不同发作类型的抑郁症与卒中后抑郁快眼动睡眠特征研究

Rapid eye movement sleep study on different episode types of depression and post-stroke depression

目的探讨抑郁症不同发作类型与卒中后抑郁的快眼动睡眠（rapid eye movement，REM）特征，为临床诊断、治疗及预后提供支持。方法于河南省精神病医院纳入单次抑郁发作患者（A组，n=22），复发性抑郁患者（发作≥2次）（B组，n=26），卒中后抑郁患者（C组，n=19）。将20名健康志愿者设为对照组。对4组入组时进行晚21时～次日晨6时的多导睡眠图（Polysomnogram，PSG）描记，患者组经5-羟色胺（5-HT）再摄取抑制剂（SSRIs）治疗6周末时进行HAMD评分及第2次PSG描记，对4组的REM指标检测结果进行对比分析。结果首次PSG检测，A组、B组REM睡眠潜伏期[A：（65．57＋18．29）min，B：（66．32±15．46）min]较C组[（79．17±20．18）min]、对照组[（87．24±16．55）min]显著缩短，REM活动度[A：（99．82±25．71）U，B：（104．70±28．23）U]、REM密度[A：（81．06±19．35）％，B：（86．61±23．83）％]较对照组[REM活动度：（79．61±18．40）U、REM密度：（68．11±17．54）％]显著增加；C组REM时间[（51．66±22．26）min]较A组[（71．43±20．70）min]、B组[（74．81±17．52）min]和对照组[（70．46±16．35）min]显著减少（P〈0．05）。患者组治疗前后两次PSG比较，治疗后A组REM睡眠潜伏期延长[（65．57±18．29）min，（81．71±21．62）min]、REM活动度降低[（99．82±25．71）U，（83．58±27．19）U]，差异有统计学意义（P〈0．05），REM密度虽有降低，但差异无统计学意义（P〉0．05）；B组REM各项指标差异无统计学意义；C组REM时间延长[（51．66±22．26）min，（68．37±20．16）min]，差异有统计学意义（P〈0．05）。结论不同发作类型的抑郁症患者在抑郁发作期大多表现为REM脱抑制现象，REM密度增高可能是抑郁症患者REM的特征型。卒中后抑郁患者的睡眠障碍以睡眠进程和睡眠连续性差为主，不具有抑郁症患者的REM特征。

Objective To explore the rapid eye movement （REM） sleep characteristics of different episode types of depression and post-stroke depression （PSD） patients and provide support for clinical diagnosis,treatment and prognosis. Methods Patients with single-episode depression （ group A, n = 22）, patients with recurrent depression （ ≥ 2 episodes, group B, n= 26 ） and patients with PSD （ group C, n= 19 ） were included from Henan Provincial Mental Hospital. 20 healthy volunteers were assigned to control group. Participants in the 4 groups were performed polysomnographic recordings （PSG） from 9 PM to 6 AM before treatment.The 3 patients groups were performed the second PSG recordings and HAMD score at the end of 6 week SSRIs treatment. The REM indexes of 4 groups were compared and analyzed. Results First PSG detection showed that REM sleep latencies （RL） were shorter in group A and B （A： （65.57±18.29） min,B： （66.32±15.46） min） than that in group C （（79.17±20.18） min ） and control group（（87.24±16.55）min）; REMactivity （RA） （A：（99.82±25.71） u,B：（104.70±28.23） u）and REM density （RD） （A： （81.06± 19.35）%, B：（86.61±23.83） % ） were increased more significantly in group A and B than those in control group （ （79.61± 18.40） u; （68.11± 17.54）% ） ; REM sleep time （RT） were decreased more significantly in group C （（51.66＋22.26） rain） than that in group A（（71.43＋20.70） min） ,group B（ （74.81± 17.52） min） and control group （ （70.46± 16.35） min） （P〈0.05）. After treatment, REM sleep latency was prolonged in group A （（65.57±18.29） min vs （81.71±21.62） rain）,and REM activity was decreased in group A （ （ 99.82±25.71 ） u vs （83.58±27.19） u）, the difference was statistically significant （P〈0.05）. REM density was decreased,hut the difference was not statistically significant （P〉0.05）.There was no significant difference in the indexes of REM in group C ; RT was prolonged （ （ 51.66 ± 22.26） rain vs （ 68.37 ± 20.16 ） min）in group C,the difference was statistically significant （P〈0.05）. Conclusion Most of depression pa- tients with different episode types have REM disinhibition phenomenon. RD increase may be REM characteristic type of depression patient. Sleep disorders of PSD patients are mainly poor sleep process and sleep continuity and have no characteristics of REM sleep disorder of depression ones.