严重精神疾病中的睡眠障碍与功能损害：一项结构方程模型研究。

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中文摘要

背景： 睡眠障碍在严重精神疾病（SMI）个体中高度普遍，并与功能损害相关。本研究在一个跨诊断的SMI样本中考察了睡眠障碍的患病率及其与精神症状和功能结局的关联。
方法： 在这项横断面研究中，SMI门诊患者完成了睡眠障碍（PSQI、ISI、STOP-Bang、ESS、SQ-RLS和SQ-RBD）、精神症状（HARS、MADRS、YMRS、PANSS-N和CGI-S）以及功能（FAST）的标准化评估。在双变量分析之后，进行了结构方程模型（SEM），包括失眠和抑郁/焦虑症状的潜在构念，以估计与功能损害的直接和间接关联。
结果： 共纳入229名参与者，69%在至少一项睡眠测量中筛查阳性，包括睡眠质量差（55.5%）。在特定的睡眠相关问题中，阻塞性睡眠呼吸暂停（OSA）高风险（45.8%）最为普遍。睡眠障碍与更高的临床严重程度和更差的功能损害相关。在SEM中，抑郁/焦虑症状（β = 0.45）、阴性症状（β = 0.38）、躁狂症状（β = 0.17）和OSA风险（β = 0.41）与功能损害独立相关。失眠表现出不一致的模式，对功能损害有负向直接效应（β = -0.47），并通过抑郁/焦虑症状产生正向间接效应（β = 0.22）。
结论： 睡眠障碍在SMI个体中高度普遍，并与功能结局相关，尤其是失眠和OSA风险。在精神科护理中系统筛查睡眠障碍可能有助于识别与功能损害相关的临床相关且可能可改变的因素。

英文摘要

BACKGROUND: Sleep disturbances are highly prevalent in individuals with severe mental illness (SMI) and are associated with functional impairment. This study examined the prevalence of sleep disturbances and their associations with psychiatric symptoms and functional outcomes in a transdiagnostic SMI sample.
METHODS: In this cross-sectional study, SMI outpatients completed standardized assessments of sleep disturbances (PSQI, ISI, STOP-Bang, ESS, SQ-RLS, and SQ-RBD), psychiatric symptoms (HARS, MADRS, YMRS, PANSS-N, and CGI-S), and functioning (FAST). Bivariate analyses were followed by structural equation modeling (SEM), including latent constructs for insomnia and depressive/anxious symptoms to estimate direct and indirect associations with functional impairment.
RESULTS: A total of 229 participants were included, and 69% screened positive for at least one sleep measure, including poor sleep quality (55.5%). Among the specific sleep-related problems, high risk of obstructive sleep apnea (OSA) (45.8%) was the most prevalent. Sleep disturbances were associated with greater clinical severity and worse functional impairment. In the SEM, depressive/anxious symptoms (β = 0.45), negative symptoms (β = 0.38), manic symptoms (β = 0.17), and OSA risk (β = 0.41) were independently associated with functional impairment. Insomnia exhibited an inconsistent pattern, with a negative direct effect (β = -0.47) and a positive indirect effect on functional impairment through depressive/anxious symptoms (β = 0.22).
CONCLUSIONS: Sleep disturbances are highly prevalent in individuals with SMI and are associated with functional outcomes, particularly insomnia and OSA risk. Systematic screening for sleep disturbances in psychiatric care may help identify clinically relevant and potentially modifiable factors associated with functional impairment.