Abstract: Objective: To explore the relationship between sleep quality, psychological status, and symptom severity in patients with atrial fibrillation, and to provide evidence for symptom management in these patients. Methods: A total of 208 hospitalized patients with atrial fibrillation were selected from the cardiology department. Data were collected using a general information questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Mental Health Inventory-5 (MHI-5), and the Atrial Fibrillation Severity Scale (AFSS). Mediation effects were analyzed using AMOS 23.0, with hypothesis models estimated by maximum likelihood and tested for significance through Bootstrap. Results: The mean PSQI score was 8.76± 3.98, the mean MHI-5 score was 73.29±16.24, and the mean symptom severity score was 9.06±4.81. Sleep quality scores were positively correlated with symptom severity (r=0.223, P<0.01), while negatively correlated with psychological status (r=-0.221, P<0.01). Psychological status was negatively correlated with symptom severity (r=-0.272, P<0.01). The direct effect of sleep quality on psychological status was-0.22 (-0.38,-0.05), the direct effect of psychological status on symptom severity was-0.28 (-0.45,-0.12), and the indirect effect of sleep quality on symptom severity was 0.06 (0.02, 0.14). Conclusion: Psychological status fully mediates the relationship between sleep quality and symptom severity in patients with atrial fibrillation. Symptom management strategies for atrial fibrillation should incorporate sleep management and psychological care to reduce the impact of symptoms and enhance quality of life.

Key words: Atrial fibrillation, Sleep quality, Psychological status, Symptoms, Structural equation model

摘要： 目的：探讨心房颤动患者睡眠质量、心理状况与症状严重程度的关系，为心房颤动患者的症状管理提供依据。 方法：选取心内科住院的208例心房颤动患者，采用一般资料调查表、匹兹堡睡眠质量指数量表、5条心理健康状况量表和房颤严重程度量表进行调查，采用AMOS 23.0进行中介效应分析，采用极大似然法对假设模型进行估计，采用Bootstrap检验中介效应是否显著。结果：心房颤动患者匹兹堡睡眠质量指数量表得分为（8.76±3.98）分，5条心理健康状况量表得分为（73.29±16.24）分，房颤严重程度量表得分为（9.06±4.81）分。 房颤患者睡眠质量得分与症状严重程度得分呈正相关（r=0.223，P＜0.01），与心理状况得分呈负相关（r=-0.221，P＜0.01）；心理状况得分与症状严重程度呈负相关（r=-0.272，P＜0.01）。 睡眠质量对心理状况的直接效应为-0.22（-0.38，-0.05），心理状况对症状严重程度的直接效应为-0.28（-0.45，-0.12），睡眠质量对症状严重程度的间接效应为0.06（0.02，0.14）。结论：心理状况在房颤患者睡眠质量与症状严重程度间呈完全中介效应，房颤症状管理策略应纳入睡眠管理和心理护理，以减少症状对患者的影响，进而提高患者生活质量。

关键词: 心房颤动, 睡眠质量, 心理状况, 症状, 结构方程模型