Froese Colleen L, Butt Arsalan, Mulgrew Alan, Cheema Rupi, Speirs Mary-Ann, Gosnell Carmen, Fleming Jon, Fleetham John, Ryan C Frank, Ayas Najib T
Department of Psychiatry, University British Columbia, Vancouver, BC.
J Clin Sleep Med. 2008 Aug 15;4(4):356-61.
Symptoms related to sleep disorders are common and may have substantial adverse impacts on mental health. Indigenous North Americans (American Indian) are a medically vulnerable population with reduced access to healthcare services. The purposes of this study were to assess (1) the prevalence of sleep symptoms and (2) the relationships between symptoms and depression in this population.
We performed a community-based, door-to-door, cross-sectional survey of 3 indigenous North American groups (Gitxsan, Nisga'a and Tsimshian) living in the northwestern part of British Columbia. Between May and September of 2006, subjects completed a comprehensive questionnaire that included questions about sleep habits, medical history, subjective sleepiness (Epworth Sleepiness Scale), and depression (Personal Health Questionnaire [PHQ-9]). Weights and heights were also measured.
Four hundred thirty adults participated in the study (response rate = 42%). Their mean age was 43.2 years. Three hundred ninety-three agreed to have heights and weights measured. Their mean body mass index (BMI) was 31.0 +/- 9.2 kg/m2; 45% of them (177/393) were obese (BMI > 30 kg/m2), and 11% (43/393) were morbidly obese (BMI > 40 kg/m2). The prevalence of sleep complaints was high; insomnia symptoms was reported by 17.2%, symptoms of restless legs syndrome (RLS) by 17.7%, and frequent witnessed apneas reported (i.e., being told they stopped breathing at least 3 nights per week) by 7.6%. Of the 76 patients who had RLS symptoms, only 3 (3.9%) reported having received a diagnosis of RLS from a physician. Thirty-three subjects reported having frequent witnessed apneas, but only 5 of them (15.1%) reported having received a diagnosis of OSA from a physician. The mean PHQ9 score was 4.86 +/- 5.13 (reported by 389 subjects). Twenty-eight subjects (7.20%) had moderate to severe depression, with a PHQ-9 score of 15 or greater. In multivariable linear regression analysis, insomnia symptoms, witnessed apneas, and RLS symptoms were independently associated with an increase in PHQ9 score; frequent witnessed apneas were associated with an increase in PHQ9 by 2.46 (95% confidence interval: 0.47-4.46), insomnia symptoms by 4.49 (95% confidence interval: 3.14-5.83), and RLS symptoms by 1.82, (95% confidence interval: 0.53-3.12).
Sleep symptoms and depression are common in the indigenous North American population of northern British Columbia. Sleep-related symptoms (insomnia symptoms, witnessed nocturnal apneas, and RLS symptoms) are independently associated with depression scores. Improving access to sleep-related diagnostic and therapeutic services may substantially improve mental health in this vulnerable patient population.
与睡眠障碍相关的症状很常见，可能对心理健康产生重大不利影响。北美原住民（美洲印第安人）是医疗上的弱势群体，获得医疗服务的机会有限。本研究的目的是评估（1）该人群中睡眠症状的患病率，以及（2）症状与抑郁之间的关系。
我们对居住在不列颠哥伦比亚省西北部的3个北美原住民群体（吉特桑人、尼斯加人、钦西安人）进行了一项基于社区的挨家挨户的横断面调查。2006年5月至9月期间，受试者完成了一份综合问卷，其中包括有关睡眠习惯、病史、主观嗜睡程度（爱泼华嗜睡量表）和抑郁情况（个人健康问卷[PHQ-9]）的问题。还测量了体重和身高。
430名成年人参与了该研究（应答率 = 42%）。他们的平均年龄为43.2岁。393人同意测量身高和体重。他们的平均体重指数（BMI）为31.0 +/- 9.2 kg/m2；其中45%（177/393）为肥胖（BMI > 30 kg/m2），11%（43/393）为病态肥胖（BMI > 40 kg/m2）。睡眠问题的患病率很高；17.2%的人报告有失眠症状，17.7%的人报告有不宁腿综合征（RLS）症状，7.6%的人报告经常有目睹的呼吸暂停（即被告知他们每周至少有3个晚上停止呼吸）。在有RLS症状的76名患者中，只有3人（3.9%）报告从医生那里得到过RLS的诊断。33名受试者报告经常有目睹的呼吸暂停，但其中只有5人（15.1%）报告从医生那里得到过阻塞性睡眠呼吸暂停（OSA）的诊断。平均PHQ9评分为4.86 +/- 5.13（389名受试者报告）。28名受试者（7.20%）有中度至重度抑郁，PHQ-9评分为15分或更高。在多变量线性回归分析中，失眠症状、目睹的呼吸暂停和RLS症状与PHQ9评分的增加独立相关；经常目睹的呼吸暂停与PHQ9评分增加2.46相关（95%置信区间：0.47 - 4.46），失眠症状与PHQ9评分增加4.49相关（95%置信区间：3.14 - 5.83），RLS症状与PHQ9评分增加1.82相关（95%置信区间：0.53 - 3.12）。
在不列颠哥伦比亚省北部的北美原住民人群中，睡眠症状和抑郁很常见。与睡眠相关的症状（失眠症状、夜间目睹的呼吸暂停和RLS症状）与抑郁评分独立相关。改善获得与睡眠相关的诊断和治疗服务的机会可能会显著改善这一弱势群体的心理健康。
