| Objective: To investigate the sleep quality of elderly patients with hypertension in the community,analyze its influencing factors and intervene using cognitive behavioral therapy,so as to help the elderly patients with hypertension in the community rebuild reasonable sleep attitude and belief,improve the sleep quality of the elderly patients with hypertension,and provide a clinical basis for improving the sleep quality of the elderly patients with hypertension in the community.Methods: In the first part,an investigation was performed.A total of 300 elderly patients with hypertension in a community health service center of Nanning were investigated using the general data questionnaire,Pittsburgh Sleep Quality Index(PSQI)and Dysfunctional Beliefs and Attitudes about Sleep Scale(DBAS),to understand the sleep quality,sleep belief and attitude of the elderly patients with hypertension in this community,and to analyze its influencing factors.In the second part,an interventional study was carried out.Eighty elderly patients with hypertension meeting the inclusion criteria were selected from the subjects in the investigation and randomly divided into control group and intervention group,with 40 patients in each group.The control group received routine community nursing,while the intervention group was intervened with cognitive behavioral therapy on the basis of the control group for 8 weeks.PSQI score,DBAS score and blood pressure were recorded and compared before intervention,4 and 8 weeks after intervention, to evaluate the intervention effect.The data were analyzed using SPSS19.0,and P < 0.05 was considered as statistically significant.Results: 1.The sleep quality of the elderly patients with hypertension in the community: the proportion of patients with PSQI score > 7 was 52.66%(n =158).The total score of DBAS and the score of its four dimensions in the sleep disorder group(PSQI score > 7)were all lower than those in the non-sleep disorder group(P < 0.05).2.Multivariate logistic regression analysis showed that gender,age,exercise frequency and sleep belief and attitude were the influencing factors of sleep quality in the elderly patients with hypertension in the community.Pearson correlation analysis demonstrated strong negative correlations of PSQI score with total DBAS score,anxiety and despair about insomnia and unrealistic expectation of sleep(P < 0.05).3.Comparison of total PSQI score and scores of all dimensions:statistical differences were found in time of falling asleep,sleep time,sleep efficiency,sleep quality,daytime function and total score between the two groups at the 8th week after intervention.In the control group,only the score of daytime function decreased compared with that before intervention(P <0.05).In the intervention group,the total score and the score of each dimension all decreased significantly compared with those before intervention(P < 0.05),and the decreasing trend in the intervention group was more obvious than that in the control group.4.Comparison in total DBAS score and the score of each dimension: the differences in all indexes between the two groups were statistically significant at the 8th week after intervention(P< 0.05).At the 8th week after intervention,all indexes in the intervention group were higher than those before intervention(P < 0.05),and the increasing trend in the intervention group was more significant than that in the control group.5.Blood pressure: the systolic pressure and diastolic pressure in the intervention group were lower than those in the control group at the 8th week after intervention,with statistically significant differences(P < 0.05).The decreasing trend of blood pressure in the intervention group was more obvious than that in the control group.6.Comparison in total efficiency of PSQI: the total effective rate was 52.63% in the control group and 78.37% in the intervention group,with a statistically significant difference.Conclusions: 1.The elderly patients with hypertension in the community suffer from sleep disorders.Their sleep quality is influenced by sleep belief and attitude,gender,age and exercise frequency.A strong negative correlation is found between sleep quality and sleep belief and attitude.2.Routine community nursing combined with cognitive behavioral therapy is superior to routine community nursing alone in improving sleep belief and attitude,enhancing sleep quality and reducing blood pressure of elderly patients with hypertension in the community.Therefore,it is worth promoting in the community. |
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