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目的 对HIV阳性者和HIV阴性对照者的睡眠障碍特征进行聚类分析以识别主要睡眠障碍类型,分析比较两组不同睡眠障碍亚型的分布情况及其流行病学特征.方法 利用2017年1-12月浙江省台州市“HIV与衰老相关疾病前瞻性队列研究”基线数据,选取符合睡眠障碍(匹兹堡睡眠质量指数＞5或Jenkins睡眠量表4个睡眠相关问题应答符合标准者)HIV阳性者459例和HIV阴性对照者798例共1 257例研究对象.对15项睡眠问题进行潜类别的聚类分析.结果 1 257例睡眠障碍者存在的睡眠问题分为3类,分别为睡眠启动维持困难组(第一类)、症状轻型组(第二类)和夜间不宁日间障碍组(第三类),在HIV阳性者和HIV阴性对照者中分别占19.4％ (89/459)和13.8％(110/798)、63.8％(293/459)和60.5％ (483/798)、16.8％(77/459)和25.7％(205/798)(x2=16.62,P＜0.001).HIV阳性者中,第一、三类的高年龄比例和衰弱得分显著大于第二类,第一类抑郁得分显著高于其他两类,第三类低体重和超重比例显著高于其他两类,差异均有统计学意义(x2=13.29,P=0.039;x2=23.33,P＜0.001;X2=25.71,P＜0.001;x2=15.37,P=0.004).HIV阴性对照者的3类人群在年龄、抑郁和衰弱得分差异与HIV阳性者结果一致.此外,其第一类文盲和小学文化程度比例高,第一、三类腰臀比超标比例显著高于第二类(x2=30.59,P＜ 0.001;x2=11.61,P=0.003).结论 HIV阳性者与HIV阴性对照者的睡眠障碍类型构成比不同.精神心理因素和身体健康状况是睡眠障碍的主导因素,针对这些因素采取干预措施是改善睡眠障碍的关键.

Objective To understand the characteristics of sleep disorder in HIV positive and negative individuals,and compare the distributions and epidemiologic characteristic of different subtypes of sleep disorder between two groups.Methods Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December,2017.A total of 459 HIV positive patients and 798 HIV negative controls with sleep disorders (Pittsburg Sleep Quality Index ＞5 or at least one question with answers of “most nights” or “every night” for Jenkins Sleep Scale) were included in the analysis.Cluster analysis was conducted to identify the different subtypes of sleep disorder based on 15 sleep-related questions.Results A total of 1 257 participants were divided into three groups (clusters),i.e.difficulty falling asleep and sleep keeping group (cluster 1),the mild symptoms group (cluster 2),and restless night and daytime dysfunction group (cluster 3),accounting for 19.4％ (89/459),63.8％ (293/459) and 16.8％ (77/459) in HIV positive group and 13.8％ (110/798),60.5％ (483/798) and 25.7％ (205/798) in HIV negative group (x2=16.62,P＜0.001).In HIV positive group,the patients in cluster 1 and 3 were older and had higher frailty score,the patients in cluster 1 had highest level of depression,and the more patients in cluster 3 had low body weight or overweight (x2=13.29,P=0.039;x2=23.33,P＜0.001;x2=25.71,P＜0.001;x2=15.37,P=0.004).In HIV-negative group,similar findings were found for age,depressive symptoms and frailty score.In addition,the proportion of those who were illiteracy or with primary school education level was significantly high in cluster 1,and the proportion of abnormal waist-to-hip ratio was significantly higher in cluster 1 and 3 (x2=30.59,P＜0.001;x2=11.61,P=0.003).Conclusions The proportion of every subtype of sleep disorder in HIV positive individuals were different to those in HIV negative individuals.Mental and physical health status were the main factors affecting the prevalence of sleep disorder.It is necessary to conduct targeted interventions to improve sleep quality.