选择性5-羟色胺再摄取抑制剂对抑郁症患者睡眠结构的影响及与临床疗效的关系研究  

Influence of Selective Serotonin Reuptake Inhibitors on Sleep Architecture of Depressive Patients and Its Relationship with the Clinical Effect

作　　者：张斌[1] 郝雪利[2] 李雪丽[1] 刘武汉[1] 

机构地区：[1]广东省人民医院,广东省医学科学院,广东省精神卫生中心,广东省广州市510120 [2]广州医学院

出　　处：《中国全科医学》2013年第1期55-58,共4页Chinese General Practice

基　　金：广东省科技厅科技计划引导项目(2010B031600154);广州市属高校科技计划项目(08A036)

摘　　要：目的探究选择性5-羟色胺再摄取抑制剂(SSRIs)对抑郁症患者睡眠结构的影响及与临床疗效的关系。方法从多导睡眠图(PSG)数据库选择了26例接受SSRIs治疗2周以上的抑郁症患者(治疗组),并同时选择了24例近3个月未接受药物治疗的抑郁症患者(未治疗组)。评估患者睡眠情况,采用汉密尔顿抑郁量表24项版本(HAMD-24)评估患者治疗前后的抑郁状况,采用Logistic回归分析抑郁症患者睡眠结构变化与临床疗效的关系。结果治疗组和未治疗组的睡眠长度、睡眠潜伏期、非快速动眼时相睡眠(NREM)Ⅱ期与Ⅲ期的睡眠比例差异均无统计学意义(P>0.05)。经过SSRIs治疗,治疗组进入快速动眼时相(REM)的时间与未治疗组相比缩短〔(77±30)min vs.(146±64)min〕,差异有统计学意义(P=0.000),并进入正常范围;治疗组的NREMⅠ期睡眠比例与治疗组相比〔(14±5)%vs.(18±8)%〕和微觉醒指数(AI)〔(14±5)次/h vs.(18±6)次/h〕均减少,但AI仍高于正常值(<5次/h),差异均有统计学意义(P<0.05)。治疗组与未治疗组HAMD-24得分间差异有统计学意义〔(17±6)分vs.(27±10)分,P=0.007〕。Logistic回归显示治疗组患者的REML越短〔OR=0.627,95%CI(0.517,0.923)〕和AI越低〔OR=0.839,95%CI(0.721,0.987)〕,就越容易显示出临床疗效。结论抑郁症的REM睡眠异常应该是抑郁症的核心睡眠节律异常,支持了抑郁症的睡眠时相前移假说;睡眠结构的改变影响临床疗效。Objective To investigate the influence of selective serotonin reuptake inhibitors（SSRIs） on sleep architecture of depressive patients and the relationship between the sleep architecture and the clinical effect of SSRIs. Methods Totally 26 depressive patients with SSRIs treated in recent 2 weeks were recruited as treatment group from the polysomnography database,and 24 age-and sex-matched depressive patients without medication in recent 3 months as un-treatment group were recruited at the same time.The Hamilton Rating Scale for Depression-24 items（HAMD-24） was used for assess the depression conditions before and after the treatment,and Logistic regression analysis was taken to determine the relationship between the sleep architecture and the clinical effect. Results There were no statistically significant differences between the two groups in sleep duration,sleep latency,percentages of stage II and III sleep（P0.05）.After SSRIs treatment,the latency of rapid eye movement（REM） in the treatment group was shortened as compared with the non-treatment group（（77±30） min vs.（146±64） min）（P=0.000） and reached into normal range,and percentage of stage I sleep（（14±5）% vs.（18±8） %）and arousal index（AI）（（14±5）times/h vs.（18±6）times/h） decreased（P0.05）,but the AI still was higher than normal（5 times/h）.The difference in HAMD-24 score between the two groups was statistically significant（（17±6） vs.（27±10）,P=0.007）.Logistic regression showed that the clinical effect was associated with shorten REM latency（OR=0.627,95%CI（0.517,0.923）） and decreased AI（OR=0.839,95%CI（0.721,0.987））. Conclusion The abnormal REM sleep may be the core of abnormal sleep rhythm in depressive disorder,which supports the hypothesis of advanced sleep phase.

关 键 词：选择性5-羟色胺再摄取抑制剂 睡眠结构 抑郁症 临床疗效 

分 类 号：R749.42[医药卫生—神经病学与精神病学]