不同维度慢性应激影响抑郁症患者睡眠结构的比较分析

Comparative analysis of sleep structure in depression patients with different dimensions of chronic stress

目的探讨不同维度慢性应激对抑郁症患者睡眠结构的影响。方法采用方便抽样法,纳入2018年12月至2019年8月在河北医科大学第一医院精神科就诊的101例抑郁症患者,完成生活事件量表(LES)和多导睡眠监测(PSG)检查。根据LES得分分为慢性应激组(n=70)和非慢性应激组(n=31),再将慢性应激组根据应激的事件数量、性质、强度分为高总应激组和低总应激组、高正性应激组和低正性应激组、高负性应激组和低负性应激组,每组35例,比较各组间PSG结果的差异。结果慢性应激组和非慢性应激组患者的微觉醒次数[74.0(46.3,112.3)次比58.0(28.0,92.0)次]、微觉醒指数[11.7(7.3,16.4)次/h比9.2(4.6,12.8)次/h]比较,差异有统计学意义(Z=-2.103、-2.113;P<0.05)。高总应激组和低总应激组的非快速眼球运动(NREM)3期比例比较[0(0,3.75)%比13.5(0,35.0)%],差异有统计学意义(Z=-3.100,P<0.01);高正性应激组和低正性应激组的睡眠呼吸暂停指数(AHI)[0.1(0,0.9)次/h比0.8(0.1,9.9)次/h]、低通气次数[1.0(0,4.0)次比5.0(0,50.5)次]、呼吸暂停+低通气次数[1.0(0,6.5)次比5.0(0,67.0)次]比较,差异有统计学意义(Z=-2.351、-2.631、-2.227;P<0.05)。高负性应激组和低负性应激组的快速眼球运动(REM)期比例[13.4(7.3,17.9)%比8.2(2.9,15.3)%]、NREM 3期比例[0(0,5.5)%比6.5(0,34.8)%]、低通气次数[1.0(0,4.5)次比6.0(0.5,43.0)次]、呼吸暂停+低通气次数[1.0(0,5.0)次比7.0(0.5,47.0)次]、AH[I 0.1(0,0.8)次/h比1.6(0.1,9.9)次/h]比较,差异有统计学意义(Z=-1.968、-2.428、-2.498、-2.161、-2.088;P<0.05)。结论慢性应激会导致抑郁症患者睡眠微觉醒次数增加,NREM 3期比例减少;高强度负性应激更易导致REM期比例增加,NREM 3期比例减少;高应激强度可能降低抑郁症患者的AHI。

Objective To explore the influence of different dimensions of chronic stress on objective sleep structure of patients with depression.Methods Using the convenient sampling method,a total of 101 patients with depression treated in the Department of Psychiatry of the First Hospital of Hebei Medical University,from December 2018 to August 2019,were enrolled to complete the examination of Life Event Scale(LES)and Polysomnography(PSG).According to LES score,the subjects were divided into chronic stress group(n=70)and non-chronic stress group(n=31).According to the number,nature and intensity of stress events the chronic stress group was further divided into high total stress group and low total stress group,high positive stress group and low positive stress group,high negative stress group and low negative stress group,with 35 cases in each group.The differences of PSG results among the groups were compared.Results There was significant difference in the number of microarousal[74.0(46.3,112.3)times vs 58.0(28.0,92.0)times]and microarousal index[11.7(7.3,16.4)times/h vs 9.2(4.6,12.8)times/h]between chronic stress group and nonchronic stress group(Z=-2.103,-2.113;P<0.05).There was significant difference in the proportions of nonrapid eye movement(NREM)3[0(0,3.75)%vs 13.5(0,35.0)%]between the high total stress group and low total stress group(Z=-3.100,P<0.01).The apnea-hypopnea index(AHI)[0.1(0,0.9)times/h vs 0.8(0.1,9.9)times/h],the number of hypoventilations[1.0(0,4.0)times vs 5.0(0,50.5)times],and the number of apnea+hypoventilation[1.0(0,6.5)times vs 5.0(0,67.0)times]were significantly different between the high positive stress group and the low positive stress group(Z=-2.351,-2.631,-2.227;P<0.05).The proportion of rapid eye movement(REM)phase[13.4(7.3,17.9)%vs 8.2(2.9,15.3)%],the proportion of NREM phase 3[0(0,5.5)%vs 6.5(0,34.8)%],the number of hypoventilation[1.0(0,4.5)times vs 6.0(0.5,43.0)times],the number of apnea+hypoventilation[1.0(0,5.0)times vs 7.0(0.5,47.0)times],and the comparison of AHI[0.1(0,0.8)times/h vs 1.6(0.1,9.9)times/h]were significantly different between the high negative stress group and the low negative stress group(Z=-1.968,-2.428,-2.498,-2.161,-2.088;P<0.05).Conclusions Chronic stress can lead to the increase of sleep microarousal and the decrease of NREM phase 3 proportion in patients with depression.High intensity negative stress is more likely to increase the proportion of REM phase and decrease the proportion of NREM phase 3.High stress intensity may reduce AHI in patients with depression.