睡眠质量低下与创伤患者创伤后应激障碍的发生相关

doi:10.12122/j.issn.1673-4254.2024.06.18

摘要/Abstract

摘要：

目的阐明创伤患者睡眠质量及创伤后应激障碍（PTSD）临床流行病学特征，系统分析睡眠质量对创伤住院患者PTSD发生的作用，为PTSD患者的临床早期识别提供参考。方法收集256例于2021年10月~2022年11月在遵义市4所综合医院招募创伤住院患者，226例完成PTSD调查评估。采用PSQI量表结合智能手环睡眠监测评估患者创伤前后睡眠质量；采用PCL-C量表随访测评PTSD发生情况。结果创伤患者1个月后PTSD检出率为19.47%，3个月后PTSD检出率为17.61%。在睡眠质量方面，PTSD患者创伤前PSQI量表评分显著增高（P<0.001），其中患者PTSD发生前睡眠异常检出率为72.73%。在创伤后（入院7 d内）睡眠质量监测方面，PTSD患者评分降低，夜间清醒次数增多（P<0.05）。在创伤1个月与3个月后睡眠质量方面，PTSD患者PSQI量表评分均高于非PTSD人群（P<0.05）。结论创伤患者中创伤前睡眠质量差者更容易发生PTSD。

关键词: 创伤, 创伤后应激障碍, 睡眠障碍, 影响因素

Abstract:

Objective To evaluate the impact of poor sleep quality on occurrence of post-traumatic stress disorder (PTSD) in trauma patients. Methods We prospectively recruited 256 trauma patients hospitalized in 4 general hospitals in Zunyi during the period from October, 2021 to November, 2022, and 226 of the participants completed the PTSD survey and assessment. The patients' sleep quality within a month before trauma was estimated using Pittsburgh Sleep Quality Index (PSQI), and their sleep quality within 7 days after admission was monitored by smart bracelet sleep monitoring; the PTSD Checklist-Civilian Version (PCL-C) was used to detect the occurrence of PTSD during the follow-up. Results The detection rate of PTSD in the patients was 19.47% at 1 month and 17.61% at 3 months after trauma. The patients who developed PTSD had poorer sleep quality before the trauma, as shown by significantly higher PSQI scale scores (P<0.001), than those without PTSD, and they showed a sleep abnormality rate as high as 72.73% prior to PTSD onset. Within 7 days after admission, the patients developing PTSD had lower sleep quality scores with more frequent night awakenings (P<0.05). A 1 month and 3 months after trauma, the patients with PTSD had significantly higher PSQI scores than those without PTSD (P<0.05). Conclusion PTSD is more likely to occur in trauma patients with poor sleep quality before trauma.

Key words: trauma, post-traumatic stress disorder, sleep disorder, risk factors

袁萍, 胡秀莉, 漆国佳, 代秀, 褚相远, 陈卫航, 石修权. 睡眠质量低下与创伤患者创伤后应激障碍的发生相关[J]. 南方医科大学学报, 2024, 44(6): 1166-1172.

Ping YUAN, Xiuli HU, Guojia QI, Xiu DAI, Xiangyuan CHU, Weihang CHEN, Xiuquan SHI. Poor sleep quality contributes to occurrence of posttraumatic stress disorder in trauma patients[J]. Journal of Southern Medical University, 2024, 44(6): 1166-1172.

图/表 7

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Index	Frequency	Constituent ratio (%)	Index	Frequency	Constituent ratio (%)
Gender			Smoking
Male	143	63.27	Yes	89	39.38
Female	83	36.73	No	130	57.52
Age (year)			Ex-smoker	7	3.10
<18	13	5.75	Drinking
18-35	47	20.80	Yes	65	28.76
36-60	156	69.03	No	156	69.03
>60	10	4.42	Ex-alcoholic	5	2.21
Place of abode			Monthly household incom(Yuan)
City	67	29.65	≤2000	40	17.70
Towns	55	24.34	2001-5000	97	42.92
Country	104	46.01	5001-8000	68	30.09
Marriage			>8000	21	9.29
Married	187	82.74
Single	32	14.16	Daily stress
Divorced	6	2.65	Never	30	13.27
Widowed	1	0.45	Rarely	58	25.66
Occupation			sometimes	55	24.34
Farmer	77	34.07	frequently	60	26.55
Worker	72	31.86	always	23	10.18
Public institution	21	9.29
Businessman	15	6.64	History of trauma
Retiree	3	1.33	Yes	50	22.12
Other	38	16.81	No	176	77.88
Education
Primary or below	107	47.35	History of operation
Middle school	73	32.30	Yes	76	33.63
Senior high school and technical secondary school	30	13.27	No	150	66.37
University or above	16	7.09	Total	226	100.00

Index	Frequency	Constituent ratio (%)	Index	Frequency	Constituent ratio (%)
Gender			Smoking
Male	143	63.27	Yes	89	39.38
Female	83	36.73	No	130	57.52
Age (year)			Ex-smoker	7	3.10
<18	13	5.75	Drinking
18-35	47	20.80	Yes	65	28.76
36-60	156	69.03	No	156	69.03
>60	10	4.42	Ex-alcoholic	5	2.21
Place of abode			Monthly household incom(Yuan)
City	67	29.65	≤2000	40	17.70
Towns	55	24.34	2001-5000	97	42.92
Country	104	46.01	5001-8000	68	30.09
Marriage			>8000	21	9.29
Married	187	82.74
Single	32	14.16	Daily stress
Divorced	6	2.65	Never	30	13.27
Widowed	1	0.45	Rarely	58	25.66
Occupation			sometimes	55	24.34
Farmer	77	34.07	frequently	60	26.55
Worker	72	31.86	always	23	10.18
Public institution	21	9.29
Businessman	15	6.64	History of trauma
Retiree	3	1.33	Yes	50	22.12
Other	38	16.81	No	176	77.88
Education
Primary or below	107	47.35	History of operation
Middle school	73	32.30	Yes	76	33.63
Senior high school and technical secondary school	30	13.27	No	150	66.37
University or above	16	7.09	Total	226	100.00

Index	Mean±SD	Index	Mean±SD
Total score	65.13±9.15	Rapid eye movement increases (h)	0.98±0.66
Total length of sleep at night (h)	7.54±3.00	Deep sleep continuity (score)	50.23±16.79
Deep sleep duration (h)	1.72±1.08	Wakefulness frequency (times)	5.31±2.74
Light sleep duration (h)	4.90±2.69	Respiratory quality score (score)	92.59±9.69

Index	Mean±SD	Index	Mean±SD
Total score	65.13±9.15	Rapid eye movement increases (h)	0.98±0.66
Total length of sleep at night (h)	7.54±3.00	Deep sleep continuity (score)	50.23±16.79
Deep sleep duration (h)	1.72±1.08	Wakefulness frequency (times)	5.31±2.74
Light sleep duration (h)	4.90±2.69	Respiratory quality score (score)	92.59±9.69

Sleep characteristics	PTSD group (n=44)	Non-PTSD group (n=182)	χ²	P
PSQI Score			58.937	<0.001
PSQI≤4	3 (6.82)	101 (55.49)
5≤PSQI≤7	9 (20.45)	40 (21.98)
7<PSQI≤10	12 (27.27)	29 (15.93)
10<PSQI≤15	18 (40.91)	12 (6.59)
15<PSQI≤21	2 (4.55)	0 (0.00)
Difficulty falling asleep	32 (72.73)	100 (54.95)	4.612	0.032
Low sleep efficiency	41 (93.18)	96 (52.75)	24.268	<0.001
Poor sleep quality	14 (31.82)	20 (10.99)	12.028	0.001
Lack of sleep	15 (34.09)	16 (8.79)	19.163	<0.001
Take hypnotic drugs	2 (4.55)	2 (1.10)	0.844	0.358
Daytime dysfunction	43 (97.73)	73 (40.11)	47.086	<0.001
Abnormal sleep disorder factor	23 (52.27)	38 (20.88)	17.722	<0.001