多发腔隙性脑梗死患者抑郁症状与睡眠-觉醒昼夜节律的关系

Relationship between depressive symptoms and sleep-wake circadian rhythm in patients with multiple lacunar infarction

目的:探讨多发腔隙性脑梗死(MLI)患者抑郁症状与睡眠觉醒昼夜节律的关系。方法:选取2020年12月至2021年12月某院住院治疗的MLI患者277例,根据DSM-5卒中后抑郁症状的诊断标准和Zung氏抑郁自评量表(SDS)评分,分为MLI抑郁症状(PSD)组和MLI无抑郁症状(NPSD)组。应用智能睡眠监测系统监测睡眠参数,评估睡眠-觉醒昼夜节律日间稳定性(IS)和昼夜变异性(IV);应用昼夜节律类型(CTI)量表评估睡眠-觉醒昼夜调节能力。比较两组基本临床特征、睡眠参数、昼夜节律指标,应用多因素logistic回归分析探讨MLI患者抑郁症状与睡眠-觉醒昼夜节律的关系。结果:(1)PSD组年龄、NIHSS评分、高同型半胱氨酸血症(HHcy)、焦虑症状及梗死病灶位于额叶、颞叶、枕叶、丘脑、脑干的比例高于NPSD组(Z=-3.322,-2.897,χ^(2)=4.737,16.184,4.925,12.710,8.974,10.598,8.334;P<0.05);(2)PSD组IS、灵活性/刚性(CTI-FR)评分低于NPSD组,IV、困倦/活力(CTI-LV)评分高于NPSD组(Z=-3.255,-2.140,-2.489,-2.010,P<0.05);(3)PSD组夜间总睡眠时间(TST)、REM时间、REM%和夜间睡眠效率(SE)均低于NPSD组(Z=-3.511,t=-4.754,-3.768,Z=-4.904,P<0.05);PSD组入睡后清醒时间(WASO)、睡眠潜伏期(SL)及浅睡眠(LST)%高于NPSD组(Z=-2.817,-2.889,t=2.222,P<0.05);(4)多因素Logistic回归分析结果显示,REM%(OR=0.910,95%CI=0.853~0.971)、夜间SE(OR=0.893,95%CI=0.821~0.972)、IS(OR=0.807,95%CI=0.662~0.984)、CTI-FR(OR=0.751,95%CI=0.588~0.958)、CTI-LV(OR=1.102,95%CI=1.012~1.200)与MLI患者抑郁症状独立相关(均P<0.05)。结论:睡眠-觉醒昼夜节律与MLI抑郁症状密切相关,REM%、夜间SE、IS、CTI-FR降低或CTI-LV增高,MLI患者发生抑郁症状的危险性增高。

Objective:To explore the relationship between depressive symptoms and sleep-wake circadian rhythm in patients with multiple lacunar infarction(MLI).Methods:A total of 277 patients with MLI who were hospitalized in Kailuan General Hospital from December 2020 to December 2021 were selected.Using the DSM-5 criteria and Zung's Self-Rating Depression Scale(SDS)score,patients were categorized into MLI depressive symptoms(PSD)and MLI no depressive symptoms(NPSD)groups.An intelligent sleep monitoring system assessed sleep parameters,inter-daily stability(IS)and intra-daily variability(IV)of the sleep-wake circadian rhythm.The circadian rhythm type(CTI)scale evaluated circadian regulation ability.Clinical characteristics,sleep parameters,and circadian rhythm indicators were compared between groups.Subsequently,we employed multivariate logistic regression analysis to investigate the relationship between depressive symptoms and the sleep-wake circadian rhythm in MLI patients.Results:1The PSD group had higher age,NIHSS score,HHcy,anxiety symptoms,and the proportion of infarction lesions located in the frontal lobe,temporal lobe,occipital lobe,thalamus,and brainstem than the NPSD group(Z=-3.322,-2.897,χ^(2)=4.737,16.184,4.925,12.710,8.974,10.598,8.334;P<0.05).2In the PSD group,the IS and flexibility/rigidity(CTI-FR)scores were lower,while the IV and languid/vigorous(CTI-LV)scores were higher than those in the NPSD group(Z=-3.255,-2.140,-2.489,-2.010,P<0.05).3 The total nighttime sleep time(TST),REM,REM%and nighttime sleep efficiency(SE)in the PSD group were lower than those in the NPSD group(Z=-3.511,t=-4.754,-3.768,Z=-4.904,P<0.05);The wake time after sleep onset(WASO),sleep latency(SL)and light sleep(LST)%in the PSD group were higher than those in the NPSD group(Z=-2.817,-2.889,t=2.222,P<0.05).④Multivariate logistic regression analysis results showed that REM%(OR=0.910,95%CI=0.853~0.971),night SE(OR=0.893,95%CI=0.821~0.972)、IS(OR=0.807,95%CI=0.662~0.984),CTI-FR(OR=0.751,95%CI=0.588~0.958),CTI-LV(OR=1.102,95%CI=1.012~1.200)were independently related to depressive symptoms in patients with MLI.Conclusion:The sleep-wake circadian rhythm is closely related to the depressive symptoms of MLI.Reductions in REM%,night SE,IS,and CTI-FR,along with increased CTI-LV,suggest MLI patients face an elevated risk of developing depressive symptoms.