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[抑郁症及合并抑郁症状的精神障碍中的睡眠脑电图]

[Sleep electroencephalography in depression and mental disorders with depressive comorbidity].

作者信息

Eiber R, Escande M

机构信息

CMME, Hôpital Sainte-Anne, Paris.

出版信息

Encephale. 1999 Sep-Oct;25(5):381-90.

Abstract

Traditional scoring of sleep EEG in depressed patients shows abnormalities in sleep maintenance, sleep architecture, REM sleep, the distribution of slow wave and REM sleep during the night. Computerized analysis that comprises the period-amplitude analysis procedure and spectral analysis discloses changes in delta activity and distribution of delta activity. However, these methods of analysing EEG sleep are not able to distinguish the various concepts of depression: endogenous and non-endogenous depression, unipolar and bipolar depression, psychotic and non-psychotic depression. Polysomnographical data in patients with recurrent depression show alteration during remission suggesting trait-like abnormalities of sleep in depression illness. Shortened REM latency is not specific in depression. This sleep parameter is defined in many different ways explaining the heterogeneousness of study results and the failure of constituting a biological marker. Many sleep parameters are affected by several factors such as age, gender and severity. Several physiopathological hypotheses have been proposed to explain EEG sleep alterations. They refer either to circadian rhythms such as the two process model of Borbély, the phase advance hypothesis and the circadian amplitude hypothesis, or to neurotransmitter abnormalities such as the cholinergic hypothesis. None of them takes sufficient account of all the sleep abnormalities. Sleep abnormalities have also been described in other psychiatric disorders such as mania, panic and obsessional-compulsive disorders, generalized anxiety, phobias, post-traumatic stress disorder, eating disorders, borderline personality, schizophrenia and dementia. None of them have a particular sleep EEG profile which allows to differentiate between them. A concomitant episode of major depression cannot be uncovered by sleep recordings.

摘要

对抑郁症患者睡眠脑电图的传统评分显示,其在睡眠维持、睡眠结构、快速眼动睡眠、夜间慢波和快速眼动睡眠分布方面存在异常。包括周期-振幅分析程序和频谱分析在内的计算机化分析揭示了δ活动及其分布的变化。然而,这些分析睡眠脑电图的方法无法区分抑郁症的各种概念:内源性和非内源性抑郁症、单相和双相抑郁症、精神病性和非精神病性抑郁症。复发性抑郁症患者的多导睡眠图数据在缓解期显示有改变,提示抑郁症存在类似特质的睡眠异常。快速眼动潜伏期缩短在抑郁症中并不具有特异性。这个睡眠参数有多种不同的定义方式,这解释了研究结果的异质性以及未能构成生物学标志物的原因。许多睡眠参数受年龄、性别和严重程度等多种因素影响。已经提出了几种生理病理假说来解释脑电图睡眠改变。它们要么涉及昼夜节律,如博尔贝利的双过程模型、相位提前假说和昼夜振幅假说,要么涉及神经递质异常,如胆碱能假说。但它们都没有充分考虑到所有的睡眠异常情况。在其他精神疾病中也描述了睡眠异常,如躁狂症、恐慌症和强迫症、广泛性焦虑症、恐惧症、创伤后应激障碍、饮食失调、边缘型人格障碍、精神分裂症和痴呆症。它们中没有一种具有特定的睡眠脑电图特征来区分彼此。睡眠记录无法发现同时存在的重度抑郁症发作。

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