养老机构认知障碍老年人睡眠质量与抑郁症状的相关性分析

doi:10.3969/j.issn.1003-9198.2026.01.004

摘要/Abstract

摘要： 目的比较养老机构轻度认知障碍(MCI)与痴呆老年人的睡眠质量及其影响因素与抑郁症状关联模式的差异。方法采用横断面研究设计,纳入522例认知障碍老年人,分别采用MMSE、匹兹堡睡眠质量指数(PSQI)、15项老年抑郁量表(GDS-15)评估研究对象的认知功能、睡眠障碍及抑郁情况。采用logistic回归分析探讨睡眠障碍相关因素与抑郁症状的关联。结果 522例参与者中60%为MCI(n=313),40%为痴呆(n=209),睡眠障碍的患病率为40.2%。MCI组存在睡眠障碍及使用催眠药物的比例均高于痴呆组(P<0.05)。多因素logistic回归分析显示,校正了年龄、性别、受教育程度等一般资料后,在MCI组,做噩梦和疼痛不适是抑郁症状的独立危险因素(P<0.05);在痴呆组,夜间易醒或早醒、呼吸不畅、咳嗽或鼾声高、感觉冷及感觉热与抑郁症状显著相关(P<0.05)。结论养老机构中,MCI和痴呆老年人的睡眠质量以及睡眠障碍表现类型与抑郁症状的关联模式存在明显差异,提示需根据认知损害阶段采取差异化的睡眠干预策略以预防或缓解抑郁。

关键词: 睡眠障碍, 轻度认知障碍, 痴呆, 抑郁症状, 老年人

Abstract: Objective To compare the association patterns of overall sleep quality and its related factors with depressive symptoms between older adults with mild cognitive impairment (MCI) and those with dementia in nursing homes. Methods This cross-sectional study enrolled 522 institutionalized older adults with cognitive impairment. Cognitive function, sleep quality, and depressive symptoms were assessed using the Mini-Mental State Examination (MMSE), the Pittsburgh Sleep Quality Index (PSQI), and the 15-item Geriatric Depression Scale (GDS-15), respectively. Multivariable logistic regression analysis was employed to investigate the correlation between specific sleep-related factors and depressive symptoms. Results Of the 522 participants, 60.0% (n=313) were classified as having MCI and 40.0% as having dementia. The overall prevalence of sleep disturbances was 40.2%. The prevalence of sleep disturbances and the use of hypnotic agents were significantly higher in the MCI group compared to the dementia group (P<0.05). After adjusting for general characteristics, multivariate logistic regression analysis revealed that in the MCI group, experiencing nightmares and pain were significantly associated with depressive symptoms(P<0.05); In the dementia group, nocturnal awakening or early morning awakening, difficulty breathing, loud snoring or coughing, feeling cold, and feeling hot were significantly associated with depressive symptoms(P<0.05). Conclusions There are signifant differences in sleep quality and in association pattrerns sleep disorder manifestations and depressive symptoms among older adults with MCI compared to those with dementia in nursing homes.These findings suggest that tailored sleep intervention strategies, based on the stage of cognitive impairment, are necessary for the effective prevention and management of depressive symptoms.

Key words: sleep disorders, mild cognitive impairment, dementia, depressive symptoms, aged

中图分类号:

R 749.4

王金峰, 宋姣, 江杨洋, 杨雪, 李颖. 养老机构认知障碍老年人睡眠质量与抑郁症状的相关性分析[J]. 实用老年医学, 2026, 40(1): 16-20.

WANG Jinfeng, SONG Jiao, JIANG Yangyang, YANG Xue, LI Ying. Association between sleep quality and depressive symptoms in residents with cognitive impairment residing in nursing homes[J]. Practical Geriatrics, 2026, 40(1): 16-20.

参考文献

[1] PAVLOVA M K, LATREILLE V. Sleep disorders[J]. Am J Med, 2019, 132(3): 292-299.
[2] NAISMITH S L, ROGERS N L, LEWIS S J G, et al. Sleep disturbance in mild cognitive impairment: differential effects of current and remitted depression[J]. Acta Neuropsychiatr, 2011, 23(4): 167-172.
[3] 蔡真真, 王晓霞, 骆钰婷, 等. 养老机构轻度认知障碍老年人睡眠质量及影响因素研究[J]. 护理学杂志, 2022, 37(7): 79-81.
[4] MALHI G S, MANN J J. Depression[J]. Lancet, 2018, 392(10161): 2299-2312.
[5] MOURAO R J, MANSUR G, MALLOY-DINIZ L F, et al. Depressive symptoms increase the risk of progression to dementia in subjects with mild cognitive impairment: systematic review and meta-analysis[J]. Int J Geriatr Psychiatry, 2016, 31(8): 905-911.
[6] 李为华, 钟兴泉, 李双力, 等. 重庆市养老机构轻度认知障碍老年人抑郁现状及影响因素分析[J]. 医药前沿, 2024(28): 1-3, 7.
[7] LEUNG D K Y, CHAN W C, SPECTOR A, et al. Prevalence of depression, anxiety, and apathy symptoms across dementia stages:a systematic review and meta-analysis[J]. Int J Geriatr Psychiatry, 2021, 36(9): 1330-1344.
[8] FANG H, TU S, SHENG J, et al. Depression in sleep disturbance:a review on a bidirectional relationship, mechanisms and treatment[J]. J Cell Mol Med, 2019, 23(4): 2324-2332.
[9] BAO Y P, HAN Y, MA J, et al. Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: meta-analysis and systematic review[J]. Neurosci Biobehav Rev, 2017, 75: 257-273.
[10] GUAN Q, HU X, MA N, et al. Sleep quality, depression, and cognitive function in non-demented older adults[J]. J Alzheimers Dis, 2020, 76(4): 1637-1650.
[11] ORCHARD F, GREGORY A M, GRADISAR M, et al. Self-reported sleep patterns and quality amongst adolescents: cross-sectional and prospective associations with anxiety and depression[J]. J Child Psychol Psychiatry, 2020, 61(10): 1126-1137.
[12] BAGLIONI C, BATTAGLIESE G, FEIGE B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies[J]. J Affect Disord, 2011, 135(1-3): 10-19.
[13] GORGONI M, LAURI G, TRUGLIA I, et al. Parietal fast sleep spindle density decrease in Alzheimer’s disease and amnesic mild cognitive impairment[J]. Neural Plast, 2016, 2016: 8376108.
[14] SHIN H Y, HAN H J, SHIN D J, et al. Sleep problems associated with behavioral and psychological symptoms as well as cognitive functions in Alzheimer’s disease[J]. J Clin Neurol, 2014, 10(3): 203-209.
[15] SHIN C, PARK M H, LEE S H, et al. Usefulness of the 15-item geriatric depression scale (GDS-15) for classifying minor and major depressive disorders among community-dwelling elders[J]. J Affect Disord, 2019, 259: 370-375.
[16] HSIEH S W, HUANG L C, HSIEH T J, et al. Behavioral and psychological symptoms in institutional residents with dementia in Taiwan[J]. Geriatr Gerontol Int, 2021, 21(8): 718-724.
[17] ONOR M L, TREVISIOL M, NEGRO C, et al. Different perception of cognitive impairment, behavioral disturbances, and functional disabilities between persons with mild cognitive impairment and mild Alzheimer’s disease and their caregivers[J]. Am J Alzheimers Dis Other Demen, 2006, 21(5): 333-338.
[18] TADOKORO K, OHTA Y, HISHIKAWA N, et al. Discrepancy of subjective and objective sleep problems in Alzheimer’s disease and mild cognitive impairment detected by a home-based sleep analysis[J]. J Clin Neurosci, 2020, 74: 76-80.
[19] FU Y, WANG Z T, QU Y, et al. Sleep characteristics and cognitive function in older adults without dementia: the CABLE study[J]. J Alzheimers Dis, 2021, 84(3): 1029-1038.
[20] TAGAI K, NAGATA T, SHINAGAWA S, et al. Anosognosia in patients with Alzheimer’s disease: current perspectives[J]. Psychogeriatrics, 2020, 20(3): 345-352.
[21] SONG D, YU D S F, SUN Q, et al. Correlates of sleep disturbance among older adults with mild cognitive impairment: a cross-sectional study[J]. Int J Environ Res Public Health, 2020, 17(13): 4862.
[22] TONON A C, CONSTANTINO D B, AMANDO G R, et al. Sleep disturbances, circadian activity, and nocturnal light exposure characterize high risk for and current depression in adolescence[J]. Sleep, 2022, 45(7): zsac104.
[23] LEWIS B A, GJERDINGEN D, SCHUVER K, et al. The effect of sleep pattern changes on postpartum depressive symptoms[J]. BMC Womens Health, 2018, 18(1): 12.
[24] VAN DEN BERG J F, LUIJENDIJK H J, TULEN J H M, et al. Sleep in depression and anxiety disorders: a population-based study of elderly persons[J]. J Clin Psychiatry, 2009, 70(8): 1105-1113.
[25] ULKE C, SANDER C, JAWINSKI P, et al. Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects[J]. World J Biol Psychiatry, 2017, 18(8): 633-640.
[26] IRWIN R S,MADISON J M. Unexplained or refractory chronic cough in adults[J]. N Engl J Med, 2025, 392(12): 1203-1214.
[27] 牛意柔. 远程指导的改良版口咽训练对单纯性鼾症的干预效果研究[D]. 长春: 吉林大学, 2023.