内蒙古地区多中心慢性肾脏病伴睡眠障碍对焦虑抑郁发病的相关影响研究

    Correlation between chronic kidney disease with sleep disorder and the incidence of anxiety and depression in Inner Mongolia region: a multicenter study

    • 摘要:
      目的  探讨慢性肾脏病(chronic kidney disease,CKD)伴睡眠障碍患者对焦虑、抑郁发病的相关影响,为预防治疗焦虑、抑郁提供更好的思路及治疗靶点。
      方法  选取内蒙古多家医院的CKD患者653例,对患者进行焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale,SDS)、汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(hamilton depression scale,HAMD)、匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)等量表评定,采集患者相关一般信息及伴随症状等临床特征,利用SPSS统计学软件进行统计分析,采用Graphpad prism统计学软件进行绘图。
      结果  内蒙古地区多中心研究发现,CKD患者焦虑发生率为6.4%,其中轻度焦虑4.4%,中度焦虑1.7%,重度焦虑0.3%;抑郁发生率13.5%,其中轻度抑郁9.2%,中度抑郁3.4%,重度抑郁0.9%;焦虑合并抑郁发病率5.2%。CKD伴有睡眠障碍的患者发病率25.7%,伴睡眠障碍患者中79.3%显示睡眠质量差。CKD患者中睡眠时间影响SAS、SDS评分,睡眠质量PSQI总分与HAMA、HAMD呈线性相关,睡眠时间小于5 h为CKD患者焦虑、抑郁、焦虑合并抑郁的独立危险因素,睡眠时间<5 h的CKD患者焦虑发生率是睡眠时间>7 h患者的5.118倍,抑郁发生率是6.76倍,焦虑合并抑郁发生率是4.244倍;睡眠时间5~7 h的CKD患者抑郁发生率是睡眠时间>7 h患者的4.426倍。60岁以上较60岁以下CKD患者更易发生睡眠障碍(P<0.05),女性较男性更易发生睡眠障碍(P<0.05),故60岁以上女性患者更易发生睡眠障碍及焦虑、抑郁,应获得更多的关注。有疲劳、疼痛、瘙痒等伴随症状CKD患者更易发生睡眠障碍(P<0.05)。焦虑发病率在非终末期(9.2%)高于终末期(5.9%);抑郁发病率在终末期(14.3%)高于非终末期(9.2%);焦虑合并抑郁发病率在非终末期(7.3%)高于终末期(4.8%),差异有统计学意义(P<0.05)。
      结论  睡眠障碍会严重影响患者心理健康情况,睡眠时间不足、质量下降与焦虑、抑郁发病有一定关系,加强患者睡眠情况管理,以促进CKD患者焦虑、抑郁的防治。

       

      Abstract:
      Objective  To explore the correlation between anxiety and depression in patients with chronic kidney disease (CKD) and sleep disorders, providing better rationales and therapeutic targets for preventing and managing anxiety and depression.
      Methods  A total of 653 CKD patients were selected from multiple hospitals in Inner Mongolia and evaluated by self-rating anxiety scale (SAS), self-rating depression scale (SDS), Hamilton anxiety scale (HAMA), Hamilton depression scale(HAMD) and Pittsburgh sleep quality index(PSQI). General profiles and accompanying symptoms were collected, and statistical analysis was conducted with SPSS and Graphpad prism software.
      Results  A multicenter study in Inner Mongolia indicated that the incidence of anxiety in CKD patients was 6.4%, including mild anxiety(4.4%), moderate anxiety (1.7%) and severe anxiety(0.3%). The incidence of depression was 13.5%, including mild depression(9.2%), moderate depression(3.4%) and severe depression(0.9%). The incidence rate of anxiety/depression was 5.2%. The incidence rate of CKD patients with sleep disorders was 25.7%. And 79.3% of patients with sleep disorders showed poor sleep quality. Sleep time affected SAS/SDS scores in CKD patients and total PSQI score of sleep quality was correlated linearly with HAMA/HAMD. Sleep time <5 h was an independent risk factor for anxiety, depression and anxiety plus depression in CKD patients. The incidence of anxiety in patients with sleep time <5 h was 5.118 folds higher than that in those with sleep time >7 h. The incidence of depression was 6.76 folds higher and the incidence of anxiety plus depression was 4.244 folds higher. The incidence of depression in CKD patients sleeping for 5-7 h was 4.426 folds higher than that in those sleeping for over 7 h. CKD patients aged over 60 years were more prone to sleep disorders than those aged under 60 years(P<0.05) and females were more prone to sleep disorders than males(P<0.05). Therefore female patients aged over 60 years were more prone to sleep disorders and anxiety/depression. CKD patients with such accompanying symptoms as fatigue, pain and itching were more prone to sleep disorders(P<0.05). The incidence rate of anxiety was higher in non-terminal stage than that in terminal stage(9.2% vs 5.9%). The incidence rate of depression in end-stage(14.3%) was higher than that in non-end-stage(9.2%). The incidence rate of anxiety/depression was higher in non terminal stage than that in terminal stage(7.3% vs 4.8%)(P<0.05).
      Conclusion  Sleep disorders may seriously affect mental health of patients. Insufficient sleep time and lower quality are correlated with an onset of anxiety/depression. Strengthening sleep management may facilitate the prevention and management of anxiety/depression in CKD patients.

       

    /

    返回文章
    返回