干眼患者睡眠质量及情绪状态分析

doi:10.6040/j.issn.1673-3770.0.2022.105

摘要/Abstract

摘要： 目的评估干眼患者的睡眠质量及情绪状态,并分析干眼临床特征与睡眠质量及情绪状态的关系。方法纳入就诊于四川大学华西医院眼科门诊的干眼患者70例,同时选取年龄和性别匹配的40例健康受试者作为对照组。对所有受试者使用中文版匹兹堡睡眠质量指数量表(Chinese version of the Pittsburgh sleep quality index, CPSQI)、Epworth嗜睡量表及失眠严重程度指数量表(insomnia severity index, ISI)评估睡眠质量,汉密尔顿焦虑量表(Hamilton anxiety scale, HAMA)及汉密尔顿抑郁量表(Hamilton depression scale, HAMD)评估情绪状态,眼表疾病指数量表(ocular surface disease index, OSDI)评估干眼症状;利用双通道客观视觉质量分析系统Ⅱ测量泪膜动态变化和客观视觉质量;LipiView^® Ⅱ眼表干涉仪获取不全眨眼比例(partial blink rate, PBR)、脂质层厚度(lipid layer thickness, LLT)和睑板腺缺失程度;同时测量泪膜破裂时间(fluorescein breakup time, FBUT)、角膜染色评分(corneal fluorescein staining, CFS)和泪液分泌试验(schirmer Ⅰ test, SⅠt)。结果干眼患者的CPSQI总分(P<0.001)及其组成因子评分、ISI评分(P<0.001)、HAMA评分(P<0.001)和HAMD评分(P=0.001)均明显高于对照组,差异均有统计学意义。睡眠质量差与睡眠质量良好的干眼患者比较,OSDI评分较高(P=0.046),SⅠt较低(P=0.032),差异均有统计学意义。睡眠质量差的干眼患者ISI评分(P<0.001)、HAMA评分(P=0.001)和HAMD评分(P<0.001)更高。相关性分析显示,OSDI评分与CPSQI总分、主观睡眠质量评分和入睡时间均呈正相关;SⅠt与CPSQI总分、主观睡眠质量、入睡时间和睡眠效率评分均呈负相关;FBUT与睡眠效率评分呈负相关;CFS与睡眠时间呈负相关,与睡眠障碍呈正相关。OSDI评分还与ISI评分和HAMA评分呈正相关。结论睡眠质量差在干眼患者较普遍,且可能伴随焦虑及抑郁。睡眠障碍可能伴随泪液分泌减少、泪膜不稳定、角膜损伤较重或心理负担增加,影响干眼的发生和发展。

关键词: 干眼, 睡眠质量, 情绪状态, 焦虑, 抑郁, 相关性

Abstract: Objective This study aimed to evaluate the sleep quality and emotional state in patients with dry eye, and to analyze the correlation between clinical characteristics of dry eye and sleep quality as well as emotional state. Methods A total of 70 patients with dry eye visiting the Department of Ophthalmology of West China Hospital of Sichuan University were enrolled, and 40 age- and gender-matched healthy subjects were included as the control group. Sleep quality was assessed by the Chinese version of the Pittsburgh sleep quality index(CPSQI), Epworth sleepiness score, and insomnia severity index(ISI). The Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were administered to evaluate the degree of anxiety and depression. The ocular surface disease index(OSDI)questionnaire was used for assessing symptoms of dry eye, while the optical quality analysis system II was used to evaluate dynamic changes of tear film and quality of vision. Moreover, LipiView^® II Ocular Surface Interferometer was used for partial blink rate(PBR), lipid layer thickness(LLT), and meibomian gland dropout degree tests. Meanwhile, fluorescein breakup time(FBUT), corneal fluorescein staining(CFS), and the schirmer Ⅰ test(SⅠt)were measured. Results Compared with participants without dry eye, the total CPSQI score and its components scores, and ISI scores were significantly higher in patients with dry eye(P<0.001). The scores of the anxiety(P<0.001)and depression(P=0.001)were also significantly higher in patients with dry eye than that in controls. Compared to patients with good sleep in the dry eye group, the OSDI score(P=0.046), and the SⅠt results(P<0.032)were worse in patients with poor sleep. The ISI scores(P<0.001), the anxiety scores(P=0.001), and the depression scores(P<0.001)were higher in patients with poor sleep. The correlation analysis revealed that the OSDI score was positively associated with the total CPSQI score, subjective sleep quality, and sleep latency. Also, SⅠt results were negatively correlated with the total CPSQI score and the score of subjective sleep quality, sleep latency, and habitual sleep efficiency. Furthermore, FBUT was negatively related to sleep efficiency score. CFS was negatively associated with sleep duration and positively correlated with sleep disorder. In addition, there were significant positive correlations between OSDI score and the degree of the anxiety and ISI score. Conclusion Poor sleep may be common and serious in patients with dry eye, which might be accompanied by anxiety and depression. Besides, sleep disorders may affect the occurrence and development of dry eye by reducing tear secretion and tear film stability and aggravating corneal injury or resulting in psychological burden.

Key words: Dry eye, Sleep quality, Emotional state, Anxiety, Depression, Correlation

中图分类号:

R777.34

黄维洁,魏然,周玉红,邓应平. 干眼患者睡眠质量及情绪状态分析[J]. 山东大学耳鼻喉眼学报, 2022, 37(6): 93-100.

HUANG Weijie, WEI Ran, ZHOU Yuhong, DENG Yingping. Analysis of sleep quality and emotional state in patients with dry eye[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 37(6): 93-100.

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