伴发抑郁、焦虑的心律失常患者睡眠与心律失常的临床分析研究

Association Between Sleep and Arrhythmia in the Arrhythmia Patients with Anxiety and Depression

目的探讨伴抑郁及焦虑情绪障碍的心律失常患者睡眠质量对心律失常的影响。方法 160例心律失常人院患者及正常健康人群50例(对照组)进行抑郁、焦虑自评量表、匹茨堡睡眠质量指数量表测评,共收集伴抑郁的心律失常患者57例(抑郁组),伴焦虑的心律失常患者48名(焦虑组),同时伴抑郁和焦虑共病的心律失常患者38名(共病组),不伴抑郁或焦虑的心律失常患者55例(病例组),进行动态心电图等常规检查,分析HRV时域指标。结果抑郁组[抑郁分(59.63±1.56)]、焦虑组[焦虑分(59.07±2.53)]、共病组[抑郁分(60.96±1.33)、焦虑分(62.15±2.19)]均显著高于对照组[抑郁分(33.21±1.26)、焦虑分(32.26±2.49)],有统计学上的差异(P<0.01)。HRV时域指标,抑郁组[SDNN(88.30±15.24)、SDANN(78.70±12.51)、rMSSD(22.04±2.63)、PNH50(15.26±1.07)]、焦虑组[SDNN(84.87±.13.21)、SDANN(79.33±13.01)、rMSSD(22.28±3.21)、PNH50(15.43±1.22)]、共病组[SDNN(85.73±14.34)、SDANN(77.66±13.53)、rMSSD(23.83±2.47)、PNH50(15.44±1.28)]均显著低于正常组[SDNN(128.89±16.34)、SDANN(120.37±12.74)、rMSSD(45.61±5.57)、PNH50(34.72±3.53)](P<0.01)。共病患者在睡眠质量因子(1.53±0.18)、睡眠总分(7.39±0.69)高于对照组(0.65±0.04)、(4.89±0.72),与对照组有统计学上的差异(P<0.05)。心律失常伴发抑郁、焦虑患者在睡眠总分、睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍5个因子分与对照组相比较有统计学差异(P<0.05)。结论伴抑郁、焦虑及焦虑抑郁共病心律失常患者HRV时域指标显著下降,表明自主神经对心脏调节功能存在障碍。在睡眠质量方面存在障碍的心律失常伴焦虑、抑郁患者,可能与自主神经对心脏调节功能障碍更严重有关,更易于发生恶性室性心律失常。

Objective To explore sleep quality of the arrhythmia patients with anxiety and depression for arrhythmia influence. Methods 160 arrhythmic patients and 50 normal human were investigated by Zung Self - Rating Anxiety Scale （SAS） , Zung Self - rating Depression Scale（SDS） , Pittsburgh Sleep Quality Index scale（PSQI） , 57 patients were the depressive group for depression, 48 patients were the anxious group for anxiety, 38 patients with anxiety and depression were the eomorbidity group. 55 patients were the patients group. 50 normal human were the control group. All patients were natural examined by dynamic electrocardiogram for HRV time domain indexes. Results There were significantly difference in depressive scale of the depressive group （47.71 ± 1.25 ） , the anxious scale of anxious group （47.26 ±2.03 ） , depressive and anxious scale of the comorbidity group [ （48.77 ±1.07 ） , （49.72 ±1.03 ） ] , and depressive and anxious scale of control group [ （ 33.21 ±1.26）, （ 32.26 ±2.49 ） ] （ P 〈 0.01 ）. There was significantly difference between the depressive group [ SDNN （ 88.30 ±15.24 ）, SDANN （ 78.70 ±12.51 ）, rMSSD （ 22.04 ±2.63 ）, PNH50 （ 15.26 ±1.07 ） ], anxious group [ SDNN（84.87 ±13.21 ） ,SDANN （79.33 ±13.01 ） ,rMSSD （22.28 ±3.21 ）, PNH50 （ 15.43 ±1.22） ], comorbidity group[ SDNN （85.73 ±14.34）,SDANN（77.66 ±13.53）,rMSSD（23.83 ±2.47）,PNH50（15.44 ±1.28）] and normal group[SDNN（128.89 ±16.34）,SDANN（120.37 ±12. 74） ,rMSSD（45. 61 ±5.57）,PNH50（34.72±3.53）]（P〈0.01）. Sleep quality（1.53 ±0.18）and total score of sleep （7.39 ±0.69 ） in comorbidity group was higher than that of control group （ 0.65 ±0.04 ） , （4.89 ±0.72 ） （ P 〈 0.01 ）. There was difference in the score of whole sleep, sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances between control and arrhythmia patients（P 〈 0.05）. Conclusion the Arrhythmic Patients with anxiety and depression is lower significantly in HRV time domain indexes,it is indicated that the function of vegetative nerve of Arrhythmic patients is dysfunction, it is possible that the function of vegetative nerve will be more serious in comorbidity group for psychological disorder of sleep quality, It is more easily to malignancy arrhythmia.