目的 本研究通过调查中国华南地区一间大型医疗机构(综合医院)中护士日间过度嗜睡的发生率及相关影响因素。方法 纳入了1 102名在职护士要求他们在一段规定的时间内完成一份自我报告问卷,其中包括人口学资料采集、生活习惯(BMI、小睡习惯、打鼾等)、失眠、抑郁、焦虑、MEQ分型、倒班、工作兴趣等与工作及睡眠相关的特征。了解EDS在被试人群中的发生率及其影响因素。结果 共有1 048名护士有效的完成了问卷(应答率为95.1%)。其中169名(16.1%)护士存在日间过度嗜睡(EDS)。抑郁症状(校正后的OR值= 2.24,95%的可信区间 1.51～3.31)、焦虑症状(1.65; 1.02～2.67)、失眠(2.29; 1.56～3.36)、倒班工作(1.98; 1.03～3.83)和对工作的低兴趣(1.74; 1.01～2.99)是EDS发生的独立危险因素。结论 日间过度嗜睡(EDS)在华南地区的综合医疗机构中的青年护士群体中普遍存在。EDS的发生可能与抑郁症状、焦虑症状、失眠、倒班工作和对工作的低兴趣存在相关。

Objective To investigate the prevalence and correlates of excessive daytime sleepiness EDS in a population of hospital nurses in South China. Methods A total of 1 102 nurses working in a large medical center were invited to participate in this cross-sectional study (females 96.9%,mean age 29.6 years). They all completed a self-reported questionnaire consisting of items on demographic variables,lifestyle factors,insomnia,anxiety,depression,and both work-related and sleep related characteristics. Results A total of 1 048 nurses gave a valid response (response rate 95.1%). Among them,169 (16.1%) reported EDS as defined as an Epworth Sleepiness Scale≥14. Depression (adjusted odds ratio=2.24,95% confidence interval 1.51～3.31),anxiety (1.65; 1.02 ～2.67),insomnia (2.29; 1.56～3.36),rotating shift work (1.98; 1.03～3.83) and low interest in work (1.74; 1.01～2.99) were all independent risk factors of the occurrence of EDS. Conclusion EDS were common among this relatively young and healthy nurse population in south China. There were clear associations with EDS and depression,anxiety,insomnia,rotating shift work and low work-related interest.

目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.