老年抑郁症患者自杀观念与多导睡眠图参数的相关性分析  

Correlation between suicidal ideation and polysomnography parameters in late-life depression patients

作　　者：蔡利强 游亚凤 魏丽丽[1,2] 覃艳华[1,2] 姚家树[1,2] 孙毅[2,3] 张力三[2,3] 陈炜[1,2] CAI Liqiang;YOU Yafeng;WEI Lili;QIN Yanhua;YAO Jiashu;SUN Yi;ZHANG Lisan;CHEN Wei(Department of Psychiatry,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Center for Sleep Medicine,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Neurology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院精神卫生科,浙江杭州310016 [2]浙江大学医学院附属邵逸夫医院睡眠中心,浙江杭州310016 [3]浙江大学医学院附属邵逸夫医院神经内科,浙江杭州310016

出　　处：《浙江大学学报（医学版）》2020年第4期462-467,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省中医药科技计划(2020ZX012);中国睡眠研究会豪森项目(2019HSB01)。

摘　　要：目的:探讨老年抑郁症患者多导睡眠图参数与自杀观念的相关性。方法:收集2017年7月至2018年7月浙江大学医学院附属邵逸夫医院收治的60岁以上的老年抑郁症患者77例,所有患者均进行整夜多导睡眠图监测和汉密尔顿抑郁量表(HAMD)评分。以汉密尔顿抑郁量表第三项(HAM-D3)评分作为分组依据,将患者分为有自杀观念组(HAM-D3得分≥1,n=46)和无自杀观念组(HAM-D3得分=0,n=31)。比较患者的睡眠效率、入睡后觉醒时间、总睡眠时间、快速眼动睡眠占比和潜伏期、非快速眼动睡眠第1~3期(N1~N3期),并采用多因素方差分析研究自杀观念与多导睡眠图参数之间的相关性:模型1将HAM-D3评分作为自变量,将多导睡眠图主要参数作为应变量进行单因素方差分析;模型2将抑郁症状评分(HAMD校正总分)作为中心协变量,采用协方差分析方法分析自杀观念与多导睡眠图参数之间的相关性是否会受到抑郁症状严重程度评分的影响。结果:有自杀观念组患者N3期睡眠时间[(55±41)min]较无自杀观念组[(104±49)min]减少(t=-4.731,P<0.05);N3期睡眠占比[(15±11)%]较无自杀观念组[(26±11)%]减少(t=-4.194,P<0.05)。相关性分析结果显示,患者N3期睡眠时间和占比与自杀观念之间具有相关性(均P<0.05)。结论:老年抑郁症患者N3期睡眠减少与自杀观念具有相关性。Objective:To investigate the relationship between sleep parameters and suicidal ideation in patients with late-life depression(LLD).Methods:Seventy-seven LLD patients over 60 years old from Sir Run Run Shaw Hospital of Zhejiang University during July 2017 and July 2018 were included in the study.All patients were assessed with Hamilton Depression Rating Scale(HAMD)and polysomnography(PSG)overnight.The suicidal score of item 3 in HAMD(HAM-D3)was used to define whether there was a suicidal ideation.Participants were subsequently grouped according to endorsement of presence(HAM-D3 score≥1,n=46)versus absence(HAM-D3 score=0,n=31)of suicidal ideation symptoms.The sleep efficiency,total sleep time,wakefulness after sleep onset,rapid eye movement percent/latency,and non-rapid eye movement sleep stages 1-3(N1-N3)were assessed.ANOVA analyses were conducted to explore the correlation of sleep parameters with suicidal ideation between the groups with and without suicidal ideation.In model 1,the HAM-D3 constituted the independent variable in separate ANOVA tests;in model 2 the impact of depressive symptoms were assessed as a covariate with sleep parameters.Results:There was less stage N3[(55±41)min,t=-4.731,P<0.05]and the reduced percentage of N3[(15±11)%,t=-4.194,P<0.05]in LLD patients with suicidal ideation,compared with the LLD patients without suicidal ideation[(104±49)min,(26±11)%].Correlation analyses revealed that there was a significant correlation between the suicidal ideation and the percentage of stage N3 and sleep time of stage N3(both P<0.05).Conclusion:Suicidal ideation is associated with less N3 sleep in LLD patients.

关 键 词：抑郁症 老年人 多道睡眠描记术 自杀观念 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R443.8[医药卫生—临床医学]