老年焦虑抑郁情绪及睡眠障碍对心率变异性的影响  

Effects of anxiety,depression and sleep disorders on heart rate variability in the elderly

作　　者：刘文娜 李榕 王晓明 李晨 黄自琛 王疏桐 LIU Wenna;LI Rong;WANG Xiaoming;LI Chen;HUANG Zichen;WANG Shutong(Department of Geriatrics,Xijing Hospital,Air Force Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学西京医院老年病科,陕西西安710032

出　　处：《空军军医大学学报》2023年第5期444-448,共5页Journal of Air Force Medical University

基　　金：国家自然科学基金(82070263);空军军医大学西京医院学科助推计划项目(XJZT19ML09)。

摘　　要：目的分析老年焦虑抑郁障碍及睡眠障碍患者以心率变异性(HRV)为主的自主神经功能的改变情况,并探讨HRV指标临床意义。方法收集2021年7月至2022年7月于空军军医大学西京医院老年病科评估心理状态及睡眠质量的住院患者(n=225),依据是否有焦虑抑郁及睡眠障碍分为A组(焦虑抑郁组,n=60)、B组(睡眠障碍组,n=62)、C组(焦虑抑郁合并睡眠障碍组,n=54)及D组(无焦虑抑郁和睡眠障碍组,n=49),比较观察所有研究对象的HRV指标[包含全部正常窦性心率R-R间期标准差(SDNN)、每5 min正常R-R间期平均值的标准差(SDANN)、相邻R-R间期差值的均方根(rMSSD)、相邻R-R间期差值大于50 ms的个数所占全部的百分比(PNN50)、低频功率(LF)、高频功率(HF)、LF与HF之比(LF/HF)]并进行分析。结果四组之间年龄、性别、体质量指数、空腹血糖、糖化血红蛋白、血脂、血压,LF/HF比较,差异无统计学意义,但SDNN、SDANN、rMSSD、PNN50、LF、HF比较差异显著(P<0.01)。A、B、C三组SDNN、SDANN、rMSSD、PNN50、LF、HF低于D组(P<0.01)。C组SDNN、SDANN、rMSSD、PNN50、LF、HF低于A、B两组(P<0.01)。四组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及匹兹堡睡眠质量指数(PSQI)评分比较差异显著(P<0.01)。A、B、C三组HAMA、HAMD及PSQI评分均高于D组(P<0.01),且C组HAMA、HAMD及PSQI评分高于A、B组(P<0.01)。多因素logistic回归分析发现SDNN、PNN50、LF减小是焦虑抑郁发生的独立危险因素(P<0.05);PNN50、LF减小是睡眠障碍发生的独立危险因素(P<0.05)。结论焦虑抑郁及睡眠障碍导致HRV降低均是以自主神经功能紊乱为主要机制,其中PNN50及LF为焦虑抑郁及睡眠障碍共同的危险因素,在衡量情绪状态及睡眠质量方面具有较好的代表性,可用来定量评估自主神经功能状态,在临床诊治过程中可予以更多关注。Objective To analyze the changes of autonomic nervous function mainly in heart rate variability(HRV)in elderly patients with anxiety,depression and sleep disorders,and explore the clinical significance of HRV indexes.Methods The inpatients who were evaluated in Department of Geriatrics,Xijing Hospital,Air Force Medical University from July 2021 to July 2022 were collected and divided into group A(anxiety and depression group,n=60),group B(sleep disorders group,n=62),group C(anxiety and depression combined with sleep disorders group,n=54)and group D(no anxiety,depression or sleep disorders group,n=49)according to whether they had anxiety,depression or sleep disorders.The HRV indexes of all subjects were compared and analyzed,including all standard deviation of normal to normal RR intervals(SDNN),standard deviation of the averages of 5-minute RR intervals(SDANN),root mean square of successive RR interval differences(rMSSD),percentage of successive RR intervals that differ by more than 50 ms(PNN50),low frequency(LF),high frequency(HF),and LF/HF ratio(LF/HF).Results There were no significant differences in age,gender,body mass index,fasting blood glucose,glycosylated hemoglobin,blood lipid,blood pressure and LF/HF among the four groups,but there were significant differences in SDNN,SDANN,rMSSD,PNN50,LF and HF among the four groups(P<0.01).SDNN,SDANN,rMSSD,PNN50,LF and HF in group A,B and C were lower than those in group D(P<0.01).SDNN,SDANN,rMSSD,PNN50,LF and HF in group C were lower than those in group A and B(P<0.01).There were significant differences in Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and Pittsburgh Sleep Quality Index(PSQI)scores among the four groups(P<0.01).HAMA,HAMD and PSQI scores in group A,B and C were higher than those in group D(P<0.01),and HAMA,HAMD and PSQI scores in group C were higher than those in group A and B(P<0.01).Multivariate logistic regression analysis showed that the decrease of SDNN,PNN50 and LF was an independent risk factor for anxiety and depression(P<0.05).De

关 键 词：焦虑 抑郁 睡眠障碍 心率变异性 老年人 

分 类 号：R749[医药卫生—神经病学与精神病学]