Xiang Yu-Tao, Wong Tak-Shun, Tsoh Joshua, Ungvari Gabor S, Correll Christoph U, Ko Fanny W S, Hui David S C, Chiu Helen F K
1Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.
COPD. 2014 Jun;11(3):319-24. doi: 10.3109/15412555.2013.858314. Epub 2013 Dec 30.
This study aimed to determine the frequency and sociodemographic/clinical correlates of insomnia in Chinese patients aged ≥60 years suffering from chronic obstructive pulmonary disease (COPD). In this case-control study of 142 outpatients with COPD and 218 sex- and age-matched control subjects, COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥2 major COPD symptoms or >1 major+minor COPD symptoms for ≥2 consecutive days). Controls were recruited from social centres in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale, life events were evaluated using the Life Event Scale, depressive symptoms were ascertained with the Geriatric Depression Scale, and quality of life was measured using the Medical Outcomes Study Short Form-12. Early, middle and late insomnia were measured using items 4, 5 and 6 of the Hamilton Rating Scale for Depression. The frequency of ≥1 type of insomnia was 47.2% in patients and 25.7% in controls; frequencies of early, middle and late insomnia in patients were 24.6%, 31.0%, and 26.1%, respectively, compared to 14.7%, 14.7% and 11.9% in controls. Group differences were non-significant after controlling for relevant covariates. However, in multiple logistic regression analysis, more physical illnesses (p = 0.02, OR = 1.3, 95% CI = 1.1-1.7) and more severe depressive symptoms (p = 0.009, OR = 1.1, 95% CI = 1.03-1.3) were independently associated with any type of insomnia in COPD patients, accounting for 21.3% of the variance. A significant proportion of older adult Chinese COPD patients suffer from insomnia that warrants more attention in clinical practice.
本研究旨在确定年龄≥60岁的中国慢性阻塞性肺疾病（COPD）患者失眠的频率以及社会人口统计学/临床相关因素。在这项病例对照研究中，选取了142例COPD门诊患者和218例性别与年龄匹配的对照者，COPD患者来自于在香港因急性COPD加重（≥2种主要COPD症状或>1种主要+次要COPD症状且持续≥2天）住院的前瞻性研究样本。对照者从香港社会中心招募。使用日常生活能力量表评估日常生活活动，使用生活事件量表评估生活事件，用老年抑郁量表确定抑郁症状，用医学结局研究简明健康调查量表-12测量生活质量。使用汉密尔顿抑郁评定量表的第4、5和6项测量早、中、晚期失眠。患者中≥1种失眠类型的频率为47.2%，对照者为25.7%；患者早、中、晚期失眠的频率分别为24.6%、31.0%和26.1%，而对照者分别为14.7%、14.7%和11.9%。在控制相关协变量后，组间差异无统计学意义。然而，在多因素logistic回归分析中，更多的躯体疾病（p = 0.02，OR = 1.3，95%CI = 1.1 - 1.7）和更严重的抑郁症状（p = 0.009，OR = 1.1，95%CI = 1.03 - 1.3）与COPD患者的任何类型失眠独立相关，可解释21.3%的变异。相当一部分中国老年COPD患者存在失眠，这在临床实践中值得更多关注。
