Maglione Jeanne E, Ancoli-Israel Sonia, Peters Katherine W, Paudel Misti L, Yaffe Kristine, Ensrud Kristine E, Tranah Greg J, Stone Katie L
Department of Psychiatry, University of California, San Diego, La Jolla, CA.
Department of Psychiatry, University of California, San Diego, La Jolla, CA; Department of Medicine, University of California, San Diego, La Jolla, CA.
Am J Geriatr Psychiatry. 2014 Apr;22(4):349-61. doi: 10.1016/j.jagp.2012.09.003. Epub 2013 Mar 26.
Aging is associated with changes in circadian rhythms. Current evidence supports a role for circadian rhythms in the pathophysiology of depression. However, little is known about the relationship between depressive symptoms and circadian activity rhythms in older adults. We examined this association in community-dwelling older women.
We performed a cross-sectional analysis of 3,020 women (mean age: 83.55 ± 3.79 years) enrolled in the Study of Osteoporotic Fractures. Depressive symptoms were assessed with the Geriatric Depression Scale categorizing participants as "normal" (0-2; referent group, N = 1,961), "some depressive symptoms" (3-5, N = 704), or "depressed" (≥6, N = 355). Circadian activity rhythm variables were measured using wrist actigraphy.
In age-adjusted and Study of Osteoporotic Fractures site-adjusted models, greater levels of depressive symptoms were associated with decreased amplitude (height; df = 3,014, t = -11.31, p for linear trend <0.001), pseudo F-statistic (robustness; df = 3,014, t = -8.07, p for linear trend <0.001), and mesor (mean modeled activity; df = 3014, t = -10.36, p for linear trend <0.001) of circadian activity rhythms. Greater levels of depressive symptoms were also associated with increased odds of being in the lowest quartile for amplitude (df = 1, χ(2) = 9240, p for linear trend <0.001), pseudo F-statistic (df = 1, χ(2) = 49.73, p for linear trend <0.001), and mesor (df = 1, χ(2) = 81.12, p for linear trend <0.001). These associations remained significant in multivariate models. Post-hoc analyses comparing mean amplitude, mesor, and pseudo F-statistic values pair-wise between depression-level groups revealed significant differences between women with "some depressive symptoms" and the "normal" group.
These data suggest a graded association between greater levels of depressive symptoms and more desynchronization of circadian activity rhythms in community-dwelling older women. This association was observed even for women endorsing subthreshold levels of depressive symptoms.
衰老与昼夜节律的变化有关。目前的证据支持昼夜节律在抑郁症病理生理学中的作用。然而，关于老年人抑郁症状与昼夜活动节律之间的关系知之甚少。我们在社区居住的老年女性中研究了这种关联。
我们对参加骨质疏松性骨折研究的3020名女性（平均年龄：83.55±3.79岁）进行了横断面分析。使用老年抑郁量表评估抑郁症状，将参与者分为“正常”（0 - 2分；参照组，N = 1961）、“有一些抑郁症状”（3 - 5分，N = 704）或“抑郁”（≥6分，N = 355）。使用手腕活动记录仪测量昼夜活动节律变量。
在年龄调整和骨质疏松性骨折研究地点调整的模型中，抑郁症状水平越高，与昼夜活动节律的振幅降低（高度；自由度 = 3014，t = -11.31，线性趋势p <0.001）、伪F统计量（稳健性；自由度 = 3014，t = -8.07，线性趋势p <0.001）和中值（平均模拟活动；自由度 = 3014，t = -10.36，线性趋势p <0.001）相关。抑郁症状水平越高，处于振幅、伪F统计量和中值最低四分位数的几率也越高（自由度 = 1，χ(2)=9240，线性趋势p <0.001；自由度 = 1，χ(2)=49.73，线性趋势p <0.001；自由度 = 1，χ(2)=81.12，线性趋势p <0.001）。这些关联在多变量模型中仍然显著。事后分析比较抑郁水平组之间的平均振幅、中值和伪F统计量值，发现“有一些抑郁症状”的女性与“正常”组之间存在显著差异。
这些数据表明，在社区居住的老年女性中，抑郁症状水平越高与昼夜活动节律的同步性越差之间存在分级关联。即使对于认可亚阈值水平抑郁症状的女性，也观察到了这种关联。
