Bilbao Adrienne-Denise V, Goldschmied Jennifer, Jang Angela, Ehrmann Daniel, Kaplish Neeraj, Pitt Bertram, Arnedt Todd, Sen Srijan, Dalack Gregory, Deldin Patricia J
Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
University of Michigan Medical School, Ann Arbor, MI, USA.
Int J Cardiol Heart Vasc. 2021 Jun 25;35:100814. doi: 10.1016/j.ijcha.2021.100814. eCollection 2021 Aug.
Major Depressive Disorder (MDD) has been linked in the literature to poorer prognosis in patients with cardiovascular dysfunction, although the mechanisms of this relationship remain unclear. Underlying Sleep Disordered Breathing (SDB) serves as a potential candidate to explain this effect due to its downstream effects on inflammatory activation and decreased nitric oxide (NO) bioavailability, both of which have been shown to contribute to the pathophysiology of both MDD and cardiovascular disease (CVD).
This study utilizes overnight polysomnography and an inflammation panel to examine the links between cardiovascular dysfunction and sleep difficulties in control participants and patients diagnosed with SDB only, MDD only, and both SDB and MDD.
Results demonstrate a strong positive relationship between sleep dysfunction and the nitric oxide synthesis inhibitor Symmetric Dimethyl Arginine (SDMA) in the MDD-only cohort, suggesting a link between SDMA-mediated NO dysregulation and CVD pathogenesis in individuals with MDD. Additionally, hypopneas, a form of sleep impairment characterized by partial reduction of airflow, were found to play a significant role in the relationship between SDB and cardiovascular dysfunction in MDD-only patients.
Results of this study demonstrate the need for widespread screening for SDB in MDD populations to detect predisposition to CVD, and also offer SDMA as a new potential target for CVD treatment in individuals with MDD.
在文献中，重度抑郁症（MDD）与心血管功能障碍患者的预后较差有关，尽管这种关系的机制尚不清楚。潜在的睡眠呼吸障碍（SDB）是解释这种效应的一个潜在候选因素，因为它对炎症激活和一氧化氮（NO）生物利用度降低具有下游影响，这两者都已被证明与MDD和心血管疾病（CVD）的病理生理学有关。
本研究利用夜间多导睡眠图和炎症指标来检查对照组参与者以及仅被诊断为SDB、仅被诊断为MDD、同时被诊断为SDB和MDD的患者中，心血管功能障碍与睡眠困难之间的联系。
结果表明，在仅患有MDD的队列中，睡眠功能障碍与一氧化氮合成抑制剂对称二甲基精氨酸（SDMA）之间存在很强的正相关关系，这表明SDMA介导的NO调节异常与MDD患者的CVD发病机制之间存在联系。此外，低通气是一种以气流部分减少为特征的睡眠障碍形式，被发现仅患有MDD的患者中，低通气在SDB与心血管功能障碍之间的关系中起重要作用。
本研究结果表明，有必要对MDD人群进行广泛的SDB筛查，以检测CVD的易感性，并且还将SDMA作为MDD患者CVD治疗的一个新的潜在靶点。
