目的 探讨慢性心力衰竭（chronic heart failure,CHF）患者睡眠障碍的发生情况,并分析其与生物、社会、心理等多维度因素的相关性,为临床干预提供依据。方法 采用回顾性横断面研究设计,选取2023年3月—2025年3月在湘潭市第二人民医院心内科收治的慢性心力衰竭患者作为调查对象,共纳入396例CHF患者。使用匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）、心力衰竭躯体知觉量表（heart failure somatic perception scale,HFSPS）、医院焦虑抑郁量表（hospital anxiety and depression scale,HADS）、社会支持评定量表（social support rating scale,SRSS）、家庭关怀度指数量表（family adaptation partnership growth affection resolve index,APGAR）评估慢性心衰患者睡眠情况、躯体感知、焦虑或抑郁状态及家庭关怀度,将患者分为睡眠障碍组（PSQI>7分）与无睡眠障碍组（PSQI≤7分）。同时收集患者一般资料、临床特征等,行单因素、多因素Logistic回归及中介效应分析。结果 396例CHF患者中,282例（71.21%）存在睡眠障碍。单因素分析显示,年龄、自我健康评价、纽约心力衰竭分级、社会支持评定量表评分、家庭关怀度指数量表评分及心力衰竭躯体感觉量表评分与睡眠障碍显著相关。多因素分析进一步表明,自我健康评价差（OR=3.485,95% CI：2.155~5.788）是睡眠障碍的独立危险因素,而较高的家庭关怀度（OR=0.869,95% CI：0.780~0.965）是保护因素。中介分析进一步表明,自我健康评价在纽约心力衰竭分级与睡眠障碍间起完全中介作用,存在遮掩效应。结论 CHF患者睡眠障碍发生率较高,其发生与自我健康评价和家庭支持密切相关,且自我健康评价是客观心功能影响睡眠的关键中介。在临床护理中,应重视对患者主观健康感受的评估与心理疏导,并加强家庭支持系统的构建,以改善患者的睡眠质量。
Abstract
Objective To investigate the prevalence of sleep disturbances in patients with Chronic Heart Failure (CHF) and analyze their correlations with biological, social, and psychological multidimensional factors, thereby providing a basis for clinical intervention. Methods A retrospective cross-sectional study was conducted. A total of 396 CHF patients admitted to the Department of Cardiology, Xiangtan Second People's Hospital between March 2023 and March 2025 were enrolled. Sleep quality, somatic perception, anxiety/depression status, social support, and family function were assessed using the Pittsburgh Sleep Quality Index (PSQI), Heart Failure Somatic Perception Scale (HFSPS), Hospital Anxiety and Depression Scale (HADS), Social Support Rating Scale (SSRS), and Family APGAR Index, respectively. Patients were divided into a sleep disturbance group (PSQI≥7) and a non-sleep disturbance group (PSQI<7). General patient data and clinical characteristics were collected. Univariate analysis, multivariate Logistic regression, and mediation effect analysis were performed. Results Among the 396 CHF patients, 282(71.21%) had sleep disturbances. Univariate analysis showed that age, self-rated health, New York Heart Association (NYHA) functional classification, SSRS score, Family APGAR score, and HFSPS score were significantly associated with sleep disturbances. Multivariate analysis further indicated that poor self-rated health (OR=3.485, 95% CI: 2.155-5.788) was an independent risk factor for sleep disturbances, while higher family support (OR=0.869, 95% CI: 0.780-0.965) was a protective factor. Mediation analysis revealed that self-rated health played a complete mediating role in the relationship between NYHA classification and sleep disturbances, indicating a suppression effect. Conclusion The incidence of sleep disturbances is high among CHF patients. Their occurrence is closely related to self-rated health and family support, with self-rated health being a key mediator through which objective cardiac function affects sleep. In clinical nursing practice, emphasis should be placed on assessing and providing psychological guidance regarding patients' subjective health perceptions, as well as strengthening the family support system, to improve patients' sleep quality.
关键词
慢性心力衰竭 /
睡眠障碍 /
自我健康评价 /
心理社会因素
Key words
chronic heart failure /
sleep disturbance /
self-rated health /
psychosocial factors
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基金
湘潭市科技局指导性项目“基于循证构建慢性心衰患者睡眠管理方案的研究”（ZP-ZDJH2022018）
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