| Background:No matter in any stage (acute or chronic) or what kind of medication status (drug used or drug naive), difficulty initiating sleep (DIS, difficulty initiating sleep), difficulty maintaining sleep (DMS, difficulty maintaining sleep), and early morning awakening (EMA, early morning awakening) are all common to see. One research were carried out in Beijing in2008to investigated the sleep of schizophrenic outpatients, and found the probability of DIS, DMS, EMA is21.2%,23.6%and11.9%, at least one kind of sleep disorders is36%. Xiang et al.(2008)investigated5926subjects in the urban and surrounding rural areas of Beijing using Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)-defined sleep disturbance, and reported that the one-year prevalence of at least one type of sleep disturbance was9.2%, and the probability of DIS, DMS, EMA is7.0%,8.0%,4.9%. The sleep of schizophrenia mainly affected by the following factors:①quality of life②severity of illness③positive symptoms④negative symptoms and suicidality⑤outcome⑥neurocognitive impairment⑦brain structure⑧antipsychotics sleep disorders can be seen as the early signal of the start or the recurrence of the disease, meanwhile, patients’sleep problem may associated with psychotic symptoms. Mean total sleep time (TST, total sleep time) in general population was7.76±1.22h, Compared with normal control group, patients with schizophrenia went to bed earlier, got up late, and their sleep latency, total sleep time, stay in bed time were prolonged. Studies using the Pittsburgh sleep index scale (PSQI, Pittsburgh sleep index scale) to research the sleep condition in schizophrenia patients, compared with normal control group, patients with schizophrenia have long sleep latency, low sleep quality, and strong sleepy feeling in the morning. Sleep problems in schizophrenia have attracted extensive attention of therapists. There are quite a number of studies verify that insomnia in schizophrenia can make interaction with quality of life, obesity and many index of clinical symptoms in abroad. The correlate research about schizophrenia sleep in China, especially large cross-sectional research about sleep condition and its influence factors for severe mental illness is rarely seen. In China, there are nearly5million schizophrenia lives in the community, occupy90%of the total number, to research schizophrenia patients who lives in community, will be helpful to understand the sleep characteristics of schizophrenia and its related influence factors.Objectives:This study use cross-sectional survey to collect a series of clinical index, such as schizophrenia patients’psychotic symptoms, emotional symptoms, sleep status, quality of life, medication status, body mass index, insight etc., understand the basic characteristics of the community-dwelling schizophrenia patients’symptoms, feature of sleep status and their quality of life, explore the correlation between the sleep characteristic and various clinical indicators, thereby improving sleep condition to improve the patient’s symptoms, and then improve the quality of life, provide the basis for the targeted community mental health services.Methods: 1. Objectives:Community-dwelling schizophrenia patients who were diagnosised by DSM-Ⅳ and can be defined by MINI(MINI, international neuropsychiatric interview). And they must live in Guangzhou Yuexiu district.2. Survey method:continuous cross-sectional sampling, face to face interview.3. Survey tools:self-rating scale:(including QIDS-SR,SLEEP,SUICEDE,SF-12); His rating scale (including demographic data, alcohol and tobacco use questionnaire, medical condition, drug, BPRS, MADRS, SAS, ITAQ, MINI etc.); height and weight apparatus and measuring tape.4. The proposed statistical methods:Using Epidata3.1for data entry and management, using SPSS19.0package for data statistical description and analysis. Use mean±standard deviation (x±s) to indicate measurement data, use independent t-test and paired sample t-test to comparing the measurement data to understand if they have insomnia or not. Count data expressed in frequency (constituent ratio), Pearson chi-square test can be used to compare the enumeration data between those two groups (insomnia or not). Independent influence factors for insomnia using multiariable Logistic regression analysis. P<0.05is considered as there has a significant difference.Results:1. The general demographic information and clinical features of our samplesThere are623valid questionnaires in our survey.349(54.7%) of them are men, and282of them were women (45.3%), For all of our patients, the mean age was (47.68±10.34)y, mean actual sleep time was (8.25±2.12) h, mean education time was (10.31±2.92) y, mean onset age was (25.68±9.57)y, mean hospitalization number was(2.21±2.62), and there are402(64.5%) were unmarried,216people (34.7%) were unemployed,54(8.7%) solitary man, BPRStotal (26.81±8.66), the current drinkers52(8.3%), current smokers149(24.0%),162(26.0%) have family history of mental disease,44(7%) had made violence behavior,238persons were combinding with other diseases (38.2%), mean waist circumference was (89.41±11.29) cm, mean BMI (24.62±4.96)kg/m2, according to BMI, the proportion of overweight and obesity were33.23%,19.10%respectively. According to their waist circumference, there are77.05%of patients reached the centrality obesity diagnostic criteria, and women patients with obesity is more common. There are232(37.2%) patients using typical antipsychotics drugs,380(61.0%) patients using atypical antipsychotics drugs, and142(22.8%) patients using benzodiazepines drugs.2. Sleep statusThe community patients with schizophrenia’s mean actual sleep time is (8.25±2.12) h, mean expected sleep time is (8.89±1.81) h, and the actual sleep time is significant longer than the actual sleep time. The proportion of DIS, DMS,EMA were20.5%,19.6%,17.7%, and the probability of at least one kind of sleep disorders was28.9%. The percentage of short sleepers, medium sleepers and long sleepers were18.1%,38.4%,43.5%, and there are no significant difference between3types of sleep disorders or2groups of sleep duration group.3. General data comparison between insomnia group and good sleep group.Insomnia patients’mean age, percentage of smoking, percentage of benzodiazepines drug using, percentage of sedative hypnotics using, score of MARDStotai, score of BPRStotal, score of BPRS positive, score of BPRS negative, score of BPRSanxiety, score of QIDStotal are all higher than good sleep group patients’. Percentage of SGA using, education time, mean waist, mean BMI, score of SF-12psychology, actual sleep time were lower than good sleep group patients’.4. Multiple logistic regression for insomniaIt is more prone to get insomnia if the patient is older or has a higher QIDS score.Conclusion:This study shows that the mean actual total sleep time in community-dwelling schizophrenia patients is longer than the general population’s. But there still have much patients with insomnia. And those insomnia ones have severe psychotic symptoms. And the study told us that we should pay more attention to insomnia no matter the patient is in clinical stability or not. What’s more, more attention should be paid to those who are older, have severe psychotic symptoms, obvious obesity, showing more anxiety and depression. Patients with schizophrenia have a high rate of obestiy, this problem should also be given sufficient attention. |
