老年人骨关节炎疼痛患者睡眠质量的多维性及其与疲劳的关系。

The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis.

机构信息

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.

出版信息

Osteoarthritis Cartilage. 2010 Nov;18(11):1365-71. doi: 10.1016/j.joca.2010.08.002. Epub 2010 Aug 10.

DOI:10.1016/j.joca.2010.08.002

PMID:20708004

Abstract

OBJECTIVE

To evaluate subjective sleep quality and its relationship to fatigue in older adults with osteoarthritis (OA).

METHOD

In a community cohort with hip/knee OA, subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and fatigue was measured by the Profile of Mood States - Fatigue subscale (POMS-F). Correlates of sleep quality and fatigue were determined by standardized interviews including socio-demographics, OA severity (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) summary score), comorbidity, depression (Center for Epidemiologic Studies Depression Scale, CES-D), stressful life events, daytime napping, symptoms of restless legs syndrome (RLS) and prior sleep disorder diagnoses. Logistic regression examined correlates of poor sleep (PSQI score>5). Linear regression evaluated the relationship between poor sleep and fatigue, and the effect of napping on this relationship.

RESULTS

In 613 respondents, mean age was 78 years, 78% were female, 11% had concomitant fibromyalgia, and 26% had 3+ comorbid conditions. Responses indicated moderate OA severity. Seventy percent reported poor sleep; 25% met criteria for RLS and 6.5% reported a diagnosed sleep disorder. Independent correlates of poor sleep were: greater arthritis severity (adjusted odds ratio (OR) per unit increase in WOMAC score=1.03, P<0.0001), 3+ comorbid conditions (adjusted OR=1.88; P=0.03), depressed mood (adjusted OR per unit increase in CES-D score=1.09, P<0.0001), and RLS (adjusted OR=1.87; P=0.02). Controlling for previously reported fatigue correlates, poor sleep was significantly associated with greater fatigue (parameter estimate=1.63, P=0.0003) and napping did not moderate this relationship (P=0.55 for the interaction between napping and poor sleep).

CONCLUSIONS

Among older people with OA, poor sleep is highly prevalent and significantly linked with fatigue. Identifying the nature of sleep disturbances in OA is important as treatment of sleep disturbances may reduce OA-related fatigue.

摘要

目的

评估老年骨关节炎（OA）患者的主观睡眠质量及其与疲劳的关系。

方法

在髋关节/膝关节 OA 的社区队列中，使用匹兹堡睡眠质量指数（PSQI）评估主观睡眠质量，使用心境状态问卷-疲劳分量表（POMS-F）测量疲劳。通过标准化访谈确定睡眠质量和疲劳的相关性，包括社会人口统计学、OA 严重程度（安大略西部和麦克马斯特大学骨关节炎指数（WOMAC）综合评分）、合并症、抑郁（流行病学研究中心抑郁量表，CES-D）、生活压力事件、白天小睡、不安腿综合征（RLS）症状和既往睡眠障碍诊断。逻辑回归检查睡眠质量差（PSQI 评分>5）的相关因素。线性回归评估睡眠质量差与疲劳的关系，以及小睡对这种关系的影响。

结果

在 613 名受访者中，平均年龄为 78 岁，78%为女性，11%伴有纤维肌痛，26%有 3 种及以上合并症。结果表明 OA 严重程度中等。70%的人报告睡眠质量差；25%符合 RLS 标准，6.5%报告有诊断性睡眠障碍。睡眠质量差的独立相关因素包括：关节炎严重程度增加（WOMAC 评分每增加一个单位的调整优势比（OR）=1.03，P<0.0001）、3 种及以上合并症（调整 OR=1.88；P=0.03）、抑郁情绪（CES-D 评分每增加一个单位的调整 OR=1.09，P<0.0001）和 RLS（调整 OR=1.87；P=0.02）。控制先前报告的疲劳相关因素后，睡眠质量差与疲劳显著相关（参数估计值=1.63，P=0.0003），小睡并不能调节这种关系（小睡和睡眠质量差之间的交互作用 P=0.55）。