阻塞性睡眠呼吸暂停患者睡眠状态感知错误的关联因素：一项横断面研究

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中文摘要

目的： 本研究旨在探讨阻塞性睡眠呼吸暂停（OSA）患者睡眠状态感知错误（SSM）的关联因素，为失眠合并阻塞性睡眠呼吸暂停（COMISA）的早期识别和干预提供依据。
方法： 本横断面研究纳入2024年6月至2026年5月期间在中国江苏省某医院睡眠中心经多导睡眠监测（PSG）诊断为OSA的700例患者。根据睡眠感知指数（SPI），患者被分为三组：负向感知错误组（n = 118）、正常感知组（n = 521）和正向感知错误组（n = 61）。在PSG当天，参与者完成了匹兹堡睡眠质量指数（PSQI）、医院焦虑抑郁量表（HADS）、睡眠功能失调信念和态度量表-16（DBAS-16）、Epworth嗜睡量表（ESS）、主观认知下降问卷（SCD-Q9）和蒙特利尔认知评估（MoCA）。在PSG后的早晨，收集了对前一晚睡眠的主观估计。采用多项logistic回归分析识别与睡眠状态感知错误相关的因素。
结果： 在以正常感知组为参照的多项logistic回归分析中，较高的N3睡眠阶段百分比（N3%）、较高的呼吸暂停低通气指数（AHI）、较低的PSQI评分和较低的睡眠效率（SE）是正向感知错误的独立相关因素（均p < 0.05）。较高的AHI、较低的SCD-Q9评分、较低的DBAS-16评分、较低的HADS-焦虑（HADS-A）评分和较低的SE是负向感知错误的独立危险因素（均p < 0.05）。
结论： OSA患者睡眠状态感知错误的方向与多维临床特征特异性相关。高AHI与正向和负向感知错误均独立相关。正向感知错误与客观睡眠结构的破坏及较好的自评睡眠质量关系更为密切，而负向感知错误的保护因素涉及更理性的睡眠相关信念、更多的主观认知下降主诉和更高水平的焦虑。这种差异提示不同的感知错误方向可能与不同的潜在精神病理学和神经认知机制有关，强调临床实践中需要针对感知错误方向制定精准筛查和分层干预策略。

英文摘要

OBJECTIVES: This study aimed to investigate factors associated with sleep state misperception (SSM) in patients with obstructive sleep apnea (OSA), and to provide evidence for the early identification and intervention of comorbid insomnia and obstructive sleep apnea (COMISA).
METHODS: This cross-sectional study enrolled 700 patients diagnosed with OSA by polysomnography (PSG) at a sleep center of a hospital in Jiangsu Province, China, between June 2024 and May 2026. Based on the Sleep Perception Index (SPI), patients were classified into three groups: a negative misperception group (n = 118), a normal perception group (n = 521), and a positive misperception group (n = 61). On the day of PSG, participants completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS-16), Epworth Sleepiness Scale (ESS), Subjective Cognitive Decline Questionnaire (SCD-Q9), and Montreal Cognitive Assessment (MoCA). On the morning after PSG, subjective estimates of the previous night's sleep were collected. Factors associated with sleep state misperception were identified using multinomial logistic regression analysis.
RESULTS: In the multinomial logistic regression analysis with the normal perception group as the reference, higher N3 sleep stage percentage (N3%), higher apnea-hypopnea index (AHI), lower PSQI score, and lower sleep efficiency (SE) were independent factors associated with positive misperception (all p < 0.05). Higher AHI, lower SCD-Q9 score, lower DBAS-16 score, lower HADS-Anxiety (HADS-A) score, and lower SE were independent risk factors associated with negative misperception (all p < 0.05).
CONCLUSION: The direction of sleep state misperception in patients with OSA is specifically associated with multidimensional clinical characteristics. High AHI was independently associated with both positive and negative misperception. Positive misperception was more closely linked to disruptions in objective sleep architecture and to better self-rated sleep quality, whereas protective factors against negative misperception involved more rational sleep-related beliefs, more subjective cognitive decline complaints, and higher levels of anxiety. This divergence suggests that different misperception directions may be related to distinct underlying psychopathological and neurocognitive mechanisms, underscoring the need for precision screening and stratified intervention strategies tailored to the direction of misperception in clinical practice.