重性抑郁障碍患者的睡眠神经生理研究

Study of sleep neurophysiology in patients with major depressive disorder

目的:探讨重性抑郁障碍患者(MDD)睡眠期电生理活动的特点。方法:对36例MDD患者(MDD组)以及36名年龄、性别相匹配的健康对照者(NC组)进行全夜多导睡眠监测(PSG);采用汉密尔顿抑郁量表-17项(HAMD-17)及匹兹堡睡眠质量指数量表(PSQI)评定入组者的抑郁程度和睡眠质量。结果:与NC组比较,MDD组总睡眠时间、睡眠效率显著降低,快速眼球运动(REM)睡眠潜伏期显著缩短;睡眠潜伏期、入睡后清醒时间显著延长,觉醒指数显著增加(P均<0.001);非快速眼球运动(NREM)睡眠中的N1%显著增加、N3%显著减少(P均<0.05);MDD组N2期中睡眠纺锤波的个数和密度显著降低(P均<0.01);PSQI评分与睡眠纺锤波的个数及密度呈负相关(r=-0.30,r=-0.26,P均<0.05);HAMD-17评分与睡眠纺锤波的密度呈负相关(r=-0.25,P<0.05),与PSQI呈正相关(r=0.76,P<0.001)。结论:MDD患者睡眠结构紊乱,睡眠质量下降;且睡眠纺锤波变化可能是MDD的特征性改变。

Objective： To explore the characteristics of the sleep neurophysiology in patients with major depressive disorder（ MDD）. Method： Totally 36 MDD patients（ MDD group） and 36 age-and sex-matched normal controls（ NC group） were tested by polysomnography（ PSG） all night. The depression degree and sleep quality of the two groups were assessed by Hamilton depression rating scales-17（ HAMD-17） and the Pittsburgh sleep quality index（ PSQI）. Results： Compared to the NC group,total sleep time,sleep efficiency and rapid eye movement（ REM） sleep latency were remarkablely decreased,sleep latency,awake time after asleep and arousal index were significantly increased in MDD group（ all P〈0. 001）. The N1% of NREM sleep was increased and N3% was decreased significantly（ all P〈0. 05）. The number and density of sleep spindles in N2 sleep were decreased significantly（ all P〈0. 01）. The score of PSQI was nageitively correlated with the number and density of sleep spindles in N2 sleep（ r = 0. 39,P〈0. 01）. The score of HAMD-17 was negatively correlated with spindle denstiy（ r =-0. 25,P〈0. 05） and positively correlated with PSQI（ r = 0. 76,P〈0. 001）.Conclusion： There are sleep structure disorder and sleep quality declduce in MDD patients. The changes of sleep spindles may be the characteristic of MDD.