伴不同程度焦虑的抑郁障碍患者睡眠质量与特征分析

Analysis on sleep quality and characteristics of depression patients with different degrees of anxiety

目的·比较伴不同程度焦虑的抑郁障碍患者的睡眠质量。方法·选取抑郁障碍患者为研究对象,组别划分:HAMA分值0~6分为无焦虑组,HAMA分值7~13分为焦虑倾向组,HAMA分值≥14分为焦虑组。采用汉密尔顿抑郁量表-17(Hamilton Depression Scale-17,HAMD-17)评估患者的抑郁程度,汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评估患者的焦虑程度,匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index Scale,PSQI)评估患者的睡眠质量。比较各组患者的睡眠质量和特征,分析睡眠质量与焦虑、抑郁程度的相关性。结果·焦虑组的PSQI分值高于焦虑倾向组和无焦虑组(均P=0.000)。偏相关分析结果表明,在控制HAMD-17分值的情况下,在不同程度焦虑组中,HAMA分值与PSQI指标相关性存在显著差异。多元线性回归分析结果表明,在控制HAMA分值的情况下,睡眠障碍依然是抑郁障碍的独立危险因素;睡眠时间、入睡时间、催眠药使用和日间功能都是HAMD-17得分的独立影响因素(均P<0.05)。结论·在抑郁障碍患者中,焦虑程度与睡眠障碍的严重程度相关,尤其在较低程度焦虑的患者中。无论是否伴有焦虑,睡眠障碍都是抑郁障碍的独立危险因素。抑郁状况与不同维度的睡眠障碍指标的关系提示睡眠障碍在抑郁障碍的发病过程中起综合性的作用。

Objective · To compare the sleep quality of depressive patients with and without anxiety symptoms. Methods · Hamilton Depression Scale-17(HAMD-17), Hamilton Anxiety Scale(HAMA) and Pittsburgh Sleep Quality Index Scale(PSQI) were used to assess the level of patients’ depression, anxiety and sleep quality. The HAMA scores of patients ranged from 0 to 6 were in the anxiety-free group, 7 to 13 in the anxiety-prone group, and 14 or more in the anxiety group. Results · The PSQI scores of the group with anxiety were higher than those of anxiety-prone group and anxiety-free group(both P=0.000). Partial correlation analysis showed that, after controlling HAMD-17 scores, the correlation between HAMA scores and PSQI scores reduced gradually with the increase of anxiety level. The multiple linear regression analysis showed that sleep disorder was still an independent risk factor for depression after controlling HAMA score. Sleep latency, sleep time, hypnotics and daytime dysfunction were independent predictive factors of HAMD-17 score(all P<0.05). Conclusion · In patients with depressive disorder, the severity of sleep disorder increases with the increase of anxiety level. In the case of comorbidity anxiety, sleep disorder is still an independent risk factor for depressive disorder, and the relationship between depressive symptoms and sleep disorder indicators of different dimensions suggests that sleep disorder plays a comprehensive role in the pathogenesis of depressive disorder.