单相和双相抑郁障碍患者睡眠特征及其认知功能相关性研究

摘要

目的 观察不同类型抑郁障碍患者的睡眠特征及其认知功能状态,探讨两者的相关性.方法 入选15例复发性抑郁症患者(单相组)、13例双相Ⅰ型情感障碍抑郁发作患者(双相组)和15名健康者(对照组),采用多导睡眠仪监测睡眠,并进行认知功能测评,对患者睡眠特征与认知功能进行相关性分析.结果 与对照组相比,双相组睡眠潜伏期延长(P=0.004),睡眠效率下降(P=0.007)；单相组睡眠效率下降(P=0.038),觉醒次数(P =0.019)增加,入睡后觉醒时间增加(P=0.035),第1期(S1)睡眠时间(P =0.028)及睡眠百分比(P=0.015)均增加,第2期(S2)睡眠百分比增加(P=0.014),第3期(S3)睡眠时间(P=0.002)及睡眠百分比(P=0.002)均减少,快速动眼睡眠(REM)潜伏期延长(P=0.019).单双相组相比睡眠监测指标差异无统计学意义.认知功能评估方面,单相组学习评分与REM睡眠时间、REM睡眠百分比高度正相关(r值分别为0.63、0.69,P值分别为0.034、0.020),与REM睡眠潜伏期高度负相关(r=-0.74,P=0.009)；记忆评分与S2睡眠百分比高度负相关(r=-0.65,P=0.029),与REM睡眠潜伏期高度负相关(r=-0.72,P=0.012).双相组睡眠指标与学习、记忆评分未发现相关性.结论 双相抑郁障碍患者存在一定睡眠结构紊乱,单相抑郁症患者存在明显的睡眠进程和睡眠结构紊乱；单双相抑郁障碍患者的睡眠指标与学习、记忆认知功能的相关性可能存在差异.%Objectives To compare the sleep parameters and certain neurocognitive tasks between patients with unipolar and bipolar depression,and to explore the correlation between sleep pattern and certain cognitive function.Methods Fifteen patients with unipolar depression,thirteen patients with bipolar depression,and fifteen health controls were recruited.Sleep parameters were recorded by polysomnography for three groups respectively.The certain cognitive tasks were finished in patients group.Results Compared with control group,the bipolar patients had longer sleep latency (P =0.004),poorer sleep efficiency(P =0.007),while the unipolar patients had poorer sleep efficiency(P =0.038),less slow wave sleep (P =0.002),more numbers of wake (P =0.019),longer duration of wake after sleep onset (P =0.035),increased proportion of S1 (P =0.028) and S2 sleep(P =0.014),decreased proportion of S3 (P =0.002),and longer REM sleep latency (P =0.019).No significant difference of polysomnographically recorded sleep parameters were found between unipolar and bipolar group.There was no significant correlation between sleep parameters and certain cognitive tasks in bipolar group.In unipolar group,the verbal learning field was related with REM sleep duration (r =0.63,P =0.034),proportion of REM (r =0.69,P =0.020),REM sleep latency(r =-0.74,P =0.009),while the visual memory field was related with proportion of S2 (r =-0.65,P =0.029) and REM sleep latency(r =-0.72,P =0.012).Conclusions The sleep disturbance in the bipolar group may be mild,while in the unipolar group,the disturbance is focused on the sleep continuity and architecture.The relationship of the sleep parameters and certain neurocognitive field may be different between unipolar and bipolar depression.