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上海社区老年人认知功能和睡眠质量现状及影响因素分析

Analysis of the current status and influencing factors of cognitive function and sleep quality of elderly people in Shanghai community

    摘要
  • 摘要:
    目的 分析上海社区老年人群的认知功能与睡眠质量，并探讨相关的影响因素。
    方法 采用分层整群随机抽样法，选择2023年9月至2023年12月上海8个社区卫生中心完成 “上海市社区老年人群健康状况综合调查”的老年人群3 677名。收集调查对象的年龄、性别、受教育水平、吸烟、饮酒、打麻将行为、运动习惯等基本信息。采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index，PSQI）量表评估调查对象的睡眠质量，主观认知障碍（subjective cognitive decline，SCD）自测问卷及简易精神状态检查表（Mini-Mental State Examination，MMSE）评估认知功能，汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）和患者健康问卷抑郁量表（patient health questionnaire-9, PHQ-9）评价焦虑和抑郁程度，微型营养评估（mininutritional assessment，MNA）评价营养状况。根据MMSE评分将调查对象分为无认知障碍组（MMSE≥27分）、轻度认知障碍组（MMSE 21～26分）和中重度认知障碍组（MMSE≤20分），比较3组的一般资料、生活习惯和量表评分。采用有序logistic回归分析睡眠质量的影响因素。
    结果 不同认知障碍组间的年龄、性别、腹围、体质量指数（body mass index, BMI）、受教育水平、养宠物、吸烟、饮酒、打麻将行为、运动习惯、量表得分等差异均有统计学意义（P＜0.05）。Logistic回归分析结果显示：年龄、性别、腹围、饮酒、打麻将行为、合并症是老年人群PSQI分级的影响因素（P＜0.05）。MMSE得分（OR＝1.037，P＝0.001）、SCD得分（OR＝1.123，P＜0.001）、HAMA得分（OR=1.183，P＜0.001）、PHQ-9得分（OR＝1.249，P＜0.001）是PSQI分级的正向影响因素，MNA得分是PSQI分级的负向影响因素（OR＝0.960，P＝0.037）。
    结论 高龄、女性、低学历、不养宠物、无打麻将行为、无运动习惯、睡眠质量差是老年人发生认知障碍的风险因素；高龄、女性、无打麻将行为、营养状况差是老年人睡眠质量差的影响因素，重度合并症、焦虑抑郁、主观认知功能下降均会影响睡眠质量。

     

    Abstract:
    Objective To analyze the cognitive function and sleep quality of the elderly in Shanghai community, and explore the related influencing factors.
    Methods A stratified cluster random sampling method was used to select 8 community health centers in Shanghai for a questionnaire survey, including 3 677 elderly individuals who completed the “Comprehensive Health Status Survey of Elderly Residents in Shanghai” from September 2023 to November 2023. Basic information of the elderly was collected, including age, gender, education level, smoking, drinking, mahjong playing behavior, and exercise habits. The Pittsburgh sleep quality index (PSQI) was used to assess the sleep quality of the elderly, subjective cognitive decline (SCD) self-assessment questionnaire and Mini-Mental State Examination (MMSE) were used to evaluate cognitive function, while the Hamilton Anxiety Scale (HAMA) and patient health questionnaire-9 (PHQ-9) were used to assess anxiety and depression levels, and the mini nutritional assessment (MNA) was used to evaluate nutritional status. According to the MMSE scores, the elderly were divided into three groups: no cognitive impairment (MMSE ≥ 27), mild cognitive impairment (MMSE 21-26), and moderate to severe cognitive impairment (MMSE ≤ 20). The general data, lifestyle habits, and scale scores of the three groups were compared. Ordered logistic regression was used to analyze the influencing factors of sleep quality.
    Results There were statistically significant differences in age, gender, waist circumference, body mass index (BMI), education level, pet ownership, smoking, drinking, mahjong playing behavior, exercise habits, and scale scores among the three groups (P＜0.05). Logistic regression analysis showed that age, waist circumference, gender, drinking habits, mahjong playing behavior, and chronic comorbidities are influencing factors for the PSQI grading in the elderly (P＜0.05). The MMSE score (OR＝1.037, P＝0.001), SCD score (OR＝1.123, P＜0.001), HAMA score (OR＝1.183, P＜0.001), PHQ-9 score (OR＝1.249, P＜0.001) are positive influencing factors for PSQI grading, while the MNA score is a negative influencing factor (OR＝0.960, P＝0.037).
    Conclusions Advanced age, female gender, low education level, no pet ownership, no mahjong playing behavior, no exercise habits, and poor sleep quality are risk factors for cognitive impairment in the elderly. Advanced age, female gender, no mahjong playing behavior and poor nutritional status are influencing factors for poor sleep quality in the elderly, and severe comorbidities, anxiety, depression, and subjective decline in cognitive function all affect sleep quality.

     

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