Sleep Medicine Institute and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Depress Anxiety. 2011 Aug;28(8):676-85. doi: 10.1002/da.20828. Epub 2011 May 23.
Sleep disturbances and symptoms of depression are common during pregnancy. Both are independent and interrelated risk factors for adverse outcomes. It is unclear the degree to which sleep differs between depressed and nondepressed pregnant women. We sought to (1) describe and compare sleep disturbances in depressed pregnant and nondepressed pregnant women, (2) determine the impact of selective serotonin reuptake inhibitors (SSRI) treatment on sleep, and (3) evaluate whether sleep at 20 weeks is associated with increased depressive symptoms and major depressive disorder (MDD) in later pregnancy.
Pregnant women (N = 240) were recruited in the second trimester (20 weeks gestation) and assigned to depressed (N = 59) and nondepressed (N = 181) groups based on a Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder. The Structured Interview Guide for the Hamilton Rating Scale with Atypical Depression Supplement was administered at 20, 30, and 36 weeks gestation from which the sleep variables were obtained.
Depressed women had more fragmented sleep at each assessment (P values≤.05). However, the frequency of insomnia symptoms was greater for depressed women only at 20 weeks gestation. SSRI use, regardless of MDD status, did significantly affect several sleep variables. Among the nondepressed women, those with short or longer sleep duration, symptoms of insomnia and long periods of nocturnal waketime had higher Structured Interview Guide for the Hamilton Rating Scale with Atypical Depression Supplement scores later in pregnancy (P values≤.05).
At 20 and 30 weeks gestation sleep was more disturbed in depressed pregnant women compared to nondepressed pregnant women. At 36 weeks, sleep was disturbed regardless of depression status or SSRI use. Among the nondepressed women, disturbed sleep in conjunction with SSRI use was associated with higher depressive symptoms.
睡眠障碍和抑郁症状在怀孕期间很常见。两者都是不良结局的独立且相互关联的危险因素。目前尚不清楚抑郁和非抑郁孕妇之间的睡眠差异程度。我们旨在：（1）描述和比较抑郁和非抑郁孕妇的睡眠障碍；（2）确定选择性 5-羟色胺再摄取抑制剂（SSRIs）治疗对睡眠的影响；（3）评估 20 周时的睡眠是否与妊娠后期抑郁症状加重和重度抑郁症（MDD）相关。
在妊娠中期（20 周妊娠）招募了 240 名孕妇，并根据 DSM-IV 重性抑郁障碍的结构临床访谈将其分为抑郁组（N=59）和非抑郁组（N=181）。在妊娠 20、30 和 36 周时使用 Hamilton 抑郁评定量表伴非典型性抑郁补充版的结构化访谈指南进行评估，从中获得睡眠变量。
抑郁组在每次评估时的睡眠碎片化程度更高（P 值均≤.05）。然而，仅在妊娠 20 周时，抑郁组女性的失眠症状频率更高。SSRIs 的使用，无论 MDD 状态如何，都显著影响了几个睡眠变量。在非抑郁女性中，睡眠持续时间较短或较长、失眠症状和夜间觉醒时间较长的女性在妊娠后期的 Hamilton 抑郁评定量表伴非典型性抑郁补充版评分更高（P 值均≤.05）。
与非抑郁孕妇相比，妊娠 20 周和 30 周时抑郁孕妇的睡眠更受干扰。在 36 周时，无论抑郁状态或 SSRIs 使用情况如何，睡眠都受到干扰。在非抑郁女性中，与 SSRIs 使用相关的睡眠障碍与更高的抑郁症状相关。
