Liu Rong, Shao Wenchao, Lai Jonathan King-Lam, Zhou Lingshan, Ren Man, Sun Nianzhe
Department of Geriatrics Ward 2 The First Hospital of Lanzhou University Lanzhou China.
Department of Cardiology Union Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China.
Aging Med (Milton). 2021 Feb 4;4(1):26-34. doi: 10.1002/agm2.12146. eCollection 2021 Mar.
Insomnia is a common problem in older persons and is associated with poor prognosis from a functional or clinical perspective. The purpose of this study was to investigate the prevalence of insomnia and identify comprehensive geriatric assessment (CGA) based clinical factors associated with insomnia in elderly hospitalized patients.
Standardized face-to-face interviews were conducted and CGA data were collected from 356 Chinese hospitalized patients aged 60 years or older. Insomnia was defined as self-reported sleep poor quality according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-Ⅴ). Multivariate logistic regression analysis was applied to assess the association between patient clinical factors together with domains within the CGA and insomnia.
Among the 365 patients, insomnia was found in 48.31% of the participants. Difficulty in initiating sleep (DIS), early morning awakening (EMA), difficulty in maintaining sleep (DMS), and snoring were found in 33.99%, 9.55%, 13.48%, and 1.69% of patients, respectively. Significant associations were found between insomnia and several covariates: female gender ( = 0.034), depression ( = 0.001), activities of daily living (ADL) ( = 0.034), instrumental activities of daily living (IADL; = 0.009), falling ( = 0.003), chronic pain ( = 0.001), and poor nutritional status ( = 0.038). According to the results of the adjustment multivariate logistic regression analysis, female sex (odds ratio [OR] = 2.057, confidence interval [CI] = 1.179-3.588, = 0.011), depression (OR = 1.889, CI = 1.080-3.304, = 0.026), and chronic pain (OR = 1.779, CI = 1.103-2.868, = 0.018) were significant independently predictors associated with insomnia.
Our study revealed that female sex, depression, and chronic pain were independently predictors of insomnia in hospitalized patients. Early identification of elderly patients with these risk factors using the CGA may improve the quality of life and treatment outcomes.
失眠是老年人常见的问题，从功能或临床角度来看，它与不良预后相关。本研究旨在调查老年住院患者失眠的患病率，并确定基于综合老年评估（CGA）的与失眠相关的临床因素。
对356名60岁及以上的中国住院患者进行了标准化的面对面访谈，并收集了CGA数据。根据《精神疾病诊断与统计手册》第五版（DSM-Ⅴ），失眠被定义为自我报告的睡眠质量差。采用多因素逻辑回归分析来评估患者临床因素以及CGA各领域与失眠之间的关联。
在365名患者中，48.31%的参与者存在失眠。分别有33.99%、9.55%、13.48%和1.69%的患者存在入睡困难（DIS）、早醒（EMA）、睡眠维持困难（DMS）和打鼾。发现失眠与几个协变量之间存在显著关联：女性（P = 0.034）、抑郁（P = 0.001）、日常生活活动能力（ADL）（P = 0.034）、工具性日常生活活动能力（IADL；P = 0.009）、跌倒（P = 0.003）、慢性疼痛（P = 0.001）和营养状况差（P = 0.038）。根据调整后的多因素逻辑回归分析结果，女性（比值比[OR]=2.057，置信区间[CI]=1.179 - 3.588，P = 0.011）、抑郁（OR = 1.889，CI = 1.080 - 3.304，P = 0.026）和慢性疼痛（OR = 1.779，CI = 1.103 - 2.868，P = 0.018）是与失眠相关的显著独立预测因素。
我们的研究表明，女性、抑郁和慢性疼痛是住院患者失眠的独立预测因素。使用CGA早期识别具有这些危险因素的老年患者可能会改善生活质量和治疗效果。
