Associations between pain, objective sleep efficiency and cognition in patients with implantable cardioverter defibrillators.
Associations between pain, objective sleep efficiency and cognition in patients with implantable cardioverter defibrillators.
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DOI：
10.1016/j.sleep.2020.03.029
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发表时间：
2020-08
期刊：
影响因子：
4.8
通讯作者：
McCrae CS
中科院分区：
文献类型：
--
作者：
Curtis AF;Roth AJ;Sears SF;Conti JB;Berry RB;Dzierzewski JM;McCrae CS
植入式心律转复除颤器（ICD）患者经常出现睡眠障碍。先前研究表明，这些患者的客观（活动记录仪监测的）睡眠与认知之间存在关联，但疼痛是否会影响睡眠碎片化指标（如睡眠效率，SE）与认知之间的关联尚不明确。本研究探讨了ICD患者中客观睡眠效率与疼痛对认知表现的独立及交互关联。
37名有自我报告睡眠障碍的ICD患者（平均年龄60.0岁，标准差12.4）完成了为期14天的活动记录仪监测。计算平均睡眠效率[（平均总睡眠时间/平均卧床时间）×100%]。患者完成了简明健康调查问卷（Short Form 36 Health Survey）的疼痛部分，以及测量执行功能（字母序列、n - 回溯任务）、持续注意力/处理速度（符号数字模式测试，SDMT）和简单反应时间的计算机化任务。多元线性回归分析用于检验睡眠效率是否独立预测或与疼痛评分相互作用以预测认知表现。
睡眠效率与疼痛相互作用可预测SDMT表现，解释了12%的独特变异。在报告疼痛更严重的患者中，较高的睡眠效率与更好的SDMT表现相关。在疼痛程度为中等或较轻的患者中，未观察到SDMT上有类似的关联模式。睡眠效率和疼痛评分均不能独立预测SDMT表现。其他认知任务的表现与任何预测因素均无关联。
较高的睡眠效率可能在改善ICD且自感疼痛严重患者的持续注意力/处理速度方面发挥重要作用。未来研究应考察旨在改善睡眠碎片化的干预措施是否对较低层次的认知有益，尤其是在疼痛更严重的患者中。
Patients with implantable cardioverter defibrillators (ICDs) frequently experience sleep disruption. Prior work shows associations between objective (actigraphic) sleep and cognition in these patients, but whether pain affects associations between measures of sleep fragmentation (e.g., sleep efficiency, SE) and cognition is unknown. The present study examined independent and interactive associations between objective SE and pain on cognitive performance in patients with ICDs. Thirty-seven patients with ICDs (Mage=60.0, SD=12.4) and self-reported sleep disturbance completed 14 days of actigraphy. Average SE was computed [(average total sleep time/average time in bed)x100%]. Patients completed the Short Form 36 Health Survey pain section, and computerized tasks measuring executive functioning (letter series, n-back task), sustained attention/processing speed (symbol digit modalities test, SDMT), and simple reaction time. Multiple linear regressions examined whether SE independently predicted or interacted with pain ratings to predict cognitive performance. SE interacted with pain to predict SDMT performance, accounting for 12% unique variance. In patients reporting worse pain, higher SE was associated with better SDMT performance. Similar patterns of association on SDMT were not observed in patients with average or low pain. SE and pain ratings did not independently predict SDMT performance. Performance on other cognitive tasks was not associated with any predictors. Better sleep efficiency may play an important role in improving sustained attention/processing speed in patients with ICDs and perceived severe pain. Future research should examine whether interventions aimed at improving sleep fragmentation provide benefit to lower order cognition, particularly in patients with worse pain.
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