Correlations of Cognitive Function with Insomnia Severity, Serum Levels of 25-hydroxy Vitamin D3 and Tumor Necrosis Factor-α in Elderly Patients with Chronic Insomnia

doi:10.12114/j.issn.1007-9572.2023.0291

Abstract

Abstract:

Background

As one of the most common diseases in the elderly, chronic insomnia is often accompanied by cognitive impairment and seriously affects the quality of life of the elderly. The biological mechanism of cognitive impairment in elderly patients with chronic insomnia still remains unclear.

Objective

To investigate the correlation of cognitive function with insomnia severity, serum 25-hydroxy vitamin D₃ [25 (OH) D₃], tumor necrosis factor-α (TNF-α) in elderly patients with chronic insomnia.

Methods

A total of 105 elderly patients with chronic insomnia in the 901th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2020 to June 2022 were selected as the research subjects. Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7) were tested before enrollment. The patients were divided into 32 cases in the mild insomnia group, 38 cases in the moderate insomnia group and 35 cases in the severe insomnia group according to the PSQI score. Photoplethysmography (PPG) was used to assess the objective sleep quality of patients, monitor the total sleep time, sleep latency, sleep efficiency and arousal times; the cognitive function of patients was evaluated by Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Serum levels of 25 (OH) D₃ and TNF-α were detected by enzyme-linked immunosorbent assay.

Results

The sleep latency, arousal times and the level of TNF-α in the severe insomnia group were higher than those in the mild and moderate insomnia groups, with lower total sleep time in the severe insomnia group compared to the mild insomnia group and lower sleep efficiency compared to the mild and moderate insomnia groups (P<0.05) ; sleep latency in the moderate insomnia group was higher than that in the mild insomnia group, with lower sleep efficiency compared to the mild insomnia group (P<0.05). MMSE and MoCA scores were lower in the severe insomnia group than the mild insomnia and moderate insomnia groups, and lower in the moderate insomnia group than the mild insomnia group (P<0.05). Serum TNF-α level was higher and 25 (OH) D₃ level was lower in the severe insomnia group than the mild and moderate insomnia groups (P<0.05) ; serum TNF-α level was higher in the moderate insomnia group than the mild insomnia group, and 25 (OH) D₃ level was lower than the mild insomnia group (P<0.05). Spearman correlation analysis results showed that MMSE and MoCA scores were positively correlated with total sleep time, sleep efficiency and 25 (OH) D₃ level (P<0.05), and negatively correlated with insomnia severity, sleep latency, arousal times and TNF-α level (P<0.05) .

Conclusion

Cognitive impairment in elderly patients with chronic insomnia may be associated with insomnia severity, reduced serum 25 (OH) D₃ level and elevated TNF-α level.

Key words: Sleep initiation and maintenance disorders, Aged, Cognition, 25 (OH) D₃, Tumor necrosis factor-alpha

摘要：

背景

慢性失眠是老年人群常见的疾病之一，常伴有不同程度的认知功能损害，严重影响老年人生活质量，而关于老年慢性失眠患者认知功能损害的生物学机制尚不明确。

目的

探讨老年慢性失眠患者认知功能与失眠严重程度、血清25-羟维生素D₃[25（OH）D₃]及肿瘤坏死因子α（TNF-α）水平的相关性。

方法

选取2020年6月—2022年6月在中国人民解放军联勤保障部队第九〇一医院诊治的老年慢性失眠患者105例为研究对象，入组前进行匹兹堡睡眠质量指数量表（PSQI）、老年抑郁量表（GDS-15）、广泛性焦虑障碍量表（GAD-7）测试，并根据PSQI评分将患者按照失眠严重程度进行分组，其中轻度失眠组32例、中度失眠组38例、重度失眠组35例。运用光电容积脉搏波描记法（PPG）评估患者客观睡眠质量，监测总睡眠时间、睡眠潜伏期、睡眠效率及觉醒次数；采用简易智能精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估患者的认知功能；运用酶联免疫吸附试验法检测患者血清25（OH）D₃、TNF-α水平。

结果

重度失眠组睡眠潜伏期长于轻度失眠组和中度失眠组，觉醒次数高于轻度失眠组和中度失眠组，总睡眠时间少于轻度失眠组，睡眠效率低于轻度失眠组和中度失眠组；中度失眠组睡眠潜伏期长于轻度失眠组，睡眠效率低于轻度失眠组（P<0.05）。重度失眠组MMSE、MoCA评分均低于轻度失眠组和中度失眠组，中度失眠组MMSE、MoCA评分均低于轻度失眠组（P<0.05）。重度失眠组血清TNF-α水平高于轻度失眠组和中度失眠组，25（OH）D₃水平低于轻度失眠组和中度失眠组（P<0.05）；中度失眠组血清TNF-α水平高于轻度失眠组，25（OH）D₃水平低于轻度失眠组（P<0.05）。Spearman秩相关分析结果显示，MMSE、MoCA评分与总睡眠时间、睡眠效率和25（OH）D₃水平呈正相关（P<0.05），与失眠严重程度、睡眠潜伏期、觉醒次数和TNF-α水平呈负相关（P<0.05）。

结论

老年慢性失眠患者认知功能损害可能与失眠严重程度及血清25（OH）D₃水平降低、TNF-α水平升高有关。

关键词: 入睡和睡眠障碍, 老年人, 认知, 25-羟维生素D₃, 肿瘤坏死因子α

WU Zixing,HU Xin,TAO Shimeng, et al. Correlations of Cognitive Function with Insomnia Severity, Serum Levels of 25-hydroxy Vitamin D₃ and Tumor Necrosis Factor-α in Elderly Patients with Chronic Insomnia[J]. Chinese General Practice, 2024, 27(03): 328-334. DOI: 10.12114/j.issn.1007-9572.2023.0291.
吴子幸,胡欣,陶诗萌等. 老年慢性失眠患者认知功能与失眠严重程度和血清25-羟维生素D₃及肿瘤坏死因子α水平的相关性研究[J]. 中国全科医学, 2024, 27(03): 328-334. DOI: 10.12114/j.issn.1007-9572.2023.0291.

Figures/Tables 5

References 43

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组别	例数	年龄（岁）	性别（男/女）	病程（年）	受教育年限（年）	GDS-15评分（分）	GAD-7评分（分）	PSQI评分（分）
轻度失眠组	32	72.4±5.1	14/18	9.8±4.3	12.0±3.2	6.7±1.8	7.3±1.4	8.3±1.3
中度失眠组	38	72.2±4.5	18/20	10.1±4.5	13.4±3.4	6.9±2.1	7.7±1.8	13.3±1.3^a
重度失眠组	35	73.2±5.0	16/19	10.3±5.0	12.2±3.4	7.1±1.9	7.9±2.1	18.3±1.6^ab
F（χ²）值		0.483	0.092^c	0.174	1.873	0.372	0.925	446.656
P值		0.619	0.955	0.841	0.159	0.691	0.400	<0.001

组别	例数	年龄（岁）	性别（男/女）	病程（年）	受教育年限（年）	GDS-15评分（分）	GAD-7评分（分）	PSQI评分（分）
轻度失眠组	32	72.4±5.1	14/18	9.8±4.3	12.0±3.2	6.7±1.8	7.3±1.4	8.3±1.3
中度失眠组	38	72.2±4.5	18/20	10.1±4.5	13.4±3.4	6.9±2.1	7.7±1.8	13.3±1.3^a
重度失眠组	35	73.2±5.0	16/19	10.3±5.0	12.2±3.4	7.1±1.9	7.9±2.1	18.3±1.6^ab
F（χ²）值		0.483	0.092^c	0.174	1.873	0.372	0.925	446.656
P值		0.619	0.955	0.841	0.159	0.691	0.400	<0.001

组别	例数	总睡眠时间（min）	睡眠潜伏期（min）	睡眠效率（%）	觉醒次数（次）
轻度失眠组	32	375.16±62.45	28.44±10.18	71.25±16.53	9.34±3.31
中度失眠组	38	354.27±78.33	36.53±14.49^a	63.48±13.19^a	11.63±5.05
重度失眠组	35	328.33±65.34^a	45.57±18.96^ab	54.37±10.25^ab	14.37±6.50^ab
F值		3.826	10.829	13.220	7.968
P值		0.025	<0.001	<0.001	0.001

组别	例数	总睡眠时间（min）	睡眠潜伏期（min）	睡眠效率（%）	觉醒次数（次）
轻度失眠组	32	375.16±62.45	28.44±10.18	71.25±16.53	9.34±3.31
中度失眠组	38	354.27±78.33	36.53±14.49^a	63.48±13.19^a	11.63±5.05
重度失眠组	35	328.33±65.34^a	45.57±18.96^ab	54.37±10.25^ab	14.37±6.50^ab
F值		3.826	10.829	13.220	7.968
P值		0.025	<0.001	<0.001	0.001

组别	例数	MMSE评分	MoCA评分
轻度失眠组	32	27.19±1.87	25.91±2.02
中度失眠组	38	25.82±2.15^a	24.47±2.01^a
重度失眠组	35	24.37±1.77^ab	23.11±1.89^ab
F值		17.512	16.711
P值		<0.001	<0.001

Correlations of Cognitive Function with Insomnia Severity, Serum Levels of 25-hydroxy Vitamin D₃ and Tumor Necrosis Factor-α in Elderly Patients with Chronic Insomnia

老年慢性失眠患者认知功能与失眠严重程度和血清25-羟维生素D₃及肿瘤坏死因子α水平的相关性研究

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组别	例数	25（OH）D₃（ng/ml）	TNF-α（pg/ml）
轻度失眠组	32	53.29±16.76	428.63±41.44
中度失眠组	38	41.61±12.33^a	494.38±50.37^a
重度失眠组	35	32.09±10.46^ab	535.82±58.29^ab
F值		21.242	37.752
P值		<0.001	<0.001

指标	MMSE评分		MoCA评分
指标	r_s值	P值	r_s值	P值
失眠严重程度	-0.509	<0.001	-0.522	<0.001
总睡眠时间	0.227	0.020	0.230	0.018
睡眠潜伏期	-0.532	<0.001	-0.536	<0.001
睡眠效率	0.263	0.007	0.258	0.008
觉醒次数	-0.374	<0.001	-0.386	<0.001
25（OH）D₃	0.535	<0.001	0.514	<0.001
TNF-α	-0.495	<0.001	-0.483	<0.001

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