Scharf M B, McDannold M, Zaretsky N, Spinner O, Stover R, Berkowitz D V, Conrad C
Tri-State Sleep Disorders Center, Cincinnati, OH, USA.
Am J Ther. 1999 Mar;6(2):77-82. doi: 10.1097/00045391-199903000-00004.
The standard methods of scoring sleep patterns do not ensure an accurate clinical impression of sleep quality. This is important especially in depressed insomniacs because persistent poor sleep increases the likelihood of recurrent depressive episodes. Changes in cyclic alternating patterns (CAP) in sleep have been shown to reflect corresponding changes in sleep quality. We evaluated the effects of nefazodone on CAP and standard sleep architecture in depressed insomniacs. The study was a single-center, single-blind, 6-week treatment of nefazodone hydrochloride followed by placebo withdrawal in 16 subjects meeting the DSM-IV criteria for depression who had a score of at least 18 on the 17-item Hamilton Depression Rating Scale, with insomnia-related items 4, 5, and 6 having a total score of 3 or greater. A mean daily dose of 339.1 +/- 141.7 mg at endpoint of nefazodone significantly reduced Hamilton Depression Scores from 21.7 +/- 3.0 on baseline to 5.8 +/- 5.3 (P <.05) by the end of the study. Polysomnography showed an improvement in sleep latency and sleep efficiency (P <.05), but no alterations in rapid-eye-movement or slow-wave sleep. Subjective estimates of sleep quality improved throughout the study, but CAP rates did not show a significant improvement. The disparity between CAP rates and sleep quality in depressed insomniacs is discussed.
睡眠模式的标准评分方法无法确保对睡眠质量有准确的临床判断。这一点在患有抑郁症的失眠患者中尤为重要，因为持续的睡眠不佳会增加复发性抑郁发作的可能性。睡眠中周期性交替模式（CAP）的变化已被证明可反映睡眠质量的相应变化。我们评估了奈法唑酮对患有抑郁症的失眠患者的CAP和标准睡眠结构的影响。该研究为单中心、单盲研究，对16名符合DSM-IV抑郁症标准、17项汉密尔顿抑郁量表评分至少为18分、与失眠相关的第4、5和6项总分至少为3分的受试者进行为期6周的盐酸奈法唑酮治疗，随后停用安慰剂。在奈法唑酮治疗结束时，平均每日剂量为339.1 +/- 141.7 mg，显著降低了汉密尔顿抑郁评分，从基线时的21.7 +/- 3.0降至研究结束时的5.8 +/- 5.3（P <.05）。多导睡眠图显示睡眠潜伏期和睡眠效率有所改善（P <.05），但快速眼动睡眠或慢波睡眠无变化。在整个研究过程中，对睡眠质量的主观评估有所改善，但CAP发生率未显示出显著改善。文中讨论了患有抑郁症的失眠患者中CAP发生率与睡眠质量之间的差异。
