共病糖尿病对稳定型心力衰竭患者睡眠特征、日间症状及身体功能的影响
Contributions of Comorbid Diabetes to Sleep Characteristics, Daytime Symptoms, and Physical Function Among Patients With Stable Heart Failure.
作者信息
Fritschi Cynthia, Redeker Nancy S
机构信息
Cynthia Fritschi, PhD, RN Assistant Professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago. Nancy S. Redeker, PhD, RN, FAHA, FAAN Professor and Associate Dean of Scholarly Affairs, School of Nursing, Yale University, New Haven, Connecticut.
出版信息
J Cardiovasc Nurs. 2015 Sep-Oct;30(5):411-9. doi: 10.1097/JCN.0000000000000183.
BACKGROUND
Diabetes mellitus (DM) and heart failure (HF) are often comorbid. Sleep disturbances, poor physical functioning, and high levels of daytime symptoms are prevalent and contribute to poor quality of life in both populations. However, little is known about the independent and additive effects of comorbid DM on sleep, physical function, and daytime symptoms among patients with HF.
OBJECTIVE
The aim of this study was to investigate the extent to which comorbid DM confers independent and additive effects on sleep disturbance, physical functioning, and symptoms among patients with stable HF.
METHODS
This secondary analysis was conducted on a sample of 173 stable class II to IV HF patients. Self-report and polysomnography were used to measure sleep quality, objective sleep characteristics, and sleep-disordered breathing. Physical function measures included wrist actigraphy, the 6-minute walk test (6MWT), and the Medical Outcomes Study 36-item Short Form physical component summary score. Fatigue, sleepiness, and depression were also measured. Univariate analyses and hierarchical regression models were computed.
RESULTS
The sample included 173 (n = 119/68% HF and n = 54/32% HF plus DM) patients (mean [SD] age, 60.4 [16.1] years). In analyses adjusted for age, gender, body mass index, and New York Heart Association classification, the HF patients with DM had longer sleep latency and spent a greater percentage of time awake after sleep onset than the HF patients who did not have DM (all P < 0.05). There were no statistically significant differences in Respiratory Disturbance Index or self-reported sleep quality. Sleep duration was low in both groups. The patients with DM had shorter 6MWT distance, lower ratio of daytime to nighttime activity, as well as lower general health and self-reported physical function. Hierarchical regression models revealed that age and DM were the only significant correlates of the sleep variables, whereas age, gender, New York Heart Association class, and DM were all associated with 6MWT distance.
CONCLUSIONS
Comorbid DM contributes independent and additive effects on sleep disturbances and poor physical functioning in patients with stable HF.
背景
糖尿病（DM）和心力衰竭（HF）常合并存在。睡眠障碍、身体功能差以及高水平的日间症状普遍存在，且会导致这两类人群的生活质量低下。然而，关于合并糖尿病对心力衰竭患者睡眠、身体功能和日间症状的独立及叠加影响，人们知之甚少。
目的
本研究旨在调查合并糖尿病对稳定型心力衰竭患者睡眠障碍、身体功能和症状产生独立及叠加影响的程度。
方法
对173例稳定的II至IV级心力衰竭患者样本进行了二次分析。采用自我报告和多导睡眠图来测量睡眠质量、客观睡眠特征和睡眠呼吸障碍。身体功能测量包括手腕活动记录仪、6分钟步行试验（6MWT）以及医学结局研究36项简短健康调查身体成分汇总得分。还对疲劳、嗜睡和抑郁进行了测量。进行了单因素分析和分层回归模型计算。
结果
样本包括173例患者（n = 119/68%为心力衰竭患者，n = 54/32%为心力衰竭合并糖尿病患者）（平均[标准差]年龄，60.4 [16.1]岁）。在对年龄、性别、体重指数和纽约心脏协会分级进行校正的分析中，合并糖尿病的心力衰竭患者比未合并糖尿病的心力衰竭患者睡眠潜伏期更长，睡眠开始后清醒时间所占百分比更高（所有P < 0.05）。呼吸紊乱指数或自我报告的睡眠质量无统计学显著差异。两组的睡眠时间均较短。合并糖尿病的患者6MWT距离较短，日间与夜间活动比例较低，总体健康状况和自我报告的身体功能也较低。分层回归模型显示，年龄和糖尿病是睡眠变量的唯一显著相关因素，而年龄、性别、纽约心脏协会分级和糖尿病均与6MWT距离相关。
结论
合并糖尿病对稳定型心力衰竭患者的睡眠障碍和身体功能差有独立及叠加影响。
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