Objective: To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of primary Sjögren' s syndrome (pSS) patients.
Methods: 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 U test, Chi-square test or Fisher' s exact test, independent samples t test, Spearman correlation analysis and Logistic regression were used for statistical analysis.
Results: 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 (P=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 (r=0.151, 0.240, 0.421, P < 0.05), but negatively correlated with C3, C4 (r=-0.021, -0.235, P < 0.05). Logistic analysis identified the course of disease(OR=2.809, 95%CI: 1.21-6.52)and PHQ-9 score(OR=1.422, 95%CI: 1.04-1.94)as predictors of sleep disorders.
Conclusion: 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.
目的: 探讨原发性干燥综合征(primary Sjögren's syndrome，pSS)患者中睡眠障碍的发生率及其相关的影响因素。
方法: 选取就诊于北京大学人民医院符合纳入及排除标准的186例pSS患者作为研究对象进行回顾性研究，采用匹兹堡睡眠质量量表(the Pittsburgh sleep quality index, PSQI)、抑郁症筛查量表(patient health questionnaire-9, PHQ-9)、广泛性焦虑量表(generalized anxiety disorder-7, GAD-7)进行调查，收集一般资料及临床数据，以欧洲抗风湿病联盟干燥综合征疾病活动度评分(the European League Against Rheumatism Sjögren's syndrome disease activity index，ESSDAI)评估疾病活动度。以pSS患者的PSQI分值>7分为界，分为152例睡眠障碍组和34例睡眠正常组。采用Mann-Whitney U秩和检验、卡方检验、t检验，Spearman相关分析以及Logistic回归进行统计学处理。
结果: pSS患者中睡眠障碍的发生率为81.7%(152/186), 其中52.7%(98/186)的pSS患者存在中重度睡眠障碍。睡眠障碍组pSS患者的PSQI平均得分为(12.29±3.30)分，睡眠正常组PSQI平均得分为(5.50±1.20)分。睡眠障碍组患者的PSQI评分、PHQ-9评分及GAD-7评分均明显高于睡眠正常组患者，并且差异均具有统计学意义，P值分别为0.000、0.035、0.031。睡眠障碍组的PSQI量表评分在睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物使用及日间功能障碍等七个方面均明显高于睡眠正常组，并且两组间的差异均具有统计学意义(P＜0.05)。疾病病程、焦虑程度、抑郁评分与PSQI评分呈正相关(r值分别为0.151、0.240、0.421，P＜0.05)，而补体C3、C4与PSQI评分呈负相关(r值分别为-0.021、-0.235，P＜0.05)。二元Logistic回归分析显示病程、PHQ-9评分为pSS患者睡眠障碍的预测指标，其中病程OR=2.809，95%CI: 1.21~6.52；PHQ-9评分，OR=1.422，95%CI: 1.04~1.94(P＜0.05)。
结论: pSS患者睡眠障碍的发生率较高，且与疾病病程、抑郁、焦虑情绪等因素密切相关
Keywords: Anxiety; Depression; Risk factors; Sjögren's syndrome; Sleep disorders.