摘要：

目的: 探讨慢性失眠患者血清维生素D水平及其与睡眠质量、焦虑和抑郁情绪的相关性。方法: 纳入2020年8月至2022年8月河北医科大学第一医院收治的246例慢性失眠患者以及性别、年龄、受教育程度相匹配的240例睡眠和认知功能正常对照者，测定血清25-羟基维生素D[25（OH）D]水平，慢性失眠患者采用匹兹堡睡眠质量指数（PSQI）评价睡眠质量、汉密尔顿焦虑量表 14项（HAMA-14）评价焦虑情绪、汉密尔顿抑郁量表 24项（HAMD-24）评价抑郁情绪。结果: 慢性失眠患者血清25（OH）D缺乏（< 20 ng/ml）发生率高于对照者（χ²=78.202，P=0.000），血清25（OH）D水平低于对照者（t=-6.677，P=0.000）。根据发病季节将慢性失眠患者分为冬春季组（156例）和夏秋季组（90例），冬春季组PSQI评分（Z=-2.694，P=0.007）、HAMA-14总评分（Z=-2.166，P=0.030）及其躯体性焦虑分评分（Z=-2.545，P=0.011）、HAMD-24评分（Z=-2.065，P=0.039）高于夏秋季组，而血清25（OH）D水平低于夏秋季组（Z=-2.681，P=0.007）。根据PSQI评分将慢性失眠患者分为轻中度失眠组（114例）以及重度失眠组（132例），重度失眠组女性比例（χ²=10.733，P=0.001）、HAMA-14总评分（Z=-4.633，P=0.000）及其精神性焦虑（Z=-5.273，P=0.000）和躯体性焦虑（Z=-2.859，P=0.004）分评分、HAMD-24评分（Z=-5.430，P=0.000）高于轻中度失眠组，血清25（OH）D水平低于轻中度失眠组（Z=-1.986，P=0.047）。相关分析显示，慢性失眠患者血清25（OH）D水平与PSQI评分（r=-0.331，P=0.000）、HAMA-14总评分（r=-0.178，P=0.005）、HAMD-24评分（r=-0.142，P=0.027）呈负相关关系。结论: 慢性失眠患者维生素D缺乏发生率较高，尤以冬春季发病患者维生素D水平更低，睡眠质量更差，焦虑、抑郁情绪更严重；睡眠质量较差患者维生素D水平更低，焦虑、抑郁情绪更严重；维生素D缺乏与睡眠障碍及焦虑、抑郁情绪发生风险密切相关。

关键词: 入睡和睡眠障碍, 羟基胆骨化醇类, 焦虑, 抑郁

Abstract:

Objective: To investigate relationship between vitamin D level and season, sleep quality and anxiety and depression in patients with chronic insomnia. Methods: Total 246 patients with chronic insomnia and treated in The First Hospital of Hebei Medical University from August 2020 to August 2022 were included. Serum 25-hydroxy vitamin D[25 (OH) D] levels were determined. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, Hamilton Anxiety Rating Scale-14 (HAMA-14) to evaluate anxiety, and Hamilton Depression Rating Scale-24 (HAMD-24) to evaluate depression. Results: The incidence of serum 25 (OH) D deficiency (< 20 ng/ml) in chronic insomnia patients was higher than that in control group (χ²=78.202, P=0.000), and serum 25 (OH) D level was lower than that in control group (Z=-6.677, P=0.000). According to the onset season, 246 chronic insomnia patients were divided into winter and spring group (n=156) and summer and autumn group (n=90). PSQI score (Z=-2.694, P=0.007), HAMA-14 total score (Z=-2.166, P=0.030), somatic anxiety score (Z=-2.545, P=0.011) and HAMD-24 score (Z=-2.065, P=0.039) in winter and spring group were higher than those in summer and autumn group. Serum 25 (OH) D level in winter and spring group was lower than that in summer and autumn group (Z=-2.681, P=0.007). According to PSQI score, 246 patients with chronic insomnia were divided into mild-moderate insomnia group (n=114) and severe insomnia group (n=132). In severe insomnia group, the proportion of female (χ²=10.733, P=0.001), HAMA-14 total score (Z=-4.633, P=0.000), mental anxiety score (Z=-5.273, P=0.000) and physical anxiety score (Z=-2.859, P=0.004), and HAMD-24 score (Z=-5.430, P=0.000) were higher than those in the mild-moderate insomnia group, and serum 25 (OH) D level was lower than those in the mild-moderate insomnia group (Z=-1.986, P=0.047). Correlation analysis showed that serum 25 (OH) D was negatively correlated with PSQI score (r=-0.331, P=0.000), HAMA-14 total score (r=-0.178, P=0.005) and HAMD-24 score (r=-0.142, P=0.027). Conclusions: Patients with chronic insomnia have lower vitamin D level, and patients with winter and spring onset have lower vitamin D level, worse sleep quality, and more severe anxiety, depression and somatization symptoms. Patients with worse sleep quality had lower vitamin D level, and more anxiety and depression. Vitamin D deficiency is associated with sleep quality and risk of anxiety and depression in patients with chronic insomnia.

Key words: Sleep initiation and maintenance disorders, Hydroxycholecalciferols, Anxiety, Depression