老年抑郁症共病阻塞性睡眠呼吸暂停低通气综合征与血脂、抑郁焦虑症状的关系

Association of obstructive sleep apnea hypopnea syndrome with blood lipid,depression and anxiety in elderly patients with depression

目的探讨老年抑郁症病人阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与血脂及抑郁、焦虑症状的相关性。方法选取2016年1月至2019年8月安徽省精神卫生中心住院的老年抑郁症病人60例,根据是否存在OSAHS,分成抑郁症伴阻塞性睡眠呼吸暂停低通气综合征组(DEP O组,30例)和抑郁症无阻塞性睡眠呼吸暂停低通气综合征组(DEP N组,30例),选取年龄、性别相匹配健康体检者30例作为健康对照组。测量三组总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL C)和低密度脂蛋白(LDL C),采用汉密尔顿抑郁量表(HAMD 24)和汉密尔顿焦虑量表(HAMA)评定三组抑郁、焦虑症状程度。结果三组在TC、HDL C和LDL C差异有统计学意义;采用LSD法进行两两比较,结果显示,DEP O组TC(4.88±0.91)mmol/L、LDL C(2.89±0.78)mmol/L高于DEP N组(4.42±0.67)mmol/L、(2.43±0.57)mmol/L(P<0.05),HDL C(1.30±0.28)mmol/L低于健康对照组(1.54±0.31)(P<0.01),LDL C高于健康对照组(P<0.05);DEP N组TC(4.42±0.67)mmol/L、HDL C(1.35±0.34)mmol/L低于健康对照组(P<0.05);三组的HAMD、HAMA评分差异有统计学意义,采用LSD法进行两两比较,结果显示,DEP O组的HAMD(27.10±6.26)分、HAMA(18.83±6.27)分高于DEP N组和对照组(P<0.05);DEP O组中HAMD、HAMA均与AHI呈正相关(P<0.05),HAMA与TC、LDL C呈正相关(P<0.05)。结论OSAHS对老年抑郁症病人的血脂代谢有影响,主要表现在TC、LDL C的升高,不论有无OSAHS,老年抑郁症病人的HDL C水平都低于健康对照组,伴有OSAHS的老年抑郁症病人有更严重的抑郁、焦虑症状,且与TC、LDL C升高以及呼吸暂停的严重程度有关。

Objective To investigate the correlation of obstructive sleep apnea hypopnea syndrome(OSAHS)with blood lipid,de pression and anxiety in geriatric depression patients.Methods Sixty cases of geriatric patients with depression,who were hospital ized in Anhui Mental Health Center from January 2016 to August 2019 were assigned,according to the presence of OSAHS or not,into depression complicated with obstructive sleep apnea hypopnea syndrome group(DEP O group,30 cases)and depression not complicated with obstructive sleep apnea hypopnea syndrom group(DEP N group,30 cases),and 30 healthy subjects having physi cal examination with matched age and gender were chosen as control group.Total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL C)and low density lipoprotein(LDL C)in the three groups were measured,and the depression and anxiety symptoms of the three groups were assessed by Hamilton depression rating scale(HAMD 24)and Hamilton anxiety rating scale(HAMA).Results There were statistically significant differences in TC,HDL C and LDL C among the three groups.LSD method was used for pairwise comparison,and the results showed that TC and LDL C levels in the DEP O group were higher than those in the DEP N group[(4.88±0.91)mmol/L vs.(4.42±0.67)mmol/L,(2.89±0.78)mmol/L vs.(2.43±0.57)mmol/L;P<0.05].HDL C level in DEP O group was lower than that in the normal control group[(1.30±0.28)mmol/L vs.(1.54±0.31),P<0.01],and LDL C level in DEP O group was higher than that in the normal control group(P<0.05).TC and HDL C levels in DEP N group were low er than those in the normal control group[(4.42±0.67)mmol/L,(1.35±0.34)mmol/L,respectively;P<0.05].HAMD and HA MA scores of the three groups showed statistically significant differences.LSD method was used for pairwise comparison,and the re sults showed that HAMD(27.10±6.26)and HAMA(18.83±6.27)scores of the DEP O group were higher than those of the DEP N group and the normal control group(P<0.05).In the DEP O group,HAMD and HAMA were positively correlated with AHI(P<0.05),and HAMA was positively correlated with TC and LDL C(P<0.05).Conclusions OSAHS has influence on the blood lipid metabolism in elderly patients with depression,mainly manifested in the increase of TC,LDL C.Regardless of the presence of OSAHS,in elderly patients with depression HDL C level is lower than that of the normal control group.Geriatric patients with de pression accompanied by OSAHS have more severe depression and anxiety symptoms,which are related to the increase of TC,LDL C and the severity of apnea.