Relationship Between Insomnia Symptoms And Metabolic Syndrome In Patients With Severe Psychiatric Disorders

BackgroundPsychiatric disorders are common,affecting as high as 10.7%adults globally.Insomnia and metabolic syndrome(Met S)have been reported as high as 30%-90%and 32.6%in patients with psychiatric disorders,respectively.Studies have reported that insomnia is related with an increased odds for Met S.However,the relationship between insomnia and Met S in patients with severe psychiatric disorders remains unclear.We hypothesized that insomnia is independent risk factor for Met S in patients with severe psychiatric disorders.ObjectiveTo evaluate sleep characteristics and metabolism related indicators in patients with severe psychiatric disorders,and to examine the relationship between insomnia symptoms and Met S in patients with severe psychiatric disorders.MethodsThe study was approved by the Research Ethics Board of Shantou University Mental Health Center and informed consent was obtained from all participants.Inclusion criteria were 1)age≥18 years,2)diagnoses with severe psychiatric disorders were based on the International Classification of Diseases,10th Edition code,3)under rather stabilized disease state[total score of Brief Psychiatric Rating Scale lower than 35],and 4)with adequate level of communication.Exclusion criteria were 1)refusal to participate in this study,2)intellectual disability,dementia or other significant cognitive impairment.Finally,a total of 272 patients were consecutively admitted from the Inpatient Department of Shantou University Mental Health Center.The demographic data,physical measurement indexes and clinical history were collected.Pittsburgh Sleep Quality Index(PSQI)was used to assess insomnia symptoms.The total scores of PSQI>7 was used to define insomnia symptoms.The diagnosis of Met S was defined according to the new International Diabetes Federation definition.Insulin resistance was assessed by homeostasis model assessment of insulin resistance(HOMA-IR).Insulin resistance was defined as HOMA-IR>1.4(the median value of the included subjects).Independent t-test,Mann-Whitney U test for continuous variables respectively,andχ2 test for categorical variables were used to examine demographic and clinical characteristics and sleep and metabolic characteristics between groups.Multiple logistic regression models was used to analyze the risk factors associated with Met S in patients with insomnia symptoms.SPSS 22.0was used for statistical analysis.Results1、A total of 272 inpatients with severe psychiatric disorders were included.In our sample,the median age was 32.00(25.00,40.00)years old,183(67.3%)were males and the body mass index was 22.30(19.47,25.01)kg/m~2.2、Patients with insomnia symptoms had significantly higher percentage of Met S(23.4%vs.12.4%,P=0.019)and hypertriglyceridemia(30.9%vs.19.1%,P=0.029),and higher levels of fasting insulin(P=0.050),HOMA-IR(P=0.055)and percentage of insulin resistance(P=0.086)compared to those without insomnia symptoms.3、Patients with Met S had significantly higher percentage of insomnia symptoms(50.0%vs.31.6%,P=0.019),and higher PSQI scores compared to those without Met S.4、Multiple logistic regressions showed that patients with insomnia symptoms had significantly higher odds for Mets[odds ratio(OR)=2.99,95%confidence interval(CI)=1.25-7.14,P=0.014],central obesity(OR=3.02,95%CI=1.18-7.76,P=0.022),hypertriglyceridemia(OR=2.46,95%CI=1.28-4.76,P=0.007)and higher odds for insulin resistance(OR=1.68,95%CI=0.93-3.02,P=0.084)after controlling for potential confounders.Conclusions1、Patients with insomnia symptoms had 3-fold higher odds for Met S compared to those without insomnia symptoms in patients with severe psychiatric disorders.2、Patients with insomnia symptoms had 3-fold higher odds for central obesity compared to those without insomnia symptoms in patients with severe psychiatric disorders.3、Patients with insomnia symptoms had 2.5-fold higher odds for hypertriglyceridemia compared to those without insomnia symptoms in patients with severe psychiatric disorders.4、Early screening and treatment of insomnia symptoms is of positive significance to prevent and improve the metabolic problems in patients with severe psychiatric disorders.