睡眠相关呼吸障碍与抑郁症的纵向关联。

Longitudinal association of sleep-related breathing disorder and depression.

作者信息

Peppard Paul E, Szklo-Coxe Mariana, Hla K Mae, Young Terry

机构信息

Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.

出版信息

Arch Intern Med. 2006 Sep 18;166(16):1709-15. doi: 10.1001/archinte.166.16.1709.

DOI:10.1001/archinte.166.16.1709

PMID:16983048

Abstract

BACKGROUND

Sleep-related breathing disorder (SRBD) and depression have each been independently associated with substantial morbidity, impairment, and disability. The development of clinical strategies for screening and managing depression in patients with SRBD requires elucidation of the association between the 2 conditions. This population-based epidemiological study assesses SRBD as a longitudinal predictor of depression.

METHODS

Men (n = 788) and women (n = 620) randomly selected from a working population were evaluated for SRBD by in-laboratory polysomnography and for depression by the Zung depression scale. Results of multiple studies, performed at 4-year intervals, were available for most participants. Sleep-related breathing disorder was characterized by the apnea-hypopnea index (AHI; events per hour) categories: AHI = 0, no SRBD; 0 < AHI < 5, minimal SRBD; 5 < or = AHI < 15, mild SRBD; and AHI > or = 15, moderate or worse SRBD. Depression was defined as a score of 50 or higher on the Zung scale or use of antidepressants. Potential confounding, interacting, and mediating factors were assessed by clinical measurements and questionnaires.

RESULTS

In purely longitudinal models, an increase of 1 SRBD category (eg, from minimal to mild SRBD) was associated with a 1.8-fold (95% confidence interval, 1.3-2.6) increased adjusted odds for development of depression. In adjusted models combining longitudinal and cross-sectional associations, compared with participants with no SRBD, the odds for development of depression were increased by 1.6-fold (95% confidence interval, 1.2-2.1) in participants with minimal SRBD, by 2.0-fold (95% confidence interval, 1.4-2.9) in participants with mild SRBD, and by 2.6-fold (95% confidence interval, 1.7-3.9) in those with moderate or worse SRBD.

CONCLUSION

Our longitudinal findings of a dose-response association between SRBD and depression provide evidence consistent with a causal link between these conditions and should heighten clinical suspicion of depression in patients with SRBD.

摘要

背景

睡眠相关呼吸障碍（SRBD）和抑郁症各自都与严重的发病率、功能损害及残疾独立相关。制定针对SRBD患者筛查和管理抑郁症的临床策略需要阐明这两种情况之间的关联。这项基于人群的流行病学研究评估SRBD作为抑郁症的纵向预测因素。

方法

从在职人群中随机选取的男性（n = 788）和女性（n = 620）通过实验室多导睡眠图评估SRBD，并通过zung抑郁量表评估抑郁症。大多数参与者有间隔4年进行的多项研究结果。睡眠相关呼吸障碍以呼吸暂停低通气指数（AHI；每小时事件数）分类来表征：AHI = 0，无SRBD；0 < AHI < 5，轻度SRBD；5≤AHI < 15，中度SRBD；AHI≥15，重度或更严重SRBD。抑郁症定义为zung量表得分50分或更高或使用抗抑郁药。通过临床测量和问卷评估潜在的混杂、交互和中介因素。

结果

在纯纵向模型中，SRBD类别增加1级（例如，从轻度到中度SRBD）与抑郁症发生的校正比值增加1.8倍（95%置信区间，1.3 - 2.6）相关。在结合纵向和横断面关联的校正模型中，与无SRBD的参与者相比，轻度SRBD参与者抑郁症发生的比值增加1.6倍（95%置信区间，1.2 - 2.1），中度SRBD参与者增加2.0倍（95%置信区间，1.4 - 2.9），重度或更严重SRBD参与者增加2.6倍（95%置信区间，1.7 - 3.9）。