慢性失眠患者血清IGF-1、ZO-1、claudin-5水平及对睡眠质量的影响和对合并认知功能障碍的诊断价值OA

Objective To investigate the serum levels of insulin-like growth factor-1(IGF-1),tight junc-tion protein-1(ZO-1),and integrated membrane protein-5(claudin-5)in patients with chronic insomnia disor-der and their effects on sleep quality and their diagnostic value for cognitive impairment.Methods A total of 98 patients with chronic insomnia admitted to the hospital from January 2023 to October 2024 were selected as the observation group and divided into the mild group,the moderate group and the severe group according to the severity of insomnia.According to the presence or absence of cognitive function,the patients were divided into the uncombined group and the combined group.In addition,98 healthy people who underwent physical ex-amination in the hospital during the same period were selected as the control group.The sleep structure of all subjects was monitored by polysomnography,including sleep latency,total sleep time,wake-up times,awake time after sleep onset,and sleep efficiency.Enzyme-linked immunosorbent assay was used to detect the serum levels of IGF-1,ZO-1 and claudin-5 in all subjects.Spearman correlation was used to analyze the correlation between serum IGF-1,ZO-1,claudin-5 levels and the severity of insomnia in patients with chronic insomnia.Pearson correlation was used to analyze the correlation of serum IGF-1,ZO-1,claudin-5 levels with sleep structure and Montreal cognitive assessment(MoCA)scores in patients with chronic insomnia.Multivariate Logistic regression was used to analyze the influencing factors of cognitive impairment in patients with chronic insomnia.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum IGF-1,ZO-1 and claudin-5 alone and in combination for cognitive impairment in patients with chronic insomnia.Results The sleep latency and wake time after falling asleep in the observation group were longer than those in the control group,the number of wake up was more than that in the control group,the total sleep time was shorter than that in the control group,the sleep efficiency,MoCA score,and the serum levels of IGF-1,ZO-1 and claudin-5 were lower than those in the control group,and the differences were statistically significant(P<0.05).Compared with the mild group,the moderate and severe groups had longer sleep laten-cy and wakefulness time after sleep onset,more wakefulness times,shorter total sleep time,lower sleep effi-ciency,MoCA score,and serum levels of IGF-1,ZO-1 and claudin-5,and the differences were statistically sig-nificant(P<0.05),the severe group had longer sleep latency and wakefulness time after sleep onset than the moderate group,and the moderate group had more wake-up times,shorter total sleep time,and lower sleep ef-ficiency,MoCA score,and serum levels of IGF-1,ZO-1,and claudin-5,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that the serum levels of IGF-1,ZO-1,and clau-din-5 in patients with chronic insomnia were negatively correlated with the severity of insomnia(P<0.05).Pearson correlation analysis showed that the serum levels of IGF-1,ZO-1,and claudin-5 in patients with chro-nic insomnia were negatively correlated with sleep latency,wake-up times,and wake-up time after sleep onset(P<0.05),and positively correlated with total sleep time,sleep efficiency,and MoCA score(P<0.05).The serum levels of IGF-1,ZO-1,and claudin-5 in the combined group were lower than those in the non-combined group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the increased serum levels of IGF-1,ZO-1 and claudin-5 were protective factors for cognitive im-pairment in patients with chronic insomnia(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum IGF-1,ZO-1,and claudin-5 alone and in combination for predicting cognitive impair-ment in patients with chronic insomnia were 0.784,0.778,0.776,and 0.909,respectively.The AUC of the combination of the three factors in diagnosing cognitive dysfunction in patients with chronic insomnia was greater than the AUC of serum IGF-1(Z=2.025,P=0.043),ZO-1(Z=2.099,P=0.036),and claudin-5(Z=2.121,P=0.034)alone.Conclusion The serum levels of IGF-1,ZO-1 and claudin-5 are decreased in patients with chronic insomnia,and the three indicators are related to poor sleep quality and cognitive dysfunc-tion.The combined detection of serum IGF-1,ZO-1 and claudin-5 can effectively improve the diagnostic value of chronic insomnia patients with cognitive dysfunction.