老年人睡眠时长与抑郁症状的关系

背景 抑郁症严重危害老年人的身心健康,睡眠与抑郁症状的关系已成为研究热点之一,但目前关于睡眠与抑郁症状之间的研究结论存在差异。目的 探讨老年人睡眠时长与抑郁症状之间的关系,为预防老年人出现抑郁症状和延缓已有抑郁症状的老年人病情发展提供参考。方法 采用2018年《中国健康与养老追踪调查》数据库（CHARLS）中8 210名年龄≥60岁老年人的调查结果。按照中文简版流调中心用抑郁量表（CESD-10）评分标准,将老年人分为存在抑郁症状和不存在抑郁症状两组。使用Logistic回归及限制性立方样条模型分析老年人睡眠时长与抑郁症状之间的关联。结果 在8 210名老年人中,检出存在抑郁症状者3 118人（37.98%）,平均每晚睡眠时长为（6.14±2.05）h。睡眠时长与抑郁症状之间存在非线性关联（χ²=412.670,P<0.01,df=4）。在调整了混杂因素后,睡眠时长<6 h、6~6.9 h和≥8 h的老年人出现抑郁症状的风险分别是睡眠时长7~7.9 h老年人的2.971倍（95% CI：2.560~3.449,P<0.01）、1.372倍（95% CI：1.161~1.621,P<0.01）和1.185倍（95% CI：1.009~1.393,P<0.05）。在不同性别及60~69岁组老年人中,未发现睡眠时长≥8 h与抑郁症状检出风险有关（P>0.05）。结论 睡眠时长与抑郁症状存在近似非线性关联,但存在性别和年龄差异。     

卒中后抑郁患者睡眠障碍的治疗

目的卒中后抑郁患者应用奥氮平治疗后症状改善情况。方法对卒中后抑郁患者86例,对照组卒中患者92例进行匹兹堡睡眠质量指数（PSQI）问卷调查,分析两组患者及组中后抑郁患者奥氮平治疗前后的睡眠情况。结果卒中后抑郁组的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能等因子评分和PSQI总分均高于对照组（P〈0．05）,经奥氮平治疗后,PSQI评分明显好转（P〈0．05）。结论情感障碍可以影响患者的睡眠质量,经奥氮平治疗后睡眠障碍明显改善,显著提高了患者生活质量。     

卒中后抑郁大鼠的多导睡眠图研究

目的 探索制备理想的PSD大鼠模型及其多导睡眠图变化.方法 SD大鼠采用双侧颈总动脉结扎法制备脑卒中大鼠模型,在此基础上结合孤养、中度的不可预测应激刺激复合制备脑PSD模型,以大鼠蔗糖水饮用量实验、体重变化、Open-Field实验、多导睡眠图等来检测模型的可行性.结果 PSD组与对照组和卒中组相比,体重增长减缓(P<0.01),蔗糖水饮用量减少(P<0.01),Open-Field实验活动量减少(P<0.01),多导睡眠图中,REM潜伏期缩短和REM时间减少(P<0.01).结论 采用大鼠双侧颈总动脉永久结扎结合不可预知应激和孤养法制备的模型,模拟了PSD的发病机制,是研究PSD的理想模型;多导睡眠图可以作为PSD动物模型制备成功的参考指标.     

艾司西酞普兰对卒中后抑郁状态及神经康复的临床研究

我们用艾司西酞普兰治疗卒中后抑郁(PSD),了解PSD患者康复阶段抗抑郁药物治疗的价值。报告如下。1对象和方法对象于我院2009年1月至2010年7月首次卒中住院,并且在病情稳定出院后仍坚持在我科康复中心进行神经功     

百忧解治疗卒中后抑郁状态的临床疗效观察

作者观察了百忧解治疗卒中后抑郁状态４１例的疗效和副反应。现报道于后。１资料与方法１．１一般资料本组病例均系首发的脑血管病患者,共１０３例。其中,男７４例,女２９例。年龄４８～８２岁,平均（６２．５±５．３）岁。均为脑出血或脑梗死。急性期病程＞３０天,恢复期病程＜１年。有意识障碍、失语、认知功能障碍、不依从检查者除外。均经头颅ＣＴ或ＭＲＩ确诊。其中,出血３６例,梗死６７例,所有病例均通过Ｈａｍｉｌｔｏｎ抑郁量表（ＨＡＭＤ）１７项版本进行测评,该１０３患者中发现有４１例ＨＡＭＤ评分≥１７分,即达到抑…     

卒中后抑郁患者匹兹堡睡眠量表与多道睡眠图研究

目的 探讨卒中后抑郁（PSD）患者的主观睡眠和客观睡眠情况,比较两种评估结果是否一致.方法 使用匹兹堡睡眠量表指数（PSQI）对PSD组和对照组患者的主观睡眠状况进行评估,并应用多道睡眠仪（PSG）对PSD组患者的客观睡眠状况进行记录,比较PSD组主客观睡眠的各项指标.结果 PSD组与对照组比较,PSQI各因子分及总分值偏高,差异有显著性;PSD组患者主观睡眠比客观睡眠障碍更加严重,差异有显著性.结论 PSD患者存在睡眠障碍,且PSD患者主观睡眠障碍比客观睡眠障碍更加严重.     

痤疮患者抑郁和睡眠质量的关系

目的探究痤疮患者抑郁和睡眠质量的关系。方法选取2018年5月～2018年12月于我院接受治疗的84例痤疮患者为研究对象,按照抑郁水平(SDS量表)将所有患者分为三组:正常组(SDS评分≤50分)、轻中度抑郁组(50 SDS评分≤70分)、重度抑郁组(SDS评分 70分),分别有31例、26例、27例,比较三组患者的一般资料以及睡眠质量水平(PSQI评分),并使用Pearson法分析SDS评分与PSQI评分的相关性。结果三组患者一般情况没有明显差异,三组患者在睡眠质量评分、睡眠时间评分、睡眠效率评分、睡眠障碍评分、入睡时间评分、催眠药物评分、日间功能评分以及总分存在差异,差异均具有统计学意义(P0.05);Pearson法分析显示SDS评分与睡眠质量、睡眠时间、睡眠效率、睡眠障碍、入睡时间、催眠药物、日间功能、总分相关系数r分别为0.356、0.297、0.388、0.465、0.621、0.553、0.601、0.517。结论痤疮患者抑郁水平与PSQI评分呈正相关,临床上可以通过改善患者的抑郁水平,提高其睡眠质量。     

脑卒中后抑郁与卒中部位关系探讨

目的 研究首发脑卒中患者第4周脑卒中后抑郁与卒中部位的关系.方法 共调查127例患者,其中113例完成所有调查,将诊断为PSD的患者列为PSD组,其余患者为非PSD组.比较2组的卒中性质和卒中部位.结果 从卒中病灶发生的部位看,左侧病灶发病率(59.18%)高于右侧病灶(38.16%),前部病灶(50.85%)高于后部病灶(29.63%).皮层病灶(57.14%)高于皮层下病灶(33.80%).2组病灶数目比较,多灶患者PSD的发生率(59.68%)明显高于单灶患者(37.25%)(P<0 .05).卒中性质与PSD无明显关系(χ2＝3.86,P>0.05).结论 脑卒中后抑郁与卒中部位存在关系.     

卒中后抑郁患者的多项睡眠图研究

目的:探讨多项睡眠图(PSG)各项指标对卒中后抑郁(PSD)患者的诊断价值.方法:卒中后抑郁组(PSD组)和卒中后无抑郁组(对照组)以年龄1∶1配对,用PSG仪对两组各59例患者进行整夜睡眠描记并对结果进行分析.结果:睡眠进程:PSD组睡眠潜伏期延长,觉醒时间增多,睡眠总时间减少,睡眠效率下降,睡眠维持率下降,两组比较...     

卒中后抑郁与卒中部位的相关研究

目的 探讨卒中后抑郁（post-stroke depression PSI））与卒中病灶部位的关系。方法通过CT或MRI进行卒中病灶定位,采用Hamilton抑郁量表对200例卒中患者在发病2周和3月进行调查评分。结果急性期和恢复期大脑半球左侧、右侧、双侧卒中PSD发生率无统计学差异。2周时大脑半球前部与后部卒中病灶两PSD发生率无统计学差异（x^2=1．9546,P〉0．1）。3月时大脑半球前部与后部卒中痛灶两PSD发生率有统计学差异（x^2=6．04,P〈0．05）。结论PSD的发生无半球偏利性。急性期大脑半球前部卒中病灶与PSD无明显相关性。恢复期走脑半球前部卒中病灶与PSD存在相关性。     

脑卒中后睡眠障碍相关因素分析

目的 探讨脑卒中患者睡眠障碍的临床情况及相关影响因素.方法 选取山东省东营市胜利油田中心医院神经内科自2005年1月至2010年6月收治的脑卒中患者204例,以匹兹堡睡眠质量指数量表(PSQI)判定是否睡眠障碍,比较不同性别、年龄、脑卒中部位患者的睡眠障碍发生率.通过症状自评量表(SCL-90)比较睡眠障碍和无睡眠障碍患者的身心健康状况,通过汉密尔顿抑郁量表(HAMD)、Barthel指数和美国国立卫生研究院卒中量表(NIHSS)评分比较睡眠障碍和无睡眠障碍患者抑郁、生活能力及神经功能缺损程度的差异.结果 本组患者睡眠障碍95例,发生率为46.6%(95/204).女性患者睡眠障碍发生率较高,差异有统计学意义(P＜0.05).≥70岁患者睡眠障碍发生率最高(57.6%),其次为＜50岁(41.5%)、50～69岁人群(32.9%),脑卒中发生在皮质下患者的睡眠障碍发生率最高(64.2%),其次为大脑皮质(27.4%)、小脑(4.5%),差异均有统计学意义(P＜0.05).卒中部位位于左半球患者睡眠障碍发生率明显高于右半球患者,差异有统计学意义(P＜0.05);与脑卒中后无睡眠障碍患者比较,脑卒中后睡眠障碍患者SCL-90 9项指标、HAMD评分及NIHSS评分均较高,而Barthel指数较低,差异均有统计学意义(P＜0.05).结论 脑卒中患者睡眠障碍发生率较高,并与性别、年龄、卒中部位有关,可导致抑郁、焦虑、神经功能缺损,生活质量下降,临床治疗过程中应积极做好护理工作.

Abstract：

Objective To explore the clinical features of sleep disorder in patients with stroke and its related factors. Methods Two hundred and four patients with stroke, admitted to our hospital from January 2005 to June 2010, were chosen; Pittsburgh Sleep Quality Index (PSQI) was employed to determine whether these patients had sleep disorder; the prevalences of sleep disorder in patients with different ages, genders and lesions of stroke were compared. Symptom Checklist-90 (SCL-90)questionnaire was used to compare the physical and mental conditions of patients with or without sleep disorder; Hamilton Depression Rating Scales (HAMD), Barthel index, and National Institutes of Health Stroke Scale (NIHSS) were employed to compare the differences of depression, viability and neurologic impairment in patients with or without sleep disorder. Results The prevalence of sleep disorder was 46.6% (95/204), and it was higher in female group (53.8% vs 38.8%; x2=3.851, P=0.033). Patients aged ≥70 years had the highest rate of sleep disorder (57.6%), followed by patients aged ＜50 years (41.5%),and then patients aged between 50 and 69 years showed the lowest rate (32.9%). The sites of stroke located in the subcortex, cortex, and cerebellum enjoyed their prevalences of 64.2%, 27.4% and 4.5%,respectively. The incidence of sleep disorder in patients with stroke located in the left hemisphere was obviously higher than that in the right hemisphere (x2=7.688, P=0.008). The results of 9 indexes of SCL-90, scores of HAMD and NIHSS in patients with sleep disorder were significantly higher than those in patients without sleep disorder, while the Barthel index was in the opposite position with obvious differences (P＜0.05). Conclusion High prevalence of sleep disorder in patients with stroke is noted,which is related to gender, age of the patients and the sites of stroke, and may lead to depression, anxiety,neurological functional deficit and decrease of life quality. And we should pay more attention to nursing care during all the treatment.     

Sleep duration and risk of stroke: a dose–response meta-analysis of prospective cohort studies

ObjectivesSuboptimal sleep duration has been considered to increase the risk of stroke incidence. Thus we aimed to conduct a dose–response meta-analysis to examine the association between sleep duration and stroke incidence.MethodsWe searched PubMed, Web of science and the Cochrane Library to identify all prospective studies evaluating the association of sleep duration and nonfatal and/or fatal stroke incidence. Then, restricted cubic spline functions and piecewise linear functions were used to evaluate the nonlinear and linear dose–response association between them.ResultsWe included a total of 16 prospective studies enrolling 528,653 participants with 12,193 stroke events. Nonlinear dose–response meta-analysis showed a J-shaped association between sleep duration and total stroke with the lowest risk observed with sleeping for 7 h. Considering people sleeping for 7 h as reference, long sleepers had a higher predicted risk of total stroke than short sleepers [the pooled risk ratios (95% confidence intervals): 4 h: 1.17 (0.99–1.38); 5 h: 1.17 (1.00–1.37); 6 h: 1.10 (1.00–1.21); 8 h: 1.17 (1.07–1.28); 9 h: 1.45 (1.23–1.70); 10 h: 1.64 (1.4–1.92); p_nonlinearity<0.001]. Short sleep durations were only significantly associated with nonfatal stroke and with total stroke in the subgroups of structured interview and non-Asian countries. Additionally, we found a slightly decreased risk of ischemic stroke among short sleepers. For piecewise linear trends, compared to 7 h, every 1-h increment of sleep duration led to an increase of 13% [the pooled risk ratios (95% confidence intervals): 1.13 (1.07–1.20); p < 0.001] in risk of total stroke.ConclusionBoth in nonlinear and piecewise linear dose–response meta-analyses, long sleep duration significantly increased the risk of stroke incidence.     

Interactive effects of delayed bedtime and family-associated factors on depression in elementary school children

Shorter sleep time was reported to be associated with psychological functioning in children. We intended to examine the relationship between nocturnal sleep duration and depression status by investigating if delayed bedtime could be one of the enhancement factors for depression in children. A cross-sectional study was performed to investigate the depression status in elementary school children in middle Taiwan. Total 676 participants from 29 schools, in grades 3-6 were recruited to participate in the study. A modified depression scale for domestic school children was used to determine the depression status. Data of depression-related demographic characteristics, family, school variables and bedtime data were collected with a structured questionnaire. The results showed that almost one in five children (18%) had depression status. Delayed bedtime, child-parent relationship, family climate, and peer relationship were found to be the main predictors of childhood depression. Further stratification analysis showed that delayed bedtime significantly interacted with family climate and peer relationship on childhood depression. The risk of depression for children with a delayed bedtime of 10 PM and either in a non-harmonious family life or without a close parent-child relationship was 4.35 and 4.73 times greater than the reference group respectively. This study provides evidence for interactive effects between delayed bedtime and family concern factors which synergistically elevated the risk of childhood depression. This information may serve as a practical guide for parents and school teachers by recognizing that an adequate bedtime schedule could serve as a preventive measure against depression in children.     

Sleep disturbance and deficits of sustained attention following stroke

Objective: To simultaneously investigate the prevalence of and impact that the poststroke complications of daytime sleepiness, poor sleep quality, depression, and fatigue may be having upon deficits of sustained attention, as assessed using the Psychomotor Vigilance Task (PVT). Method: Twenty-two patients with stroke (mean age: 68.23 ± 12.17 years) and 20 healthy control participants (mean age: 68.1 ± 9.5 years) completed subjective measures of daytime sleepiness, sleep quality, fatigue, and depression and an objective measure of sustained attention as assessed using the PVT. Results: Patients with stroke compared to controls showed heightened levels of fatigue (p = .001, η² = .29) and depression (p = .002, η² = .23), plus greater deficits of sustained attention as reflected by poorer performance across all PVT outcome measures including: slower mean reaction times (p = .002, η² = .22); increased number of lapses (p = .002, η² = .24); and greater variability in reaction time (RT) responses (p = .016, η² = .15). Reaction time distribution analysis suggested that daytime sleepiness and sleep quality had little influence across PVT performance; however, depressive symptomology was associated with longer RT responses, indicative of inattention, and fatigue impacted upon the entire distribution of PVT responses. Conclusions: PVT performance illustrated significant deficits across the domain of sustained attention for patients with stroke in comparison to healthy controls, in terms of inattention as well as slower sensory–motor speed. The common poststroke complications of depressive symptomology and fatigue appear to be associated with these deficits in sustained attention, warranting further investigation.