Wang Y F, Fan Z, Cheng Y B, Jin Y B, Huo Y, He J
Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China.
Department of Rheumatology and Immunology, Jinmen NO.1 People's Hospital, Jingmen 448000, Hubei, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Dec 18;52(6):1063-1068. doi: 10.19723/j.issn.1671-167X.2020.06.012.
To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of primary Sjögren' s syndrome (pSS) patients.
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 Sjögren'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 test, Chi-square test or Fisher' s exact test, independent samples t test, Spearman correlation analysis and Logistic regression were used for statistical analysis.
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 (=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 (=0.151, 0.240, 0.421, < 0.05), but negatively correlated with C3, C4 (=-0.021, -0.235, < 0.05). Logistic analysis identified the course of disease(=2.809, 95%: 1.21-6.52)and PHQ-9 score(=1.422, 95%: 1.04-1.94)as predictors of sleep disorders.
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.
调查原发性干燥综合征（pSS）患者队列中睡眠障碍的患病率及其相关决定因素。
本研究纳入了186例pSS患者，这些患者均入住北京大学人民医院且符合纳入和排除标准。采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量。分别通过患者健康问卷（PHQ）-9、广泛性焦虑障碍（GAD）-7评估抑郁、焦虑情况。同时记录人口统计学和临床数据。采用欧洲抗风湿病联盟干燥综合征疾病活动指数（ESSDAI）评估疾病活动度和损伤情况。根据PSQI评分>7，将pSS患者分为睡眠障碍组152例和正常睡眠组34例。采用曼-惠特尼检验、卡方检验或费舍尔精确检验、独立样本t检验、Spearman相关性分析和Logistic回归进行统计分析。
pSS患者中睡眠障碍（PSQI>7）的患病率为81.7%（152/186），52.7%（98/186）有中度或重度睡眠障碍（PSQI≥11）。睡眠障碍组的平均PSQI评分为（12.29±3.30），而正常睡眠组的PSQI评分为（5.50±1.20）。睡眠障碍组的PSQI评分、PHQ-9评分和GAD-7评分均显著高于正常睡眠组（P=0.000、0.035、0.031）。睡眠障碍组在主观睡眠质量、入睡潜伏期、睡眠时间、习惯性睡眠效率、睡眠障碍、催眠药物使用和日间功能障碍这七个方面的PSQI评分均显著高于正常睡眠组。差异均有统计学意义。根据Spearman相关性分析结果，PSQI与病程、焦虑、抑郁评分呈显著正相关（r=0.151、0.240、0.421，P<0.05），但与C3、C4呈负相关（r=-0.021、-0.235，P<0.05）。Logistic分析确定病程（β=2.809，95%CI：1.21-6.52）和PHQ-9评分（β=1.422，95%CI：1.04-1.94）为睡眠障碍的预测因素。
pSS患者睡眠障碍的发生率较高，且与病程、焦虑、抑郁等因素密切相关。对该疾病进行全面评估和管理至关重要。
