双相障碍患者阻塞性睡眠呼吸暂停的临床特征。

Clinical characteristics of obstructive sleep apnea in bipolar disorders.

机构信息

Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, cedex 10, France; Fondation FondaMental, Créteil 94000, France..

Univ. Bordeaux, SANPSY, USR 3413 F-33000 Bordeaux, France; CNRS-SANPSY, USR 3413, F-33000 Bordeaux, France; Clinique du sommeil, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.

出版信息

J Affect Disord. 2019 Feb 15;245:1-7. doi: 10.1016/j.jad.2018.10.096. Epub 2018 Oct 9.

DOI:10.1016/j.jad.2018.10.096

PMID:30359809

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is one of the leading non-psychiatric comorbidities in bipolar disorders (BD). We sought to explore associations between risk of OSA in BD, clinical characteristics alongside with both subjective sleep complaints and objective sleep abnormalities.

METHODS

Euthymic patients with BD (n = 144) were assessed over a three-week period, by actigraphy, clinical interviews and questionnaires.

RESULTS

Of the study sample, 32 (22%) individuals were at high risk of OSA (HR-OSA) and 112 (78%) had a low risk (LR-OSA), as assessed with the Berlin questionnaire. HR-OSA, compared to LR-OSA, were older (p = 0.031), had higher BMI (p < 0.0005), larger neck circumference (p = 0.002), and more residual depressive symptoms (p < 0.0005). HR-OSA was also associated with greater sleepiness (p = 0.003), poorer sleep quality (p = 0.003), insomnia complaints (p = 0.027), "languid" chronotype (p = 0.002), and higher actigraphy-derived fragmentation index (p = 0.015). Backward stepwise linear regression retained BMI and depressive symptoms (correct classification of 83% of participants). Classification increased up to 85.4% when adding sleepiness and languid-vigorous scales and up to 87.8% when adding fragmentation index. Combining ROC curve analysis and Youden Index provided best cut-offs (HR-OSA if cut-off greater than or equal to) of 29.84 for BMI (Sensibility(Se) = 0.47, Specificity(Spe) = 0.96) and 1.5 for MADRS total score (Se = 0.84, Spe = 0.58).

LIMITATIONS

No confirmation of OSA diagnosis with polysomnography.

CONCLUSIONS

Higher BMI and residual depressive symptoms are the two best independent predictors of OSA in BD. Such information contributes to improving the screening and management of OSA in BD.

TRIAL NUMBER

NCT02627404.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）是双相情感障碍（BD）的主要非精神共病之一。我们旨在探讨 BD 中 OSA 的风险与临床特征以及主观睡眠主诉和客观睡眠异常之间的关联。

方法

144 名病情稳定的 BD 患者在三周内通过活动记录仪、临床访谈和问卷调查进行评估。

结果

在研究样本中，32 名（22%）个体存在 OSA 高风险（HR-OSA），112 名（78%）个体存在 OSA 低风险（LR-OSA），评估工具为柏林问卷。与 LR-OSA 相比，HR-OSA 的年龄更大（p=0.031）、BMI 更高（p<0.0005）、颈围更大（p=0.002）、残留抑郁症状更多（p<0.0005）。HR-OSA 还与嗜睡程度更高（p=0.003）、睡眠质量更差（p=0.003）、失眠主诉更多（p=0.027）、“懒散”的昼夜节律型（p=0.002）和更高的活动记录仪衍生碎片化指数（p=0.015）相关。向后逐步线性回归保留 BMI 和抑郁症状（正确分类 83%的参与者）。当加入嗜睡和懒散活跃量表时，分类增加到 85.4%，当加入碎片化指数时，分类增加到 87.8%。结合 ROC 曲线分析和 Youden 指数提供了最佳的截断值（如果截断值大于或等于 HR-OSA）为 29.84（BMI 的敏感性（Se）为 0.47，特异性（Spe）为 0.96）和 1.5（MADRS 总分的 Se 为 0.84，Spe 为 0.58）。