Clark C, Dupont R, Golshan S, Gillin J C, Rapaport M H, Kelsoe J R
Department of Psychiatry 9116A University of California at San Diego 92093, USA.
J Affect Disord. 2000 Jul;59(1):77-83. doi: 10.1016/s0165-0327(99)00135-4.
One night of total sleep deprivation or of late-night partial sleep deprivation (PSD) produces a temporary remission in approximately 40-60% of patients with major depressive disorder; however, little is known about polysomnography (PSG) characteristics of responders to these types of sleep deprivation (SD).
Twenty-three unmedicated unipolar patients (17-item Hamilton Depression Rating Scale (HDRS17) >16) and 14 normal controls underwent 1 night of late-night PSD (awake after 3 a.m.) Subjects underwent baseline PSG and received the HDRS17 at standard times before and after PSD. Clinical response was defined as a reduction of >30% in the modified HDRS17 (omitting sleep and weight loss items) following PSD.
The 12 responders and 11 nonresponders did not differ from each other significantly on baseline HDRS17 or PSG variables. The only PSG variable correlating with percent decrease in modified HDRS17 was baseline REM density (Pearson's r=-0.52, n=23, P=0.01.) In other words, the lower the baseline REM density, the more robust the antidepressant response was.
Subject numbers are relatively small.
Increased REM density, which reflects the number of rapid eye movements per epoch of REM sleep, may be a physiological marker for severity or poor prognosis in a variety of psychiatric disorders, including relapse in recovering alcoholics, suicidality in schizophrenia, and poor response to PSD or interpersonal psychotherapy in depression.
一晚的完全睡眠剥夺或深夜部分睡眠剥夺（PSD）可使约40%-60%的重度抑郁症患者获得暂时缓解；然而，对于这些类型睡眠剥夺（SD）的反应者的多导睡眠图（PSG）特征知之甚少。
23名未用药的单相抑郁症患者（汉密尔顿抑郁量表17项版（HDRS17）>16）和14名正常对照者接受了1晚的深夜PSD（凌晨3点后保持清醒）。受试者接受了基线PSG检查，并在PSD前后的标准时间接受HDRS17评估。临床反应定义为PSD后改良HDRS17（省略睡眠和体重减轻项目）降低>30%。
12名反应者和11名无反应者在基线HDRS17或PSG变量上无显著差异。与改良HDRS17降低百分比相关的唯一PSG变量是基线快速眼动睡眠密度（Pearson相关系数r=-0.52，n=23，P=0.01）。换句话说，基线快速眼动睡眠密度越低，抗抑郁反应越强。
受试者数量相对较少。
快速眼动睡眠密度增加反映了快速眼动睡眠每个时段的快速眼动次数，可能是多种精神障碍严重程度或预后不良的生理标志物，包括戒酒者复发、精神分裂症患者自杀倾向以及抑郁症患者对PSD或人际心理治疗反应不佳。
