具有自杀倾向的抑郁症患者睡眠脑电图特点

戴春晓 高力舒 张海生 尚玉珊 谢健

[關键词] 抑郁症;自杀;多导睡眠;REM期睡眠

[中图分类号] R749.4          [文献标识码] B          [文章编号] 1673-9701（2021）29-0117-05

Characteristics of sleep electroencephalogram in depression patients with suicidal tendency

DAI Chunxiao   GAO Lishu   ZHANG Haisheng   SHANG Yushan   XIE Jian

Department of Clinical Psychology， Affiliated Hangzhou First People′s Hospital， Zhejiang University School of Medicine， Hangzhou   310006， China

[Abstract] Objective To explore the characteristics of sleep EEG in patients with suicidal depression and the correlation between abnormal sleep parameters and suicide risk. Methods From January 2017 to December 2019， a total of 71 patients with depression at risk of suicide， 66 patients with depression at no suicide risk， and 65 patients normal controls hospitalized in the Department of Clinical Psychology in the Affiliated Hangzhou First People′s Hospital， Zhejiang University School of medicine were monitored by polysomnography.The various sleep parameters were compared. The correlation between abnormal EEG indicators and the risk of suicide in depression was explored. Results ① There were significant differences in HAMD24 and HAMA among the three groups（P<0.01）. HAMD24 in the suicide risk group was significantly higher than the suicide risk group （P<0.01）.There was no significant difference in HAMA between the two groups （P>0.05）.②There were significant differences in the total sleep time （TST）， sleep latency （SL）， the percentage of non-rapid eye movement sleep stage one （NREM1%）， REM latency （RL）， REM density （RD）， among the three groups （P<0.05）. There was no significant difference in pairwise comparisons （P>0.05）. The sleep maintenance rate （SM%）， wake time （A）， NREM2%， NREM3%+4%， rapid eye movement sleep percentage （REM%）， rapid eye movement sleep time （REMT）， REM activity （RA）， REM intensity （RI） parameters were significantly different among the three groups （P<0.01）.And there were significant differences in pairwise comparisons between the three groups（P<0.01）.③After controlling the two factors of anxiety and depression， the risk of suicide was still positively correlated with RA （r=0.333， P<0.01）， RI（r=0.279，P<0.01）， and RD（r=0.148， P<0.01）. Conclusion Depression patients at risk of suicide have more extensive sleep indicator abnormalities， and abnormal sleep in the REM phase may indicate a high risk of suicide.

[Key words] Depression; Suicide; Polysomnography; REM sleep

抑郁症是有高自杀风险的常见精神疾病[1]，11%～63%的抑郁症患者有自杀观念[2]，而15%的患者存在着多次的自杀未遂[3]。诸多研究结果提示睡眠紊乱和自杀之间存在着关联[4-5]，失眠可能是自杀的一个独立风险因子[6]。睡眠紊乱几乎贯穿抑郁症发生、发展及疾病的转归，不仅影响抑郁症的发生，更会影响抑郁严重程度甚至复发[7]。抑郁症患者存在着多个睡眠脑电图参数的改变[8]，但抑郁症自杀风险与多导睡眠参数相关性的报道国内外不多。本研究探讨具有自杀倾向的抑郁症患者的睡眠脑电图特征，并试图探索异常的睡眠指标与自杀风险的相关性，现报道如下。

1 资料与方法

1.1 一般资料

所有病例为2017年1月至2019年12月在杭州市第一人民医院临床心理科住院患者。纳入标准[9]：①年龄18～65岁;②本次发作符合美国精神障碍诊断与统计手册第5版（Diagnostic and statistical manual of mental disorders，fifth edition，DSM-5）重性抑郁障碍的诊断标准[10];③24项汉密尔顿抑郁量表（Hamilton depression scale，HAMD24）总分≥20分;④未服用任何抗抑郁药及其他精神药物，或入组前停用该类药物4周以上。排除标准[11]：①妊娠及哺乳期妇女;②药物、酒精依赖者;③排除有严重躯体疾病及精神活性物质依赖者;④排除有睡眠呼吸暂停综合征者。符合标准者137例。采用M.I.N.I（the MINI-International neuropsychiatric interview，M.I.N.I.）自杀模块来评估自杀风险，该模块共6个问题[12]：①您是否觉得死了会更好或者希望自己已经死了？回答是计1分;②您是否想要伤害自己？回答是计2分;③您是否想到自杀？……