舍曲林对抑郁症患者循环交替模式的影响

Sertraline and cyclic alternating pattern in depressed patients

目的探讨舍曲林对抑郁症患者循环交替模式（cyclic alternating pattern, CAP）的影响，及其与抑郁程度和睡眠紊乱的关系。方法本研究为1项8周的开放性舍曲林治疗研究，共纳入31例符合入组和排除标准的抑郁症患者，其中22例完成全部试验。在基线和治疗的第1、14、28、56天，对抑郁症患者进行多导睡眠监测（polysomnograph, PSG）及HAMD17、Epworth嗜睡量表（Epworth Sleepiness Scale, ESS）、匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）评估，并对PSG数据进行CAP分析和常规的睡眠结构分析；采用ANOVA检验和Kruskal Wallis检验等方法比较各个时间点的临床指标以及PSG和CAP指标的差异。结果（1）在治疗终点（第56天），临床治愈率为45.4%（10/22），HAMD17、PSQI和ESS评分显著低于基线水平，F=13.02, 11.14, 15.57,均P〈0.01。（2）与基线比较，治疗终点CAP指标均显著降低：CAP时间[（128.3±42.1）min与（157.0±46.3）min]、CAP率[（38.9±9.5）%与（57.2±11.3）%]、A1亚型（164±37与211±32）、A2亚型（63±15与109±17）、A3亚型（60±13与88±10），F=6.05, 7.24, 4.86, 11.41, 6.37,均P〈0.05或P〈0.01。CAP指标的减分率与HAMD17、PSQI和ESS的减分率呈正相关（r=0.27~0.61，P〈0.05或P〈0.01）。结论抑郁症患者可能存在CAP活动异常，舍曲林所致的CAP活动下降与抑郁症状和睡眠症状的改善存在正相关。

Objective To investigate the effect of sertraline on Cyclic alternating pattern （CAP） of depressed patients and the correlation between severity of depression and sleep disturbance. Methods Patients affected by major depression on treatment with sertraline were recruited in an open-label 8-week trial. All depressed patients were assessed by polysomnography （PSG）,Hamilton Depression Scale-17 Items （HAMD17）, Epworth Sleepiness Scale （ESS）, Pittsburgh Sleep Quality Index （PSQI） at baseline, 1st day, 14th day, 28th day, and 56th day. Both sleep structure and CAP were analyzed. Clinical features, PSG and CAP characteristics were compared among different visits by ANOVA and Kruskal Vallis test.Results 31 depressed patients were recruited, and 22 patients completed this clinical trail. （1） The clinical remission rate reached 45. 4% （10/22） on the 56th day. Compared with the baseline, HAMD17, PSQI, and ESS significantly decreased （F=13.02, 11.14, 15.57, P〈0.01）. （2） After 8 weeks of treatment, CAP duration （（128.3±42.1） minutes vs. （157.0±46.3） minutes）, CAP rate（（38.9±9.5）% vs. （57.2±11.3）%）, subtype A1（（164±37） vs. （211±32））, subtype A2（（63±15） vs. （109±17）） and subtype A3 （（60±13） vs. （88±10）） significantly reduced （F=6.05, 7.24, 4.86, 11.41, 6.37, P〈0.05 or P〈0.01）. The reduction of CAP parameters positively correlated with reduction of HAMD17, PSQI, and ESS on the 56th day （r=0.27-0.61, P〈0.05 or P〈0.01）. Conclusion Depressed patients may present with abnormally high CAP parameters. Sertraline decreases CAP parameters in parallel with the improvements of depression and sleep disturbances.