Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands.
J Clin Psychiatry. 2012 Jan;73(1):31-6. doi: 10.4088/JCP.10m06455. Epub 2011 Aug 9.
Evidence from several clinical trials in patients with coronary heart disease suggests that depression that does not respond to treatment is associated with a particularly high risk of adverse cardiac outcomes. The purpose of this study was to determine whether obstructive sleep apnea/hypopnea syndrome (OSAHS) is associated with a poor response to antidepressant medication in patients with coronary heart disease.
This was a secondary analysis of data from a randomized, double-blind, placebo-controlled clinical trial of omega-3 fatty-acid augmentation of sertraline for depression in patients with coronary heart disease. Patients with documented coronary heart disease were recruited between May 2005 and December 2008 from cardiology practices in St Louis, Missouri, and through cardiac diagnostic laboratories affiliated with Washington University School of Medicine, St Louis, Missouri. One hundred five patients (mean age = 58 years) with coronary heart disease and current major depressive disorder (DSM-IV) were randomized to receive sertraline plus either omega-3 or placebo for 10 weeks. Cyclical heart-rate patterns associated with OSAHS were detected via ambulatory electrocardiography prior to treatment. Symptoms of depression were measured at baseline and follow-up with the Beck Depression Inventory-II (BDI-II) and the 17-item Hamilton Depression Rating Scale (HDRS-17). The primary endpoint was the BDI-II score at 10 weeks.
Thirty of the 105 patients (29%) were classified as having probable moderate to severe OSAHS on the basis of nighttime heart-rate patterns. These OSAHS patients had significantly higher scores on both the BDI-II (t = -2.78, P = .01) and the HDRS-17 (t = -2.33, P = .02) at follow-up as compared to the reference group. Adjustment for baseline depression score, treatment arm (omega-3 vs placebo), body mass index, and inflammatory markers did not change the results. Patients with OSAHS reported higher item scores at follow-up on all depressive symptoms measured with the BDI-II compared to those without OSAHS.
Obstructive sleep apnea/hypopnea syndrome is associated with a relatively poor response to sertraline treatment for depression. Future research should determine the contribution of OSAHS to the increased risk of adverse cardiac outcome associated with treatment-resistant depression.
几项冠心病患者临床试验的证据表明，未对治疗产生反应的抑郁症与不良心脏结局的风险特别高有关。本研究的目的是确定阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）是否与冠心病患者对抗抑郁药物治疗的反应不良有关。
这是对 omega-3 脂肪酸增强舍曲林治疗冠心病患者抑郁症的随机、双盲、安慰剂对照临床试验数据的二次分析。2005 年 5 月至 2008 年 12 月，密苏里州圣路易斯的心脏病学诊所和密苏里州圣路易斯华盛顿大学医学院附属心脏诊断实验室招募了有记录的冠心病患者。105 名（平均年龄=58 岁）有冠心病和当前重性抑郁障碍（DSM-IV）的患者被随机分配接受舍曲林加 omega-3 或安慰剂治疗 10 周。在治疗前通过动态心电图检测与 OSAHS 相关的周期性心率模式。在基线和随访时使用贝克抑郁量表第二版（BDI-II）和 17 项汉密尔顿抑郁量表（HDRS-17）测量抑郁症状。主要终点是 10 周时的 BDI-II 评分。
根据夜间心率模式，105 名患者中有 30 名（29%）被归类为可能患有中度至重度 OSAHS。与参考组相比，这些 OSAHS 患者在 BDI-II（t=-2.78，P=.01）和 HDRS-17（t=-2.33，P=.02）的随访时得分明显更高。调整基线抑郁评分、治疗组（omega-3 与安慰剂）、体重指数和炎症标志物并没有改变结果。与没有 OSAHS 的患者相比，OSAHS 患者在所有用 BDI-II 测量的抑郁症状上的随访时报告了更高的项目得分。
阻塞性睡眠呼吸暂停/低通气综合征与舍曲林治疗抑郁症的反应不良相对相关。未来的研究应确定 OSAHS 对治疗抵抗性抑郁症相关不良心脏结局风险增加的贡献。
