Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
Sleep Med. 2012 Oct;13(9):1171-7. doi: 10.1016/j.sleep.2012.06.024. Epub 2012 Aug 19.
Alterations in circadian rhythms can have profound effects on mental health. High co-morbidity for psychiatric disorders has been observed in patients with circadian rhythm disorders, such as delayed sleep phase disorder (DSPD), and in those with an evening-type circadian preference. The aim of this study was to systematically determine the prevalence and type of Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM IV) Axis-I disorders in those with DSPD compared to evening-type controls.
Forty-eight DSPD and 25 evening-type participants took part in this study. Sleep and wake parameters were assessed with actigraphy, diary and questionnaires (Pittsburgh Sleep Quality Index (PSQI) and Functional Outcomes of Sleep Questionnaire (FOSQ). Evening-type preference was defined by the Horne-Ostberg questionnaire. DSPD was determined by an interview according to International Classification of Sleep Disorders criteria. Current and past diagnoses of psychiatric disorders were assessed with a Structured Clinical Interview for DSM-IV disorders.
DSPD was associated with a later wake time, longer sleep time, higher PSQI score and lower Horne-Ostberg and FOSQ scores compared to evening-types. There were no significant differences in the prevalence or type of Axis-I disorders between those with DSPD or evening-type preference. Over 70% of participants met criteria for at least one past Axis-I disorder. Approximately 40% of both the DSPD and evening-types met criteria for a past diagnosis of mood, anxiety (most frequently phobia) or substance-use disorders. Evening types were more likely to have a past diagnosis of more than one Axis-I disorder.
These results highlight the important link between circadian rhythms and mental disorders. Specifically, an evening circadian chronotype regardless of DSPD status is associated with a risk for anxiety, depressive or substance-use disorders.
昼夜节律的改变会对心理健康产生深远的影响。睡眠时相延迟障碍（DSPD）等昼夜节律障碍患者以及傍晚型昼夜节律偏好者的精神障碍共病率较高。本研究旨在系统地确定与傍晚型对照组相比，DSPD 患者中第四版《精神障碍诊断与统计手册》（DSM-IV）轴 I 障碍的患病率和类型。
48 名 DSPD 患者和 25 名傍晚型参与者参加了这项研究。使用活动记录仪、日记和问卷（匹兹堡睡眠质量指数（PSQI）和睡眠功能结果问卷（FOSQ）评估睡眠和觉醒参数。傍晚型偏好通过霍恩-奥斯特伯格问卷定义。根据国际睡眠障碍分类标准，通过访谈确定 DSPD。使用DSM-IV 障碍的结构临床访谈评估当前和过去的精神障碍诊断。
与傍晚型相比，DSPD 患者的觉醒时间较晚，睡眠时间较长，PSQI 评分较高，Horne-Ostberg 和 FOSQ 评分较低。DSPD 患者和傍晚型偏好者之间的轴 I 障碍患病率或类型无显著差异。超过 70%的参与者符合至少一种过去轴 I 障碍的标准。大约 40%的 DSPD 和傍晚型患者符合过去情绪、焦虑（最常见的恐惧症）或物质使用障碍的诊断标准。傍晚型更有可能有过去的一种以上轴 I 障碍的诊断。
这些结果强调了昼夜节律和精神障碍之间的重要联系。具体而言，无论 DSPD 状态如何，傍晚的昼夜节律时型与焦虑、抑郁或物质使用障碍的风险相关。
