.20 <0.001*

表4

pSS患者睡眠障碍组和睡眠正常组PHQ-9、GAD-7评分比较"

Items Sleep-disordered group Normal sleep group P value
Total cases, n 152 34
PHQ-9, M (P25, P75) 6 (4,8) 4 (2,5) 0.035*
GAD-7, M (P25, P75) 3.5 (2,6) 2 (1,4) 0.031*
[1] Mariette X, Criswell LA. Primary Sjögren’s syndrome[J]. N Engl J Med, 2018,378(10):931-939.
pmid: 29514034
[2] Cafaro G, Croia C, Argyropoulou Od, et al. One year in review 2019: Sjögren’s syndrome[J]. Clin Exp Rheumatol, 2019, 37, 118(3):3-15.
[3] Tsukamoto M, Suzuki K, Takeuchi T. Ten-year observation of patients with primary Sjögren’s syndrome: Initial presenting characteristics and the associated outcomes[J]. Int J Rheum Dis, 2019,22(5):929-933.
doi: 10.1111/1756-185X.13464 pmid: 30588773
[4] Shen L, He J, Kramer JM, et al. Sjögren’s syndrome: animal models, etiology, pathogenesis, clinical subtypes, and diagnosis[J]. J Immunol Res, 2019, 5(2019-05-20)[2020-04-10]. https://pubmed.ncbi.nlm.nih.gov/31236421.
[5] Cui Y, Xia L, Li L, et al. Anxiety and depression in primary Sjögren’s syndrome: a cross-sectional study[J]. BMC Psychiatry, 2018,18(1):131.
doi: 10.1186/s12888-018-1715-x pmid: 29769121
[6] Milin M, Cornec D, Chastaing M, et al. Sicca symptoms are associated with similar fatigue, anxiety, depression, and quality-of-life impairments in patients with and without primary Sjögren’s syndrome[J]. Joint Bone Spine, 2016,83(6):681-685.
doi: 10.1016/j.jbspin.2015.10.005 pmid: 26774177
[7] Priori R, Minniti A, Antonazzo B, et al. Sleep quality in patients with primary Sjögren’s syndrome[J]. Clinical and Experimental Rheumatology, 2016,34(3):373-379.
pmid: 27087620
[8] Tishler M, Barak Y, Paran D, et al. Sleep disturbances, fibro-myalgia and primary Sjögren’s syndrome[J]. Clin Exp Rheumatol, 1997,15(1):71-74.
pmid: 9093776
[9] 中华医学会风湿病学分会. 干燥综合征诊断及治疗指南[J]. 中华风湿病学杂志, 2010,14(11):766-768.
[10] Qin B, Wang J, Yang Z, et al. Epidemiology of primary Sjögren’s syndrome: a systematic review and meta-analysis[J]. Ann Rheum Dis, 2015,74(11):1983-1989.
doi: 10.1136/annrheumdis-2014-205375 pmid: 24938285
[11] 李晏, 张胜利, 黄烽. 强直性脊柱炎患者睡眠质量及相关因素分析[J]. 中华风湿病学杂志, 2012,16(4):25l-254.
[12] Lee YC, Chibnik LB, Lu B, et al. The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study[J]. Arthritis Res Ther, 2009,11(5):160.
[13] Palagini L, Tani C, Mauri M, et al. Sleep disorders and systemic lupus erythematosus[J]. Lupus, 2014,23(2):115-123.
pmid: 24421291
[14] Mustafa M, Bawazir Y, Merdad L, et al. Frequency of sleep disorders in patients with rheumatoid arthritis[J]. Open Access Rheumatol, 2019,11:163-171.
doi: 10.2147/OARRR.S201556 pmid: 31308768
[15] Gudbjornsson B, Broman JE, Hetta J, et al. Sleep disturbances in patients with primary Sjögren’s syndrome[J]. Br J Rheumatol, 1993,32(12):1072-1076.
pmid: 8252317
[16] Segal BM, Pogatchnik B, Henn L, et al. Pain severity and neuropathic pain symptoms in primary Sjögren’s syndrome: A comparison study of seropositive and seronegative Sjögren’s syndrome patients[J]. Arthritis Care Res(Hoboken), 2013,65(8):1291-1298.
[17] Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the american academy of sleep medicine and sleep research society[J]. Sleep, 2015,11(6):591-592.
[18] Usmani ZA, Hlavac M, Rischmueller M, et al. Sleep disordered breathing in patients with primary Sjögren’s syndrome: A group controlled study[J]. Sleep Medicine, 2012,13(8):1066-1070.
doi: 10.1016/j.sleep.2012.06.010 pmid: 22841036
[19] Abad VC, Sarinas PS, Guilleminault C. Sleep and rheumatologic disorders[J]. Sleep Med Rev, 2008,12(3):211-228.
[20] Walker J, Gordon T, Lester S, et al. Increased severity of lower urinary tract symptoms and daytime somnolence in primary Sjögren’s syndrome[J]. J Rheumatol, 2003,30(11):2406-2412.
pmid: 14677185
[21] Hackett KL, Gotts ZM, Ellis J, et al. An investigation into the prevalence of sleep disturbances in primary Sjögren’s syndrome: a systematic review of the literature[J]. Rheumatology, 2017,56(4):570-580.
doi: 10.1093/rheumatology/kew443 pmid: 28013207
[22] Theander L, Strombeck B, Mandl T, et al. Sleepiness or fatigue? Can we detect treatable causes of tiredness in primary Sjögren’s syndrome?[J]. Rheumatology, 2010,49(6):1177-1183.
doi: 10.1093/rheumatology/keq023 pmid: 20308122
[23] Ayaki M, Kawashima M, Negishi K, et al. Sleep and mood disorders in dry eye disease and allied irritating ocular diseases[J]. Sci Rep, 2016,6:22480.
doi: 10.1038/srep22480 pmid: 26927330
[24] Julich M, Budweiser S, Thoden J, et al. Sleep apnea in Sjögren’s syndrome potentially influences the EULAR Sjögren’s syndrome patient reported index[J]. Mod Rheumatol, 2019,29(3):563-565.
doi: 10.1080/14397595.2018.1467526 pmid: 29669457
[25] Hilditch CJ, McEvoy RD, George KE, et al. Upper airway surface tension but not upper airway collapsibility is elevated in primary Sjögren’s syndrome[J]. Sleep, 2008,31(3):367-374.
doi: 10.1093/sleep/31.3.367 pmid: 18363313
[26] Chung SW, Hur J, Ha YJ, et al. Impact of sleep quality on clinical features of primary Sjögren’s syndrome[J]. Korean J Intern Med, 2019,34(5):1154-1164.
doi: 10.3904/kjim.2017.158 pmid: 29458245
[27] Meier-Ewert HK, Ridker PM, Rifai N, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk[J]. J Am Coll Cardiol, 2004,43(4):678-683.
doi: 10.1016/j.jacc.2003.07.050 pmid: 14975482
[28] Emami Zeydi A, Jannati Y, Darvishi Khezri H, et al. Sleep quality and its correlation with serum C-reactive protein level in hemodialysis patients[J]. Saudi J Kidney Dis Transpl, 2014,25(4):750-755.
doi: 10.4103/1319-2442.134962 pmid: 24969183
[29] Ho KKN, Simic M, Smastuen MC, et al. The association between insomnia, C-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway[J]. Scand J Pain, 2019,19(4):765-777.
doi: 10.1515/sjpain-2019-0033
[30] Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation[J]. Biol Psychiatry, 2016,80(1):40-52.
doi: 10.1016/j.biopsych.2015.05.014 pmid: 26140821
[31] Ranjbaran Z, Keefer L, Stepanski E, et al. The relevance of sleep abnormalities to chronic inflammatory conditions[J]. Inflamm Res, 2007,56(2):51-57.
pmid: 17431741
[32] Irwin MR, Wang M, Campomayor CO, et al. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation[J]. Arch Intern Med, 2006,166(16):1756-1762.
doi: 10.1001/archinte.166.16.1756 pmid: 16983055
[33] Bollinger T, Bollinger A, Skrum L, et al. Sleep-dependent activity of T cells and regulatory T cells[J]. Clin Exp Immunol, 2009,155(2):231-238.
doi: 10.1111/j.1365-2249.2008.03822.x pmid: 19040608
[34] Tripp NH, Tarn J, Natasari A, et al. Fatigue in primary Sjögren’s syndrome is associated with lower levels of proinflammatory cytokines[J]. Rmd Open, 2016,2(2):e000282.
doi: 10.1136/rmdopen-2016-000282 pmid: 27493792
[1] 苏俊琪,宋扬,谢尚. 口腔鳞状细胞癌患者修复重建术后感染的病原学特征及感染风险预测模型的构建[J]. 北京大学学报(医学版), 2022, 54(1): 68-76.
[2] 许昊,张国栋,范桄溥,陈彧. 冠状动脉旁路移植术后新发心房颤动的血浆预测因子:倾向性评分匹配研究[J]. 北京大学学报(医学版), 2021, 53(6): 1139-1143.
[3] 牛占岳,薛艳,张静,张贺军,丁士刚. 胃腺瘤性息肉的内镜和病理特点及癌变的危险因素分析[J]. 北京大学学报(医学版), 2021, 53(6): 1122-1127.
[4] 朱敬先,鲁胜楠,蒋艳芳,姜玲,王健全. 老年肩袖损伤手术患者术前肺功能的影响因素[J]. 北京大学学报(医学版), 2021, 53(5): 902-906.
[5] 王佳文,刘敬超,孟令峰,张威,刘晓东,张耀光. 间质性膀胱炎/膀胱疼痛综合征患者生活质量及相关因素分析[J]. 北京大学学报(医学版), 2021, 53(4): 653-658.
[6] 孙争辉,黄晓娟,董靖晗,刘茁,颜野,刘承,马潞林. 临床T1期肾细胞癌肾窦侵犯的危险因素[J]. 北京大学学报(医学版), 2021, 53(4): 659-664.
[7] 樊理诗,高敏,Edwin B.FISHER,孙昕霙. 北京市通州区和顺义区747例2型糖尿病患者生存质量影响因素[J]. 北京大学学报(医学版), 2021, 53(3): 523-529.
[8] 周柏林,李危石,孙垂国,齐强,陈仲强,曾岩. 脊柱手术后深部切口感染患者多次清创的危险因素[J]. 北京大学学报(医学版), 2021, 53(2): 286-292.
[9] 夏芳芳,鲁芙爱,吕慧敏,杨国安,刘媛. 系统性红斑狼疮伴间质性肺炎的临床特点及相关因素分析[J]. 北京大学学报(医学版), 2021, 53(2): 266-272.
[10] 刘晓强,杨洋,周建锋,刘建彰,谭建国. 640例单牙种植术对血压和心率影响的队列研究[J]. 北京大学学报(医学版), 2021, 53(2): 390-395.
[11] 侯国进,周方,田耘,姬洪全,张志山,郭琰,吕扬,杨钟玮,张雅文. 后路短节段跨伤椎椎弓根螺钉固定治疗胸腰段爆裂骨折术后再发后凸的危险因素[J]. 北京大学学报(医学版), 2021, 53(1): 167-174.
[12] 孟昭婷,穆东亮. 肺叶切除术中少尿与术后急性肾损伤的关系[J]. 北京大学学报(医学版), 2021, 53(1): 188-194.
[13] 王迎春,黄永辉,常虹,姚炜,闫秀娥,李柯,张耀鹏,郑炜. 十二指肠乳头息肉良、恶性病变比较及活检准确性[J]. 北京大学学报(医学版), 2021, 53(1): 204-209.
[14] 唐果,龙丽,韩雅欣,彭清,刘佳君,尚华. 类风湿关节炎合并结核感染的临床特点及相关因素[J]. 北京大学学报(医学版), 2020, 52(6): 1029-1033.
[15] 陈家丽,金月波,王一帆,张晓盈,李静,姚海红,何菁,李春. 老年发病类风湿关节炎的临床特征及其心血管疾病危险因素分析:一项大样本横断面临床研究[J]. 北京大学学报(医学版), 2020, 52(6): 1040-1047.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究(英文稿)[J]. 北京大学学报(医学版), 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报(医学版), 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报(医学版), 2009, 41(2): 135 -140 .
[4] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报(医学版), 2009, 41(2): 217 -220 .
[5] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报(医学版), 2009, 41(1): 52 -55 .
[6] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报(医学版), 2009, 41(1): 109 -111 .
[7] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报(医学版), 2009, 41(3): 297 -301 .
[8] Jian-wei GU, Emily YOUNG, Zhi-jun PAN, Kevan B. TUCKER, Megan SHPARAGO, Min HUANG, Amelia Purser BAILEY. SD大鼠长期高盐饮食可导致其高血压并改变肾细胞因子基因表达谱[J]. 北京大学学报(医学版), 2009, 41(5): 505 -515 .
[9] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报(医学版), 2009, 41(5): 599 -601 .
[10] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报(医学版), 2009, 41(5): 516 -520 .