肝硬化患者睡眠质量的潜在类别分析及生活质量的差异研究

doi:10.16138/j.1673-6087.2023.06.007

摘要/Abstract

摘要：

目的：对肝硬化患者的睡眠质量进行潜在类别分析，探讨不同睡眠质量类别患者的生活质量差异。方法：采用便利抽样法，选取2020年6月至2021年6月入住本院感染科的肝硬化患者221例，采用匹兹堡睡眠质量指数和慢性肝病问卷进行调查,使用Mplus 8.0对肝硬化患者睡眠质量进行潜在类别分析。结果：肝硬化患者的睡眠质量分为低质量-低效率睡眠（24.4%）、睡眠良好（43.9%）、睡眠时长不足（12.7%）和入睡困难-日间困乏（19.0%） 4个潜在类别，睡眠障碍发生率分别为98.2%、4.1%、60.7%和76.2%；以睡眠良好组为参照，各潜在类别患者的生活质量存在差异（P<0.05）；多元线性逐步回归提示日间功能障碍、主观睡眠质量差和睡眠紊乱是影响生活质量的主要睡眠问题（P<0.05）。结论：肝硬化患者的睡眠质量存在异质性，生活质量下降与睡眠质量不佳总体一致，应对不同睡眠质量类别的特点和差异加强关注，通过针对性的干预措施改善睡眠和生活质量。

关键词: 睡眠质量障碍, 潜在类别分析, 生活质量, 匹兹堡睡眠质量指数

Abstract:

Objective To identify the classification characteristics of sleep quality in liver cirrhosis patients, and explore the difference of quality of life(QOL) among the patients with different sleep quality categories. Methods A total of 221 liver cirrhosis patients in the infectious disease department of our hospital were selected as the research subjects from June 2020 to June 2021 by using convenient sampling method, in which Pittsburgh sleep quality index (PSQI) and chronic liver disease questionnaire(CLDQ) were investigated. Results According to sleep quality，the patients with liver cirrhosis were divided into 4 potential categories, which were sleep disorder group (24.4%), good sleep quality group (43.9%), lack of sleep group (12.7%) and prolonged sleep latency-daytime sleepy group (19.0%); and the incidence of sleep disturbance in 4 groups was 98.2%, 4.1%, 60.7% and 76.2%, respectively. Using good sleep quality group as reference, the score of QOL among the other groups of potential categories showed significant difference (P<0.05); the multiple linear stepwise regression suggested that daytime dysfunction, poor subjective sleep quality and sleep disorder were the main sleep problems affecting life quality(P<0.05). Conclusions There is heterogeneity in the sleep quality of cirrhosis patients, and the decreased QOL is generally consistent with poor sleep quality. It is necessary to learn the characteristics and differences of different sleep quality categories and improve the quality of sleep and life through targeted intervention.

Key words: Sleep quality disorder, Latent class analysis, Quality of life, Pittsburgh sleep quality index

中图分类号:

R573.1

蒋萍梅, 项晓刚, 蔡晓兰, 薛敏, 钱珠萍. 肝硬化患者睡眠质量的潜在类别分析及生活质量的差异研究[J]. 内科理论与实践, 2023, 18(06): 410-415.

JIANG Pingmei, XIANG Xiaogang, CAI Xiaolan, XUE Min, QIAN Zhuping. Identification of latent class of sleep quality and analysis of differences of quality of life in liver cirrhosis patients with different sleep quality[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(06): 410-415.

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模型	Log L	AIC	BIC	aBIC	P		熵值	类别概率
模型	Log L	AIC	BIC	aBIC	LMR	BLRT	熵值	类别概率
1	-903.513	1821.026	1844.814	1822.630	-	-	-	-
2	-780.176	1590.351	1641.324	1593.788	0.000	0.000	0.803	0.45/0.54
3	-756.231	1558.462	1636.620	1563.731	0.398	0.000	0.791	0.35/0.16/0.49
4	-742.213	1546.427	1651.770	1553.530	0.001	0.000	0.838	0.24/0.44/0.13/0.19
5	-738.921	1555.842	1688.370	1564.777	0.344	1.000	0.793	0.41/0.14/0.19/0.13/0.13
6	-735.512	1565.025	1724.739	1575.794	0.382	1.000	0.822	0.01/0.16/0.14/0.10/0.18/0.41

项目	低质量-低效率睡眠组（n=54）	睡眠良好组（n=97）	睡眠时长不足组（n=28）	入睡困难-日间困乏组（n=42）	F	P
CLDQ总分	30.25±5.70^2）	35.95±4.35	34.90±4.16	31.99±4.29^2）	19.58	0.000
腹部症状	5.22±1.44^2）	6.16±1.01	6.14±1.01	5.74±1.19^1）	8.21	0.000
困乏	4.64±1.37^2）	5.59±1.24	5.59±1.18	4.64±1.16^2）	10.50	0.000
系统症状	5.42±0.84^2）	6.06±0.68	6.08±0.84	5.66±0.79^2）	9.85	0.000
活动能力	5.12±1.38^2）	5.96±1.18	5.86±1.23	5.19±1.38^2）	6.94	0.000
情感功能	4.69±1.17^2）	6.20±0.82	5.68±0.84^2）	5.39±0.97^2）	29.98	0.000
焦虑	5.17±1.63^2）	5.98±1.13	5.55±0.99	5.37±1.09^2）	5.56	0.001

变量	回归系数	标准误	标准化回归系数	t	P
常数	40.868	1.354		30.182	0.000
日间功能障碍	-1.886	0.337	-0.423	-5.597	0.000
主观睡眠质量	-1.898	0.536	-0.273	-3.540	0.001
睡眠紊乱	-1.633	0.740	-0.166	-2.206	0.029