摘要目的：:探讨糖尿病视网膜病变（DR）的严重程度和睡眠障碍、睡眠时间异常的关系。方法：:横断面调查研究。于2012年7月至2013年5月对抚顺市将军街道已确诊为2型糖尿病的居民进行基本信息采集、眼科专科检查、血液化验及问卷调查。DR的诊断及分级依据改良的美国早期治疗糖尿病视网膜病变研究小组标准，分为非DR、轻度非增殖性糖尿病视网膜病变（NPDR）、中度NPDR、重度NPDR和增殖性糖尿病视网膜病变（PDR）。采用匹兹堡睡眠质量指数（PSQI）量表评估DR患者的睡眠质量。根据患者性别、年龄（分为≥65岁和<65岁）、病程（分为≥5年和<5年）、血脂异常、受教育程度（分为文盲、小学、初中、高中、大学本科及以上）、收入情况、全身疾病（冠心病、肾功能不全等）、认知障碍及焦虑情况等不同临床特征进行分组，分析各组PSQI得分情况。不同组间DR患者睡眠质量得分比较采用 t或 H检验，DR对睡眠的影响采用广义评估方程分析。 结果：:共纳入2型糖尿病患者2 224例，最终纳入眼底像和PSQI量表完整者1 408例用于数据分析。男569例（40.4%），女839例（59.6%），年龄（61.5±8.6）岁。1 408例糖尿病患者中诊断为DR患者516例（36.6%）。根据PSQI量表评估睡眠障碍检出率为22.2%，睡眠时间异常检出率为21.3%。根据广义评估方程分析显示：未进行调整前，PDR是睡眠障碍的危险因素（ OR=2.37，95% CI：1.13~4.97， P=0.023）；在控制年龄、性别因素后，PDR作为睡眠障碍的危险因素更为明显（ OR=2.67，95% CI：1.30~5.48， P=0.007）；在控制年龄、性别、病程、教育、低密度脂蛋白、总胆固醇、冠心病、肾功能不全、焦虑、认知障碍及其他眼病（包括角膜白斑、青光眼、白内障、视网膜动静脉阻塞、视网膜脱离）等协变量后，PDR的睡眠障碍发生率为非DR的2.374倍（ OR=2.37，95% CI：1.08~5.20， P=0.031）。在未进行调整前以及在控制年龄、性别后均未发现DR严重程度与睡眠时间异常相关；在调整所有协变量后，重度NPDR睡眠时间异常检出率为非DR的1.814倍（ OR=1.81，95% CI：1.03~3.19， P=0.039）。 结论：:DR严重程度与睡眠障碍和睡眠时间异常有关，其中PDR是睡眠障碍危险因素，重度NPDR是睡眠时间异常的危险因素。

abstractsObjective::To assess the correlation between the severity of diabetes retinopathy (DR) and sleep disorders, as well as abnormal sleep duration.Methods::This was a cross-sectional study on type 2 diabetic retinopathy conducted in the Jiangjun community of Fushun between July 2012 and May 2013. Basic information, detailed ophthalmic examination, laboratory tests, and questionnaires were completed to collect the information. The diagnosis and status of diabetes retinopathy were determined according to the improved American early treatment of diabetes retinopathy research group (ETDRS) standard. This standard included a five-stage disease severity classification for diabetic retinopathy including none, mild nonproliferative diabetes retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetes retinopathy (PDR). The Pittsburgh sleep quality index (PSQI) scale was used to evaluate the sleep quality of patients. In the statistical of PSQI score distribution, patients were grouped based on their basic information and relevant medical history, including gender, age (≥65 years, <65 years), disease course (≥5 years, <5 years), dyslipidemia, education level (illiteracy, primary school, junior high school, high school, undergraduate and above), income situation, systemic diseases (coronary heart disease, renal insufficiency, etc.), cognitive impairment, and anxiety. The sleep quality scores of different DR patients were compared using t tests or Kruskal-Wallis H tests. The generalized evaluation equation was employed to assess and analyze the impact of DR on sleep. Results::Totally 2 224 patients with type 2 diabetes were recruited, and 1 408 patients with complete fundus photography and PSQI scale were included for data analysis. Among them, 569 (40.4%) were males and 839 (59.6%) were females, with an average age of 61.5 ± 8.6 years. Among the examined diabetes patients, 516 (36.6%) were diagnosed with DR. According to the PSQI scale, the incidence of sleep disorders was 22.2% (312/1 408), and the incidence of abnormal sleep duration was 21.3% (300/1 408). In the generalized estimation equation evaluation analysis. Before adjustment, PDR was identified as a risk factor for sleep disorders [ OR=2.37, 95% confidence interval ( CI): 1.13-4.97, P=0.023]. After adjusting for age and gender factors, PDR became a more pronounced risk factor for sleep disorders ( OR=2.67, 95% CI: 1.30-5.48, P=0.007). After adjusting for age, gender, course of disease, education, low density lipoprotein, total cholesterol, coronary heart disease, renal insufficiency, anxiety, cognitive impairment, and other eye diseases (including corneal leukoplakia, glaucoma, cataract, retinal arteriovenous obstruction, and retinal detachment), the incidence of sleep disorders in PDR was 2.374 times higher than that of non-DR ( OR=2.37, 95% CI: 1.08-5.20, P=0.031). Before and after adjustment of age and gender, no correlation was found between DR and abnormal sleep time. However, after adjusting for all covariates, we observed that the incidence of abnormal sleep time in severe NPDR was 1.814 times higher than that of non-DR ( OR=1.81, 95% CI: 1.03-3.19, P=0.039). Conclusions::The severity of DR is correlated with sleep disorders and abnormal sleep duration. PDR is a risk factor for sleep disorders, while severe NPDR is a risk factor for abnormal sleep duration.