伴发中重度阻塞性睡眠呼吸暂停综合征的抑郁障碍患者心肺耦合分析研究  

Cardiopulmonary Coupling Analysis in Patients with Depressive Disorders Associated with Moderate to Severe Obstructive Sleep Apnea Syndrome

作　　者：宋苏琪 张凯[1,2] 周晓琴 刘寰忠[1,2] SONG Suqi;ZHANG Kai;ZHOU Xiaoqin;LIU Huanzhong(Department of Psychiatry,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;Anhui Psychiatric Center,Anhui Medical University,Hefei 238000,China)

机构地区：[1]安徽医科大学附属巢湖医院精神科,安徽省合肥市238000 [2]安徽省精神医学中心,安徽省合肥市238000

出　　处：《中国全科医学》2021年第26期3288-3294,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(81801341);安徽省重点研究和开发计划项目(202004j07020030)。

摘　　要：背景阻塞性睡眠呼吸暂停综合征(OSAS)会改变抑郁障碍临床表现,持续抑郁障碍整个病程,影响抑郁障碍患者疗效及预后,增加复发风险,但目前探讨抑郁障碍伴发OSAS影响因素的研究少有报道。目的探讨伴发中重度OSAS和不伴发中重度OSAS的抑郁障碍患者的睡眠差异及伴发中重度OSAS的影响因素。方法选择2017年6月-2019年9月在安徽医科大学附属巢湖医院心身疾病科住院的抑郁障碍患者为研究对象。由2名具有丰富临床经验的精神科主治医师进行结构化访谈并推荐入组。采用自制问卷(参考以往临床研究文献编制)记录研究对象的性别、年龄、体质指数(BMI)、病程、抑郁发作次数。采用匹兹堡睡眠质量指数(PSQI)评估最近1个月内患者主观睡眠质量,采用17项汉密尔顿抑郁量表(HAMD-17)评估患者的抑郁程度,采用心肺耦合(CPC)睡眠质量评估系统采集睡眠参数〔睡眠总时间(TST)、熟睡时间、浅睡时间、REM睡眠时间、觉醒时间、初入熟睡时间、睡眠效率、睡眠呼吸暂停指数(AHI)〕。根据AHI将患者分为伴发中重度OSAS的抑郁障碍组(AHI≥15次/h)和不伴发中重度OSAS的抑郁障碍组(AHI<15次/h)。采用Person相关性分析探讨抑郁障碍患者的一般情况及量表评分与CPC睡眠质量评估指标的相关性;采用二元Logistic回归分析探讨伴发中重度OSAS的抑郁障碍影响因素。结果本研究共纳入符合入组标准的抑郁障碍患者102例(64.7%),伴发中重度OSAS的抑郁障碍组31例,不伴发中重度OSAS的抑郁障碍组71例。伴发中重度OSAS的抑郁障碍组患者的PSQI评分、HAMD-17总分及躯体焦虑化评分、睡眠障碍评分、绝望感评分、迟缓评分高于不伴发中重度OSAS的抑郁障碍组,浅睡时间大于不伴发中重度OSAS的抑郁障碍组,熟睡时间小于不伴发中重度OSAS的抑郁障碍组(P<0.05)。TST与PSQI评分(r=-0.28)呈负相关(P<0.05),浅睡时间与PSQI评分(r=-0Background Obstructive sleep apnea syndrome(OSAS)can perpetuate depression throughout the course of the disorder,altering the clinical presentation of depression,affecting the efficacy and prognosis,and increasing the risk of relapse.However,there are few reports on the influencing factors of depressive disorder associated with OSAS.Objective To comparatively analyze the sleep quality of depressive disorder patients with and without moderate to severe OSAS,and to examine associated factors for moderate to severe OSAS in depressive disorders.Methods Inpatients with depressive disorders were recruited from Department of Psychosomatic Diseases,Chaohu Hospital of Anhui Medical University from June 2017 to September 2019 by two senior attending psychiatrists using structured interviews.The sex,age,BMI,course of depression and the number of depressive episodes were collected through a survey with a questionnaire(compiled by us on the basis of reviewing available related clinical studies).The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the subjective sleep quality in the month prior to the study.Hamilton Depression Scale-17(HAMD-17)was used to evaluate the degree of depression.Cardiopulmonary coupling(CPC)was used to estimate sleep quality,and sleep parameters were collected,including total sleep time(TST),deep sleep time,light sleep time,REM sleep time,awakening time,duration of first stage of deep sleep,sleep efficiency,and apnea-hypopnea index(AHI).AHI≥15 times per hour was defined as moderate to severe OSAS.Person correlation analysis was used to examine the correlation of CPC sleep parameters with demographic information,PSQI and 17-item Hamilton Rating Scale for Depression(HAMD-17)scores.The factors associated with moderate to severe OSAS in depressive disorders were identified through binary logistic regression analysis.Results Altogether,102 cases were included,accounting for 64.7%of the total inpatients admitted during the period.There were 31 patients with moderate to severe OSAS and 71 patients

关 键 词：抑郁症 睡眠呼吸暂停综合征 阻塞性 影响因素分析 心肺耦合分析 

分 类 号：R749.41[医药卫生—神经病学与精神病学] R749.79[医药卫生—临床医学]