度洛西汀对抑郁症多导睡眠图及主观睡眠质量的影响

目的研究度洛西汀对阻滞性和非阻滞性抑郁症患者多导睡眠图(PSG)和主观睡眠质量的影响。方法将符合中国精神障碍分类与诊断标准第3版(CCMD-3)中抑郁发作标准纳入观察的抑郁症患者32例按汉密尔顿抑郁量表(HAMD)阻滞因子的得分,分为阻滞组16例和非阻滞性组16例,两组均采用度洛西汀治疗,疗程4周。治疗前后采用PSG测定睡眠特点,匹兹堡睡眠质量指数(PSQI)评定主观睡眠质量,HAMD减分率评定疗效。结果阻滞组治疗前和治疗后PSQI评分与非阻滞组相比无显著差异(P>0.05);两组治疗后PSQI评分均显著低于治疗前(P<0.05)。阻滞组和非阻滞组治疗后觉醒次数和觉睡比增加,睡眠效率降低,S1百分比增加,SWS时间延长,快速眼动(REM)睡眠百分比及睡眠时间减少,REM睡眠潜伏期延长,REM活动度和强度及密度均降低,与治疗前比较均有显著性差异(P<0.05);治疗后阻滞组REM睡眠百分比及睡眠时间高于非阻滞组(P<0.01),余各指标治疗后两组间比较无明显差异(P>0.05)。相关分析显示,阻滞组和非阻滞组PSQI的变化率与所有PSG指标变化率均无显著相关性(P>0.05)。结论度洛西汀能延长阻滞性和非阻滞性抑郁症患者慢波睡眠,度洛西汀治疗后PSG和主观睡眠质量变化间可能并不存在相关性。

Effect of duloxetine on polysomnography and subjective sleep quality of the patients with retardative depression and non-retardative depression

Objective To investigate the effect of duloxetine on polysomnography and subjective sleep quality in retardative depression and non-retardative depression.Methods The 32 patients with depression without any medicine at least for 1 month were assessed in this study.Based on the scores of retardation of Hamilton Depression Scale(HAMD),the patients were divided into the group of retardative depression and the group of non-retardative depression.All the subjects were received duloxetine for 4 weeks,polysomnography and Pittsburgh sleep quality index(PSQI) were estimated at the begin and 4 weeks after treatments.Results There was no significant difference between retardative depression group and non-retardative depression group either before or after treatment on PSQI(P>0.05).The scores of PSQI both in two groups after treatment were lower than before(P<0.05).Compared with before,higher AN(awakening number) and A/TST%(the percentage of AT),lower SE(sleep efficiency),higher S1%(the percentage of 1 sleep),higher SWS%,lower RT(REM sleep time) and RT%(the percentage of RT),higher SL(sleep latency),and lower RA(REM activity),RI(REM intensity) and RD(REM density) were showed significant difference after treatment both in retardative depression group and non-retardative depression group(P<0.05 or 0.01).After treatment,except for RT and RT%(P<0.05),there were no significant difference between two groups(P>0.05).The correlation between the reduction rate of the PSQI total score and the change rate of all the PSG was not great(P>0.05).Conclusion Duloxetine could both extend the SWS(S3+S4) in retardative depression and non-retardative depression.There is no relationship between the reduction rate of the PSQI total score and the change rate of all the PSG parameters after treatment.