中国现代神经疾病杂志 ›› 2023, Vol. 23 ›› Issue (8): 716-722. doi: 10.3969/j.issn.1672-6731.2023.08.010

• 睡眠障碍 • 上一篇    下一篇

2 慢性失眠患者维生素D水平及其与睡眠质量和情绪相关分析

郝永慈1, 张赛1,2, 张婷1,2, 王阳1, 沈莉3, 顾平1,2,*()   

  1. 1. 050000 石家庄, 河北医科大学第一医院 首都医科大学宣武医院河北医院神经内科
    2. 050000 石家庄, 河北省脑老化与认知神经科学重点实验室 河北省神经医学技术创新中心
    3. 050000 石家庄, 河北医科大学第一医院 首都医科大学宣武医院河北医院检验中心
  • 收稿日期:2023-06-11 出版日期:2023-08-25 发布日期:2023-08-25
  • 通讯作者: 顾平
  • 基金资助:
    河北省重点研发计划项目民生科技专项(20377721D)

The correlation of vitamin D level with sleep quality and mood in patients with chronic insomnia

Yong-ci HAO1, Sai ZHANG1,2, Ting ZHANG1,2, Yang WANG1, Li SHEN3, Ping GU1,2,*()   

  1. 1. Department of Neurology, The First Hospital of Hebei Medical University; Xuanwu Hospital Hebei Hospital, Capital Medical University, Shijiazhuang 050000, Hebei, China
    2. Hebei Key Laboratory of Brain Aging and Cognitive Neuroscience; Hebei Neuromedical Technology Innovation Center, Shijiazhuang 050000, Hebei, China
    3. Inspection Center, The First Hospital of Hebei Medical University; Xuanwu Hospital Hebei Hospital, Capital Medical University, Shijiazhuang 050000, Hebei, China
  • Received:2023-06-11 Online:2023-08-25 Published:2023-08-25
  • Contact: Ping GU
  • Supported by:
    Program of Hebei People's Livelihood Science and Technology Special Project(20377721D)

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