a Erasme Hospital, Department of Psychiatry and Sleep Laboratory , Université libre de Bruxelles, ULB , Brussels , Belgium.
Clin Exp Hypertens. 2019;41(6):538-547. doi: 10.1080/10641963.2018.1516775. Epub 2018 Oct 10.
Since few studies have investigated the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression, the aim of this study was to examine this risk in a large sample of individuals with major depression.
Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. High blood pressure status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg during at least two medical examinations. Logistic regression analyses were conducted to examine the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression.
After adjustment for major confounding factors associated with high blood pressure, multivariate logistic regression analysis revealed that severe objective insomnia, low complaints of repeated nighttime awakenings or early morning awakening, and intermediate or low self-reported insomnia complaints were significant risk factors of high blood pressure in major depression.
In major depression, severe objective insomnia and lower self-reported insomnia complaints are associated with higher risk of high blood pressure, which justifies a better management of objective insomnia and a better assessment of insomnia complaints in this particular subpopulation to avoid the negative consequences related to the co-occurrence of high blood pressure and major depression. AHI, Apnea-Hypopnea Index; BDI, Beck Depression Inventory; BMI, Body Mass Index; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition - Text Revision; ESS, Epworth Sleepiness scale; ISI, Insomnia Severity Index; HBP, High Blood Pressure; OSA, Obstructive Sleep Apnea Syndrome; REM, rapid eye movement sleep.
由于很少有研究调查客观失眠和重度抑郁症患者自述失眠与高血压风险之间的关系，因此本研究旨在大型重度抑郁症患者样本中检验这种风险。
对从伊拉斯谟医院睡眠实验室的研究数据库招募的 703 名重度抑郁症患者的数据进行了分析。高血压状态的定义为以下之一：访谈时自我报告有医生诊断或服用降压药；或至少两次体检时平均收缩压≥140mmHg 或平均舒张压≥90mmHg。进行逻辑回归分析以检验重度抑郁症中客观失眠和自述失眠与高血压风险之间的关系。
在调整与高血压相关的主要混杂因素后，多变量逻辑回归分析显示，严重的客观失眠、夜间反复醒来或清晨醒来次数少、以及自述失眠程度中等或较低是重度抑郁症中高血压的显著危险因素。
在重度抑郁症中，严重的客观失眠和较低的自述失眠与高血压风险增加相关，这证明在这一特定亚人群中，需要更好地管理客观失眠和评估失眠症状，以避免高血压和重度抑郁症同时发生带来的负面影响。AHI，呼吸暂停-低通气指数；BDI，贝克抑郁量表；BMI，体重指数；DSM-IV-TR，精神障碍诊断与统计手册第四版 - 文本修订版；ESS，嗜睡量表；ISI，失眠严重程度指数；HBP，高血压；OSA，阻塞性睡眠呼吸暂停综合征；REM，快速眼动睡眠。
