摘要
目的观察有氧运动训练联合认知行为疗法对睡眠障碍并血压正常高值患者血压、运动耐量及睡眠质量的影响。方法前瞻性选取温州医科大学第三附属医院(瑞安市人民医院)在2022年2月至2024年2月进行社区居民健康筛查者, 共纳入60例睡眠障碍合并血压正常高值患者, 采用随机数字表法分为两组, 认知组和联合组各30例。认知组采用认知行为疗法干预, 联合组采用有氧运动训练联合认知行为疗法干预。比较两组患者血压变化情况、杓型血压比例、运动耐量、匹兹堡睡眠质量指数量表(PSQI)评分变化, 统计两组睡眠障碍总有效率。结果干预前, 认知组与联合组血压差异无统计学意义(P > 0.05)。干预后, 认知组和联合组24 h平均收缩压(24hMSBP)[(121.63±3.47)mmHg(1 mmHg=0.133 kPa)和(114.56±3.07)mmHg]和舒张压(24hMDBP)[(81.03±2.78)mmHg和(77.59±2.09)mmHg]均较干预前降低(t=10.54、17.52、5.52、10.68, 均P < 0.05), 且联合组较认知组降低更明显(t=8.36、5.41, 均P < 0.001)。干预前, 认知组与联合组杓型血压比例比较, 差异无统计学意义(P > 0.05);干预后, 认知组与联合组杓型血压比例分别为40.00%(12/30)和66.67%(20/30), 均较干预前升高(χ^(2)=4.02、11.38, 均P < 0.05), 且联合组较认知组更高(χ^(2)=4.28, P < 0.05)。干预前, 认知组与联合组运动耐量比较, 差异无统计学意义(P > 0.05);干预后, 联合组无氧阈值[(1 475.25±415.65)mL/min]、氧脉搏[(14.78±2.86)mL/次]均较干预前明显升高(t=3.58、7.49, 均P < 0.05), 而通气代偿点时的二氧化碳通气当量(VE/VCO_(2)@VCP)与干预前差异无统计学意义(P > 0.05), 且干预后联合组无氧阈值、氧脉搏较认知组[(1 137.41±349.86)mL/min和(9.94±2.05)mL/次]更高(t=-3.40、-7.53, 均P < 0.05);认知组干预前后运动耐量比较, 差异无统计学意义(P > 0.05)。干预前, 认知组与联合组PSQI评分比较, 差异无统计学意义(P > 0.05);干预后, 认知组与联合组睡眠质量[(1.65±0.26)分和(1.24±0.23)分]、入睡时间[(1.51±0.19)分和(1.33±0.18)分]、睡眠时间[(1.47±0.23)分和(1.31±0.20)分]、睡眠效率[(1.31±0.20)分和(1.05±0.19)分]、睡眠障碍[(0.93±0.15)分和(0.77±0.20)分]、催眠药物评分[(0.96±0.22)分和(0.67±0.17)分]、日间功能评分[(1.19±0.25)分和(1.02±0.22)分]等7个维度评分均较干预前降低(t=8.21、15.58、9.86、14.76、10.02、15.36、8.78、17.59、7.84、12.36、5.74、11.98、12.03、17.14, 均P < 0.05), 且联合组PSQI评分较认知组更低(t=6.46、3.76、2.87、5.16、3.50、5.71、2.79, 均P < 0.05)。联合组睡眠障碍总有效率为86.67%(26/30)高于认知组的63.33%(19/30)(χ^(2)=4.35, P < 0.05)。结论有氧运动训练联合认知行为疗法可提高睡眠障碍合并血压正常高值患者运动耐量, 降低血压, 提高睡眠质量。
Objective:To investigate the effects of aerobic exercise training combined with cognitive behavioral therapy on blood pressure,exercise tolerance,and sleep quality in patients with sleep disorders complicated by high-normal blood pressure.Methods:A total of 60 individuals with sleep disorders complicated by high-normal blood pressure,who underwent community health screening and received treatment at the Third Affiliated Hospital of Wenzhou Medical University(Ruian People's Hospital)from February 2022 to February 2024,were prospectively included in this study.The patients were randomly assigned to two groups using a random number table:a cognitive therapy group and a combined intervention group,with 30 patients in each group.The cognitive therapy group received cognitive behavioral therapy,while the combined intervention group received both aerobic exercise training and cognitive behavioral therapy.Changes in blood pressure,the proportion of patients with elevated blood pressure,exercise tolerance,and Pittsburgh Sleep Quality Index(PSQI)score were compared between the two groups.Additionally,the overall effective rate of treatment for sleep disorders was evaluated for both groups.Results:Before intervention,there was no statistically significant difference in blood pressure between cognitive therapy and combined intervention groups(P>0.05).After intervention,the 24-hour mean systolic blood pressure was(121.63±3.47)mmHg(1 mmHg=0.133 kPa)for the cognitive therapy group and(114.56±3.07)mmHg for the combined intervention group.The 24-hour mean diastolic blood pressure was(81.03±2.78)mmHg for the cognitive therapy group and(77.59±2.09)mmHg for the combined intervention group.Both the 24-hour mean systolic and diastolic blood pressures in each group significantly decreased when compared with the values recorded before intervention(t=10.54,17.52,5.52,10.68,all P<0.05).After intervention,both the 24-hour mean systolic and diastolic blood pressures in the combined intervention group were significantly lower than those in the cognitive therapy group(t=8.36,5.41,both P<0.001).Before intervention,there was no statistically significant difference in the proportion of patients with elevated blood pressure between the two groups(P>0.05).After intervention,the proportion of patients with elevated blood pressure was 40.00%(12/30)in the cognitive therapy group and 66.67%(20/30)in the combined group.Both groups showed a significant increase in the proportion of patients with elevated blood pressure compared with pre-intervention values(χ^(2)=4.02,11.38,both P<0.05).After intervention,the proportion of patients with elevated blood pressure in the combined intervention group was significantly higher than that in the cognitive therapy group(χ^(2)=4.28,P<0.05).Before intervention,there was no significant difference in exercise tolerance between the two groups(P>0.05).After intervention,the combined intervention group showed significant increases in anaerobic threshold[(1475.25±415.65)mL/min]and oxygen pulse[(14.78±2.86)mL/beat]compared with pre-intervention values(t=3.58,7.49,both P<0.05).However,there was no significant difference in the carbon dioxide ventilation equivalent(VE/VCO_(2)@VCP)at the ventilatory compensation point compared with pre-intervention levels(P>0.05).After intervention,the anaerobic threshold and oxygen pulse in the combined intervention group were significantly higher than those in the cognitive therapy group[(1137.41±349.86)mL/min,(9.94±2.05)mL/beat](t=-3.40,-7.53,both P<0.05).There was no significant difference in exercise tolerance in the cognitive therapy group between pre-and post-intervention(P>0.05).Before intervention,there was no significant difference in PSQI score between cognitive therapy and combined intervention groups(P>0.05).After intervention,score for sleep quality[(1.65±0.26)points,(1.24±0.23)points],sleep onset time[(1.51±0.19)points,(1.33±0.18)points],sleep time[(1.47±0.23)points,(1.31±0.20)points],sleep efficiency[(1.31±0.20)points,(1.05±0.19)points],sleep disturbance[(0.93±0.15)points,(0.77±0.20)points],hypnotic medication use[(0.96±0.22)points,(0.67±0.17)points],and daytime function[(1.19±0.25)points,(1.02±0.22)points]decreased in both groups compared with pre-intervention scores(t=8.21,15.58,9.86,14.76,10.02,15.36,8.78,17.59,7.84,12.36,5.74,11.98,12.03,17.14,all P<0.05).After intervention,PSQI score in the combined intervention group was significantly lower than that in the cognitive therapy group(t=6.46,3.76,2.87,5.16,3.50,5.71,2.79,all P<0.05).The total effective rate for treating sleep disorders in the combined intervention group was 86.67%(26/30),which was significantly higher than that in the cognitive therapy group[63.33%(19/30),χ^(2)=4.35,P<0.05].Conclusions:Aerobic exercise training combined with cognitive behavioral therapy can improve exercise tolerance,reduce blood pressure,and enhance sleep quality in patients with sleep disorders and high-normal blood pressure.
作者
潘嘉西
张云瑞
孔繁奇
Pan Jiaxi;Zhang Yunrui;Kong Fanqi(Department of Cardiovascular Medicine,Third Afiliated Hospital of Wenzhou Medical University(Ruian People's Hospital),Ruian 325200,Zhejiang Province,China)
出处
《中国基层医药》
2025年第2期214-221,共8页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省温州市医药卫生科研项目(2022009)。
关键词
入睡和睡眠障碍
运动疗法
认知疗法
高血压前期
运动耐量
Sleep initiation and maintenance disorders
Exercise therapy
Cognitive therapy
Prehypertension
Exercisetolerance
