摘要目的 探讨睡眠和2型糖尿病(T2DM)之间的关系.方法 病例组为2013年徐州市慢病基线调查时首次确诊的T2DM患者,年龄25～70岁,在本地居住5年以上,排除其他类型糖尿病、神经系统相关疾病、现患其他内分泌系统疾病、心肝肾功能不全、呼吸衰竭、恶性肿瘤等严重疾病者.对照组为无T2DM者,排除标准同病例组.采用1∶1匹配的病例对照研究方法,病例和对照共771对.匹配条件按年龄(相差不超过3岁)、性别、居住地、T2DM家族史四个方面,每个病例匹配1个对照,减少混杂因素的影响.采用自行设计的一般状况调查表和国际匹兹堡睡眠质量指数(PSQI)量表对病例组和对照组进行调查;采用t检验、x2检验和多元条件logistic回归进行统计学分析.结果 病例组PSQI平均得分为(5.15±2.40)分,对照组PSQI平均得分为(2.71±1.93)分,两组PSQI分值差异有统计学意义(t=21.96,P＜0.01).在主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物的应用、日间功能障碍7个维度得分方面,病例组分值均高于对照组(P＜0.01).除了夜间易醒早醒、睡眠中感觉寒冷、做恶梦睡眠障碍行为3个因素之外,病例组睡眠障碍相关行为所占的比例均高于对照组(P＜0.01).单因素logistic回归分析显示,睡眠质量差者患T2DM的风险比睡眠质量好者增加1.06倍(OR=2.06,95％CI:1.46 ～ 2.90),调整混杂因素后,风险仍增加0.72倍(OR=1.72,95％CI:1.38～2.43).5个睡眠维度——主观睡眠差、入睡困难、睡眠不足、睡眠效率低、睡眠障碍和T2DM存在关联(OR值分别为3.34、1.63、1.10、1.87、3.89).结论 睡眠质量差与T2DM发病密切相关.

abstractsObjective To explore the association between sleep quality and the increasing risk of type 2 diabetes mellitus (T2DM).Methods A total of 771 patients aged 25-70 years living in Xuzhou City of Jiangsu Province for at least 5 years were enrolled for the survey of risk factor related noninfectious chronic disease in 2013.In this investigation,those who suffered from other types of diabetes,neuropathy,other endocrine disease,cardiovascular,renal and hepatic dysfunction,dyspnea or cancer were excluded.To reduce the influence of confounding factors,another 771 participants were enrolled as controls.Each case was arranged to have a control who was matched in age (difference not more than 3 years),gender,residence and family history.All the participants were interviewed with self-designed questionnaire,and sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI) questionnaire.Student's t test,Chi-square and multivariate logistic regression were used for data analysis.Results The PSQI score in the T2DM patients vs.the controls were 5.15±2.40 vs.2.71 ± 1.93 (t=21.96,P＜0.01).The scores of sleep-related factors,including subjective poor sleep quality,bedtime resistance,short sleep duration,sleep efficiency,sleep disturbance,use of sleep medication and daytime dysfunction,of the T2DM patients were higher than those of the controls.The proportion of sleep related behaviors of the T2DM patients was higher,except for early awakening,cold feeling and nightmare.Poor sleep quality was associated with the increasing risk of T2DM (odds ratio 2.06,95％ CI 1.69-2.52).In multivariate logistic regression,when adjusted for confounding factors,the risk of T2DM was still increased (odds ratio 1.72,95％ CI 1.62-1.83).Sleep-related factors (e.g.subjective poor sleep quality,bedtime resistance,short sleep duration,sleep efficiency and sleep disturbance) were correlated with the risk of T2DM (odds ratio was 3.34,1.63,1.10,1.87 and 3.89,respectively).Conclusion Low quality of sleep may be strongly associated with an increased risk of T2DM.