[老年2型糖尿病患者睡眠质量与血糖水平、糖尿病并发症的关系]

[The relationship between sleep quality and glucose level, diabetic complications in elderly type 2 diabetes mellitus].

作者信息

Jin Qi-Hui, Chen Huai-Hong, Yu Hua-Liang, Li Tian-Lang

机构信息

Department of Geriatrics, the Second Hospital Affiliated to Medical College, Zhejiang University, Hangzhou 310009, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2012 May;51(5):357-61.

PMID:22883333

Abstract

OBJECTIVE

To explore the relationship between sleep quality and glucose level, diabetic complications in elderly type 2 diabetes mellitus.

METHODS

A total of 130 hospitalized elderly type 2 diabetes in our hospital were included in the study. Questionnaires and other related clinical data were collected within one week after admission. Patients were divided into two groups: poor-sleeper group and good-sleeper group according to Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Sixty percent (78/130) of these patients were poor sleepers. The following parameters differed in the two groups: the duration of diabetes [(7.9 ± 1.8) years vs (7.2 ± 1.5) years, t = 2.318], systolic blood pressure [(148 ± 30) mm Hg (1 mm Hg = 0.133 kPa) vs (138 ± 23) mm Hg, t = 2.037], fasting plasma glucose (FPG) [(10.7 ± 2.2) mmol/L vs (9.8 ± 1.9) mmol/L, t = 2.410], hemoglobin A1c (HbA1c) [(8.6 ± 2.2)% vs (7.8 ± 2.1)%, t = 2.068], high-sensitive C-reactive protein (hs-CRP) [(5.27 ± 2.34) mg/L vs (4.44 ± 1.76) mg/L, t = 2.179], ratio of diabetic complications (61% vs 32%, χ(2) = 4.257), percentage of depression (20% vs 8%, χ(2) = 3.722), score of life quality [(98 ± 19) scores vs (89 ± 13) scores, t = 2.980], and proportion of patients treated with insulin (32% vs 12%, χ(2) = 4.489). All the above parameters were significantly higher in poor-sleeper group than the good-sleeper group (all P value < 0.05). Multiple correlation analysis showed that the factors affecting sleep quality were FPG, HbA1c, duration of diabetes, diabetic complications, depression, life quality and insulin application (r = 0.213, 0.257, 0.223, 0.335, 0.422, 0.3451, 0.231, respectively; all P value < 0.05). By multivariate logistic regression analysis, the followings were found: FPG (β = 1.29, P < 0.05) and PSQI (β = 1.07, P < 0.05) were found to be correlated with HbA1c. With increasing of PSQI, FPG, HbA1c, diabetic complications and life quality were changed significantly (all P value < 0.05). The independent risk factors of diabetic complications were duration of diabetes (OR = 1.32, 95%CI 1.01 - 2.01), HbA1c (OR = 2.01, 95%CI 1.63 - 2.67), hs-CRP (OR = 1.12, 95%CI 1.08 - 1.21) and PSQI (OR = 1.71, 95%CI 1.58 - 2.02).

CONCLUSIONS

Elderly type 2 diabetes mellitus are usually poor sleepers. Sleep quality probably affects blood glucose regulation, and is closely correlated with the occurrence of complications. In addition, poor sleep quality results in poor life quality.

摘要

目的

探讨老年2型糖尿病患者睡眠质量与血糖水平、糖尿病并发症之间的关系。

方法

选取我院收治的130例老年2型糖尿病住院患者纳入研究。入院后1周内收集问卷及其他相关临床资料。根据匹兹堡睡眠质量指数（PSQI）将患者分为两组：睡眠差组和睡眠好组。

结果

这些患者中有60%（78/130）睡眠差。两组在以下参数上存在差异：糖尿病病程[（7.9±1.8）年 vs （7.2±1.5）年，t = 2.318]、收缩压[（148±30）mmHg（1mmHg = 0.133kPa） vs （138±23）mmHg，t = 2.037]、空腹血糖（FPG）[（10.7±2.2）mmol/L vs （9.8±1.9）mmol/L，t = 2.410]、糖化血红蛋白（HbA1c）[（8.6±2.2）% vs （7.8±2.1）%，t = 2.068]、高敏C反应蛋白（hs-CRP）[（5.27±2.34）mg/L vs （4.44±1.76）mg/L，t = 2.179]、糖尿病并发症发生率（61% vs 32%，χ² = 4.257）、抑郁发生率（20% vs 8%，χ² = 3.722）、生活质量评分[（98±19）分 vs （89±13）分，t = 2.980]以及胰岛素治疗患者比例（32% vs 12%，χ² = 4.489）。上述所有参数在睡眠差组均显著高于睡眠好组（所有P值 < 0.05）。多元相关分析显示，影响睡眠质量的因素有FPG、HbA1c、糖尿病病程、糖尿病并发症、抑郁、生活质量及胰岛素应用（r分别为0.213、0.257、0.223、0.335、0.422、0.3451、0.231；所有P值 < 0.05）。通过多因素logistic回归分析发现：FPG（β = 1.29，P < 0.05）和PSQI（β = 1.07，P < 0.05）与HbA1c相关。随着PSQI、FPG、HbA1c、糖尿病并发症及生活质量的升高，变化显著（所有P值 < 0.05）。糖尿病并发症的独立危险因素为糖尿病病程（OR = 1.32，95%CI 1.01 - 2.01）、HbA1c（OR = 2.01，95%CI 1.63 - 2.67）、hs-CRP（OR = 1.