疼痛和抑郁对类风湿关节炎患者自我报告的睡眠障碍的影响

The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis.

Pain 2012 Jan;153(1):107-12 PMID:22051047

Nicassio PM,Ormseth SR,Kay M,Custodio M,Irwin MR,Olmstead R,Weisman MH

Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. pnicassio@mednet.ucla.edu

摘要：本文旨在评估疾病活动度，疼痛，心理因素对类风湿关节炎（RA）患者自我报告的睡眠障碍的影响，并评估抑郁是否可调节疼痛对睡眠障碍的影响。研究样本包括106例RA确诊患者，在参加帮助这些患者治疗RA的前瞻性研究前，对他们进行了疾病活动度，疼痛，心理功能和睡眠障碍的基线评估。自我监测包括风湿病疾病活动度快速评估，SF-36疼痛量表，无助及关节炎无助指数内控子量表，疼痛治疗调查表主动和被动疼痛应对量表，流行病学研究中心抑郁量表，Pittsburgh睡眠质量指数。分层多元回归分析证实，收入较高，疼痛，内控性和抑郁可独立引起较严重的睡眠障碍。一项中介分析表明，抑郁症是一个重要机制，通过抑郁，疼痛可导致睡眠障碍。横断面研究结果表明，疼痛和抑郁在RA患者自我报告睡眠障碍中发挥重要的作用。有数据显示，疼痛和抑郁靶向治疗干预可改善现有医疗条件下的睡眠。

The objective of this article is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology, the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.