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Abstract
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BACKGROUND: Obstructive sleep apnea syndrome(OSAS)can perpetuate depression throughout the course of the disorder, altering the clinical presentation of depression, affecting the efficacy and prognosis, and increasing the risk of relapse. However, there are few reports on the influencing factors of depressive disorder associated with OSAS.
OBJECTIVE: To comparatively analyze the sleep quality of depressive disorder patients with and without moderate to severe OSAS, and to examine associated factors for moderate to severe OSAS in depressive disorders.
METHODS: Inpatients with depressive disorders were recruited from Department of Psychosomatic Diseases, Chaohu Hospital of Anhui Medical University from June 2017 to September 2019 by two senior attending psychiatrists using structured interviews. The sex, age, BMI, course of depression and the number of depressive episodes were collected through a survey with a questionnaire(compiled by us on the basis of reviewing available related clinical studies). The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the subjective sleep quality in the month prior to the study. Hamilton Depression Scale-17(HAMD-17)was used to evaluate the degree of depression. Cardiopulmonary coupling(CPC)was used to estimate sleep quality, and sleep parameters were collected, including total sleep time(TST), deep sleep time, light sleep time, REM sleep time, awakening time, duration of first stage of deep sleep, sleep efficiency, and apnea-hypopnea index(AHI). AHI≥15 times per hour was defined as moderate to severe OSAS. Person correlation analysis was used to examine the correlation of CPC sleep parameters with demographic information, PSQI and 17-item Hamilton Rating Scale for Depression(HAMD-17)scores. The factors associated with moderate to severe OSAS in depressive disorders were identified through binary logistic regression analysis.
RESULTS: Altogether, 102 cases were included, accounting for 64.7% of the total inpatients admitted during the period. There were 31 patients with moderate to severe OSAS and 71 patients without moderate to severe OSAS. Compared to patients without moderate to severe OSAS, those with moderate to severe OSAS had higher mean PSQI score, total score and scores of four subscales(anxiety somatic, insomnia, depressed mood, retardation)of HAMD-17, longer mean light sleep time and shorter mean deep sleep time(P<0.05). TST was negatively correlated with PSQI score(r=-0.28)(P<0.05). Light sleep time was negatively correlated with PSQI score(r=-0.71), HAMD-17 total score(r=-0.28), suicide score(r=-0.20), depressed mood score(r=-0.23)and retardation score (r=-0.30)(P<0.05). Deep sleep time was positively correlated with PSQI score(r=0.34)and HAMD-17 total score(r=0.22)(P<0.05). REM sleep time was negatively correlated with BMI(r=-0.24), and positively correlated with PSQI score(r=0.30), HAMD-17 total score(r=0.21)and suicide score(r=0.21)(P<0.05). Awakening time was positively correlated with PSQI score(r=0.29)(P<0.05). The duration of first stage of deep sleep was negatively correlated with anxiety somatic score(r=-0.21)(P<0.05). Sleep efficiency was negatively correlated with PSQI score(r=-0.29)(P<0.05). AHI was positively correlated with PSQI score(r=0.48), HAMD-17 total score(r=0.38), anxiety somatic score(r=0.24), insomnia score(r=0.20), depressed mood score(r=0.22)and retardation score(r=0.31)(P<0.05). Binary Logistic regression analysis showed that PSQI total score 〔OR=2.11, 95%CI(1.23, 3.63)〕, HAMD-17 total score 〔OR=1.45, 95%CI(1.11, 1.91)〕 and light sleep time〔OR=22.65, 95%CI(3.75, 136.68)〕 were the influencing factors of moderate to severe OSAS in depressive disorder(P<0.05).
CONCLUSION: Depression disorder patients with moderate and severe OSAS had sleep abnormalities, such as longer light sleep time and shorter deep sleep time. PSQI score, HAMD-17 total score, and light sleep time were influencing factors for depression disorder with moderate to severe OSAS. It is necessary to screen these depressive patients using CPC. Copyright © 2021 by the Chinese General Practice.
Language: zh |