Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
J Clin Sleep Med. 2018 Mar 15;14(3):427-435. doi: 10.5664/jcsm.6992.
Posttraumatic stress disorder (PTSD) is associated with suicidal ideation (SI) and obstructive sleep apnea (OSA). There are no studies of OSA diagnosed by sleep study and SI in patients with PTSD.
Forty consenting civilians with PTSD (38 female, mean ± standard deviation age: 44.60 ± 12.73) underwent a Level 3 home sleep apnea test (WatchPAT200; Itamar Medical, Israel). OSA severity was measured with the respiratory disturbance index (RDI) (number of apneas, hypopneas and respiratory effort related arousals per hour). SI was measured with Items 9, 35, 39, and 50 of the Brief Symptom Inventory (BSI). Other patient-rated measures included the Beck Depression Inventory, second edition (BDI-II), PTSD Checklist for DSM-5 (PCL-5), and the Pittsburgh Sleep Quality Index PTSD Addendum modified to include only Items 1c, 1e, 1f, and 1g that address nightmares.
The RDI ( = .757, < .001) and oxygen desaturation index ( = .633, < .001) were directly correlated to SI. Multiple regression analysis using SI as the dependent variable and patient-rated measures as independent variables revealed only RDI (β = .480, = 4.167, < .001) and BDI-II (β = .469, = 3.375, = .002) as predictors of SI, with adjusted R = 0.718. In patients with RDI < 30 events/h (n = 37) correlation of SI with RDI ( = .511, = .001) but not ODI ( = .312, = .060) remained significant. Multiple regression analysis (when RDI < 30 events/h) revealed only BDI-II (β = .603, = 3.492, = .002), and not RDI (β = .247, = 1.723, = .096) as a significant predictor of SI.
OSA severity in PTSD was directly related to SI. Depression was a significant mediator in the relationship between RDI and SI, with OSA-related intermittent hypoxemia possibly contributing to this relationship only in severe OSA.
创伤后应激障碍（PTSD）与自杀意念（SI）和阻塞性睡眠呼吸暂停（OSA）有关。目前尚无研究通过睡眠研究和 PTSD 患者的 SI 来诊断 OSA。
40 名同意参加研究的 PTSD 平民（38 名女性，平均年龄 ± 标准差：44.60 ± 12.73 岁）接受了三级家庭睡眠呼吸暂停测试（WatchPAT200；Itamar Medical，以色列）。OSA 严重程度用呼吸紊乱指数（RDI）（每小时呼吸暂停、低通气和呼吸努力相关觉醒的次数）来衡量。SI 用 Brief Symptom Inventory（BSI）的项目 9、35、39 和 50 来衡量。其他患者自评量表包括 Beck 抑郁量表第二版（BDI-II）、DSM-5 PTSD 检查表（PCL-5）和匹兹堡睡眠质量指数 PTSD 附加量表，该量表仅包括第 1c、1e、1f 和 1g 项，用于评估噩梦。
RDI（r =.757，p <.001）和氧减指数（r =.633，p <.001）与 SI 呈正相关。以 SI 为因变量，患者自评量表为自变量的多元回归分析显示，只有 RDI（β =.480，p = 4.167，p <.001）和 BDI-II（β =.469，p = 3.375，p =.002）是 SI 的预测因子，调整后的 R 为 0.718。在 RDI < 30 事件/小时的患者中（n = 37），SI 与 RDI 的相关性（r =.511，p =.001）仍然显著，但与 ODI 的相关性（r =.312，p =.060）不显著。当 RDI < 30 事件/小时时，多元回归分析显示只有 BDI-II（β =.603，p = 3.492，p =.002），而不是 RDI（β =.247，p = 1.723，p =.096）是 SI 的显著预测因子。
PTSD 中的 OSA 严重程度与 SI 直接相关。抑郁是 RDI 与 SI 之间关系的重要中介，OSA 相关的间歇性低氧血症可能仅在严重 OSA 中对这种关系有贡献。
