抑郁症及失眠症患者睡眠结构与认知功能的变化

To investigate the difference of sleep quality and cognitive impairment between depression with insomnia and simple insomnia

目的探讨抑郁症与失眠症患者睡眠结构与认知功能的变化。方法采用威斯康星卡片分类测验(WCST)对36例存在失眠症状的抑郁患者(抑郁伴失眠组)、31例失眠症患者(单纯失眠组)及23名健康对照组(对照组)认知功能进行评估,采用匹兹堡睡眠指数量表(PSQI)及基于心肺耦合技术的便携式睡眠监测仪(CPC)对3组被检者进行测评,并对结果进行相关性分析。结果WCST评分显示,抑郁伴失眠组总应答数、持续性应答数、非持续性错误高于对照组(P<0.05),正确率、概念化水平百分数、完成分类数低于对照组(P<0.05);单纯失眠组总应答数、持续性应答数、非持续性错误高于对照组(P<0.05),正确率(P<0.01)、概念化水平百分数、完成分类数低于对照组(P<0.05);CPC睡眠结构分析,单纯失眠组熟睡时间占比低于对照组及抑郁伴失眠组(P<0.05),浅睡时间占比高于对照组及抑郁伴失眠组(P<0.05);抑郁伴失眠组熟睡时长占比高于单纯失眠组,快速眼球运动(REM)期时长高于对照组(P<0.01);抑郁伴失眠组PSQI睡眠障碍因子分与持续性应答数、非持续性错误呈正相关(r=0.5177、0.5180,P<0.01),与WCST正确率、概念化水平百分数、完成分类数呈负相关(r=-0.4428、-0.5189、-0.5068,P<0.01)。结论抑郁症及失眠症患者睡眠结构发生改变,部分认知功能下降。

Objective To investigate the difference of sleep quality and cognitive impairment between the patients with depression accompanied with insomnia and the patients with simple insomnia.Methods The Wisconsin Card Classification Test(WCST)was used to evaluate the cognitive function of 36 patients with depression accompanied with insomnia(depression-insomnia group),31 patients with insomnia alone(simple insomnia group)and 23 healthy control group(the control group)matched by age and education level.Hamilton Depression Scale,Pittsburgh Sleep Index Scale,and portable sleep monitor based on cardiopulmonary coupling(CPC)technology were used for clinical evaluation of the subjects.Results WCST score showed that the total number of responses(P<0.05),the number of persistent responses(P<0.05)and the number of non-persistent errors(P<0.01)in the depression-insomnia group were higher than those in the control group.The accuracy rate,percentage of conceptualization level and number of completed classification were lower than those of the control group(P<0.05).The total number of responses(P<0.05),the number of persistent responses(P<0.01)and the number of non-persistent errors(P<0.01)in the simple insomnia group were higher than those in the control group.The accuracy rate(P<0.01),percentage of conceptualization level(P<0.01)and number of completed categories(P<0.05)were lower than those of the control group.According to CPC sleep structure analysis,the sleep time ratio in the simple insomnia group was lower than that in the control group(P<0.05)and the depression group with insomnia(P<0.01).The proportion of light sleep time was higher than that of control group and depression-insomnia group(P<0.05).The sleep duration of the depression group with insomnia was higher than that of the simple insomnia group(P<0.01),and the REM duration was higher than that of the control group(P<0.01).The score of PSQI sleep disorder factor was positively correlated with the number of persistent responses and non-persistent errors,and negatively correlated with the correct rate of WCST,percentage of conceptualization level and number of completed classification in depression-insomnia group.Conclusion This study shows that the abilities of abstract generalization,concept formation,attention and cognitive transfer all decrease in patients with depression accompanied with insomnia.The sleep depth of patients with simple insomnia is lower than that of healthy people and patients with depression accompanied with insomnia.REM duration increases in patients with depression accompanied with insomnia.There is a correlation between cognitive function and PSQI sleep disorder factor in patients with depression accompanied with insomnia.Good sleep can improve cognitive impairment and reduce the accumulation of negative emotions.It is suggested that sleep health education and adjustment of sleep structure should be paid attention to.