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

doi:10.12114/j.issn.1007-9572.2021.00.533

摘要/Abstract

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=-0.71）、HAMD-17总分（r=-0.28）、自杀评分（r=-0.20）、绝望感评分（r=-0.23）、迟缓评分（r=-0.30）呈负相关（P<0.05），熟睡时间与PSQI评分（r=0.34）、HAMD-17总分（r=0.22）呈正相关（P<0.05），快速眼球运动（REM）睡眠时间与BMI（r=-0.24）呈负相关（P<0.05），与PSQI评分（r=0.30）、HAMD-17总分（r=0.21）、自杀评分（r=0.21）呈正相关（P<0.05），觉醒时间与PSQI评分（r=0.29）呈正相关（P<0.05），初入熟睡时间与躯体焦虑化评分（r=-0.21）呈负相关（P<0.05），睡眠效率与PSQI评分（r=-0.29）呈负相关（P<0.05），AHI与PSQI评分（r=0.48）、HAMD-17总分（r=0.38）、躯体焦虑化评分（r=0.24）、睡眠障碍评分（r=0.20）、绝望感评分（r=0.22）、迟缓评分（r=0.31）呈正相关（P<0.05）。二元Logistic回归分析结果显示，PSQI评分〔OR=2.11，95%CI（1.23，3.63）〕、HAMD-17总分〔OR=1.45，95%CI（1.11，1.91）〕及浅睡时间〔OR=22.65，95%CI（3.75，136.68）〕是伴发中重度OSAS的抑郁障碍的影响因素（P<0.05）。结论　伴发中重度OSAS的抑郁障碍患者存在浅睡时间长、熟睡时间短等睡眠异常，而PSQI评分、HAMD-17总分及浅睡时间是伴发中重度OSAS的抑郁障碍的影响因素，有必要对这部分抑郁障碍患者使用CPC睡眠质量评估系统进行筛查。

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

Abstract: Background　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 without moderate to severe OSAS. Compared to patients without moderate to severe OSAS，those with moderate to severe OSAS had higher mean PSQI score，total score and scores of four subscales（anxiety somatic，insomnia，depressed mood，retardation）of HAMD-17，longer mean light sleep time and shorter mean deep sleep time（P<0.05）. TST was negatively correlated with PSQI score（r=-0.28）（P<0.05）. Light sleep time was negatively correlated with PSQI score（r=-0.71），HAMD-17 total score（r=-0.28），suicide score（r=-0.20），depressed mood score（r=-0.23）and retardation score（r=-0.30）（P<0.05）. Deep sleep time was positively correlated with PSQI score（r=0.34）and HAMD-17 total score（r=0.22）（P<0.05）. REM sleep time was negatively correlated with BMI（r=-0.24），and positively correlated with PSQI score（r=0.30），HAMD-17 total score（r=0.21）and suicide score（r=0.21）（P<0.05）. Awakening time was positively correlated with PSQI score（r=0.29）（P<0.05）. The duration of first stage of deep sleep was negatively correlated with anxiety somatic score（r=-0.21）（P<0.05）. Sleep efficiency was negatively correlated with PSQI score（r=-0.29）（P<0.05）. AHI was positively correlated with PSQI score（r=0.48），HAMD-17 total score（r=0.38），anxiety somatic score（r=0.24），insomnia score（r=0.20），depressed mood score（r=0.22）and retardation score（r=0.31）（P<0.05）. Binary Logistic regression analysis showed that PSQI total score 〔OR=2.11，95%CI（1.23，3.63）〕，HAMD-17 total score 〔OR=1.45，95%CI（1.11，1.91）〕 and light sleep time〔OR=22.65，95%CI（3.75，136.68）〕 were the influencing factors of moderate to severe OSAS in depressive disorder（P<0.05）. Conclusion　Depression disorder patients with moderate and severe OSAS had sleep abnormalities，such as longer light sleep time and shorter deep sleep time. PSQI score，HAMD-17 total score，and light sleep time were influencing factors for depression disorder with moderate to severe OSAS. It is necessary to screen these depressive patients using CPC.

Key words: Depressive disorders；Sleep apnea, obstructive；Root cause analysis；Cardiopulmonary coupling analysis

宋苏琪,张凯,周晓琴,等. 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[J]. 中国全科医学, 2021, 24(26): 3288-3294. DOI: 10.12114/j.issn.1007-9572.2021.00.533.
SONG Suqi,ZHANG Kai,ZHOU Xiaoqin, et al. Cardiopulmonary Coupling Analysis in Patients with Depressive Disorders Associated with Moderate to Severe Obstructive Sleep Apnea Syndrome　[J]. Chinese General Practice, 2021, 24(26): 3288-3294. DOI: 10.12114/j.issn.1007-9572.2021.00.533.

参考文献

［1］HUANG Y Q，WANG Y，WANG H，et al．Prevalence of mental disorders in China：a cross-sectional epidemiological study［J］．Lancet Psychiatry，2019，6（3）：211-224．DOI：10.1016/S2215-0366（18）30511-X.
［2］STUBBS B，VANCAMPFORT D，VERONESE N，et al．The prevalence and predictors of obstructive sleep apnea in major depressive disorder，bipolar disorder and schizophrenia：a systematic review and meta-analysis［J］．J Affect Disord，2016，197：259-267．DOI：10.1016/j.jad.2016.02.060.
［3］严保平，孙秀丽，桑文华，等．双重抑郁症与单一抑郁症患者睡眠质量及应对方式的研究［J］．中国全科医学，2014，17（1）：98-100，104．DOI：10.3969/j.issn.1007-9572.2014.01.030.
YAN B P，SUN X L，SANG W H，et al．Sleep quality and coping style of patients with double depression and major depression［J］Chinese General Practice，2014，17（1）：98-100，104．DOI：10.3969/j.issn.1007-9572.2014.01.030.
［4］张斌，李雪丽，刘武汉. 抑郁症患者的睡眠结构特征分析［J］．中国全科医学，2011，14（13）：1486-1488．DOI：10.3969/j.issn.1007-9572.2011.13.031.
ZHANG B，LI X L，LIU W H. Feature of sleep architecture in depressive patients［J］．Chinese General Practice，2011，14（13）：1486-1488．DOI：10.3969/j.issn.1007-9572.2011.13.031.
［5］TAKAESU Y，INOUE Y，ONO K，et al．Circadian rhythm sleep-wake disorders predict shorter time to relapse of mood episodes in euthymic patients with bipolar disorder：a prospective 48-week study［J］．J Clin Psychiatry，2018，79（1）：17m11565．DOI：10.4088/JCP.17m11565.
［6］SOEHNER A M，KAPLAN K A，HARVEY A G. Prevalence and clinical correlates of co-occurring insomnia and hypersomnia symptoms in depression［J］．J Affect Disord，2014，167：93-97．DOI：10.1016/j.jad.2014.05.060.
［7］ZHU D M，ZHANG C，YANG Y，et al．The relationship between sleep efficiency and clinical symptoms is mediated by brain function in major depressive disorder［J］．J Affect Disord，2020，266：327-337．DOI：10.1016/j.jad.2020.01.155.
［8］COLEMAN M Y，MCGLASHAN E M，VIDAFAR P，et al．Advanced melatonin onset relative to sleep in women with unmedicated major depressive disorder［J］．Chronobiol Int，2019，36（10）：1373-1383．DOI：10.1080/07420528.2019.1644652.
［9］CAI L Q，XU L Y，WEI L L，et al．Evaluation of the risk factors of depressive disorders comorbid with obstructive sleep apnea［J］．Neuropsychiatric Dis Treat，2017，13：155-159．DOI：10.2147/NDT.S122615.
［10］HEIN M，LANQUART J P，LOAS G，et al．Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in major depression：a observational and retrospective study on 703 subjects［J］．BMC Pulm Med，2017，17（1）：165．DOI：10.1186/s12890-017-0522-3.
［11］MCCALL WV，BENCA RM，RUMBLE ME，et al．Prevalence of obstructive sleep apnea in suicidal patients with major depressive disorder［J］．J Psychiatr Res，2019，116：147-150．DOI：10.1016/j.jpsychires.2019.06.015.
［12］宋璇，葛义俊，孔晓艺，等．心肺耦合分析技术对睡眠障碍诊断的可靠性观察［J］．中华医学杂志，2020，100（11）：817-822. DOI：10.3760/cma.j.cn112137-20190911-02008.
SONG X，GE Y J，KONG X Y，et al．Cardiopulmonary coupling analysis in diagnosis of sleep disorders［J］．National Medical Journal of China，2020，100（11）：817-822. DOI：10.3760/cma.j.cn112137-20190911-02008.
［13］刘志鹏，伍海林，胡茂荣. 广泛性焦虑障碍及其共病抑郁障碍的心率变异性研究［J］．中国全科医学，2019，22（33）：4069-4072．DOI：10.12114/j.issn.1007-9572.2019.00.597.
LIU Z P，WU H L，HU M R. Heart rate variability in patients with generalized anxiety disorder and depressive disorder［J］．Chinese General Practice，2019，22（33）：4069-4072．DOI：10.12114/j.issn.1007-9572.2019.00.597.
［14］CLAUDIO V，VALENTINA C，GIANLUCA G M，et al．Description of the relationship between NOHL classification in drug-induced sleep endoscopy and initial AHI in patients with moderate to severe OSAS，and evaluation of the results obtained with oral appliance therapy［J］. Acta Otorhinolaryngol Ital，2020，40：50-56. DOI：10.14639/0392-100X-2290.