胚胎移植女性孕早期睡眠质量及关联因素分析OACSTPCD
Sleep quality and associated factors during early pregnancy after embryo transfer
背景 胚胎移植女性经受了身体和心理的双重挑战,孕早期的生活质量,尤其是睡眠质量会受到较大的影响.目的 分析胚胎移植女性孕早期睡眠质量及相关影响因素.方法 选取 2022年 6-12月于河北医科大学第二医院生殖医学科进行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)助孕成功的患者,在其移植后 45d返院复查B超时进行问卷调查,调查内容包括匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、中文简化版心理弹性量表(Connor Davidson resilience scale,CD-RISC)和社会支持评定量表.以PSQI>7分为判断睡眠障碍的标准,通过多因素Logistic回归模型分析睡眠质量与各个影响因素的关系,并使用信息增益算法对影响睡眠质量的主要因素进行影响程度评估.结果 发放问卷 336份,回收325份,回收率 96.7%.325例IVF-ET孕妇年龄(32.46±4.52)岁,睡眠质量总分为(7.79±3.63)分,其中 126例孕妇总分≤7分为睡眠正常组,199例孕妇总分>7分为睡眠障碍组(61.23%,199/325).相关心理学评估:焦虑自评量表(43.75±8.86)分;抑郁自评量表(50.89±10.54)分;心理弹性量表总分(64.18±11.34),其中坚韧性(32.66±10.28)分,力量性(21.75±6.37)分,乐观性(9.74±3.26)分;社会支持评定量表总分为(42.27±4.93)分,其中客观支持(9.15±2.13)分,主观支持(25.30±4.26)分,对支持的利用度(7.82±1.91)分.Logistic回归结果提示,年龄越大、越焦虑,越容易出现睡眠障碍;文化程度中,以初中及以下人群作为参照,高中或中专学历的人群更不容易出现睡眠障碍;心理弹性水平越高,睡眠障碍出现概率越低(P均<0.05).信息增益分析结果显示,影响睡眠质量的因素按影响力大小依次为心理弹性中的坚韧性(1.186)、社会支持量表中的主观支持分(0.807)、心理弹性量表中的力量性(0.806)、心理弹性量表中的乐观性(0.510)、社会支持量表中的对支持的利用度(0.422)、文化程度(0.419)、客观支持分(0.391)、职业(0.216)、婆媳关系(0.213)、SAS(0.192)、SDS(0.162)、第几次移植(0.146)、年龄(0.117)、第几次取卵(0.108)、社会支持总分(0.107)、现有子女个数(0.088)、月收入(0.082)、夫妻关系(0.051)、居住地(0.035).结论 胚胎移植女性在孕早期睡眠质量较差;患者的不良心理状态对睡眠有负面影响,而心理弹性和社会支持对睡眠质量则起到了积极的正面影响,临床可以从改善患者心理弹性状态、增加社会支持方向入手,帮助IVF-ET孕妇从孕早期开始改善睡眠质量,从而提高生活质量,保证母婴健康.
Background Women undergoing embryo transfer have experienced both physical and psychological challenges,and their quality of life in the first trimester of pregnancy,especially their sleep quality,has been greatly affected.Objective To analyze the sleep quality and related factors of embryo transfer(ET)female in early pregnancy.Methods Patients with successful IVF-ET assisted pregnancy in the Reproductive Medicine Department of the Second Hospital of Hebei Medical University from June to December in 2022 were selected,and a questionnaire survey was conducted when they returned to the hospital 45 days after transplantation for re-examination B-ultrasound.The investigation included Pittsburgh Sleep Quality Index(PSQI),Self Rating Anxiety Scale(SAS),Self Rating Depression Scale(SDS),Simplified Chinese version of the Psychological Resilience Scale(CD-RISC),and Social Support Rating Scale were applied.PSQI>7 was used as the criterion to diagnose sleep disorders.The relationship between sleep quality and various influencing factors was analyzed by multivariate Logistic regression model,and the influence degree of major factors affecting sleep quality was evaluated by using information gain algorithm.Results Totally 336 questionnaires were sent out and 325 were collected,with a recovery rate of 96.7%.The age of 325 IVF-ET pregnant women was(32.46±4.52)years.The participants achieved a score of(43.75±8.86)on the SAS,(50.89±10.54)on the SDS.The total score of mental resilience scale on the psychological resilience scale was(64.18±11.34),with subscore of(32.66±10.28)for tenacity,(21.75±6.37)for strength,and(9.74±3.26)for optimism.The total score on the social support rating scale was(42.27±4.93),which included an objective support subscore of(9.15±2.13),a subjective support subscore of(25.30±4.26),and a subscore for utilization of support of(7.82±1.91).Logistic regression results suggested that older age and higher levels of anxiety were associated with a greater likelihood of experiencing sleep disorders.Compared to individuals with a junior high school education or below,those with a senior high school or vocational high school education were less likely to experience sleep disorders;higher levels of psychological resilience were associated with fewer occurrence of sleep disorders(P<0.05).The results of information gain analysis showed that the factors affecting sleep quality were as follows:toughness in the mental resilience scale(1.186),subjective support score in the social support scale(0.807),strength in the mental resilience scale(0.806),optimism in the mental resilience scale(0.510),utilization of support in the social support scale(0.422),literacy level(0.419),objective support score(0.391),occupation(0.216),relationship between mother-in-law and daughter-in-law(0.213),SAS(0.192),SDS(0.162),number of transplants(0.146),age(0.117),number of egg retrieval(0.108),total social support(0.107),number of existing children(0.088),monthly income(0.082),marital relationship(0.051),residence(0.035).Conclusion The sleep quality of embryo transfer women is poor in early pregnancy.Patients'bad mental state has a negative impact on sleep,while mental resilience and social support have positive impact on sleep quality.Clinical studies can start with improving patients'mental resilience and increasing their social support,so as to find means to improve patients'sleep quality and thus improving their quality of life.
万芳芳;高源;张杰;李爱民;范艳丽;管延彧;刘玲
河北医科大学第二医院生殖医学科,河北省出生缺陷临床医学研究中心,河北省不孕不育与遗传重点实验室,河北石家庄 050000北京航空航天大学,北京 100083解放军总医院第三医学中心妇产科,北京 100039
临床医学
体外受精-胚胎移植孕妇睡眠质量心理弹性社会支持焦虑抑郁信息增益调查研究
in vitro fertilization-embryo transferpregnant womensleep qualitymental resiliencesocial supportself-rating anxiety scaleself-rating depression scaleinformation gain
《解放军医学院学报》 2024 (007)
724-730,745 / 8
河北省省级科技计划(21377720D)
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