Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania.
Arch Phys Med Rehabil. 2023 Aug;104(8):1203-1208. doi: 10.1016/j.apmr.2023.01.013. Epub 2023 Feb 2.
To examine which 24-hour rest-activity rhythm (RAR) characteristics are associated with depression symptoms in stroke survivors.
Cross-sectional observational study examining associations of RAR characteristics with the presence of depression symptoms adjusting for age, sex, race, and medical comorbidity.
Community setting.
Stroke survivors: (1) recruited locally (N women=35, N men=28) and (2) a nationally representative probability sample (the National Health and Nutrition Examination Survey [NHANES]; N women=156, N men=124).
None.
Objective RAR characteristics derived from accelerometer recordings including activity onset/offset times and non-parametric measures of RAR strength (relative amplitude), stability (interdaily stability), and fragmentation (intradaily variability). The presence of depression symptoms was categorized using Patient Health Questionnaire scores.
In both samples, the only RAR characteristic associated with depression symptoms was intradaily variability (fragmentation): local sample, odds ratio=1.96 [95% confidence interval=1.05-3.63]; NHANES sample, odds ratio=1.34, [95% confidence interval=1.01-1.78]). In the NHANES sample, which included both mild and moderate/severe depression, the association between 24-hour sleep-wake fragmentation and depression symptoms was driven by moderate-to-severe cases.
Stroke survivors with higher levels of RAR fragmentation were more likely to have depression symptoms in both samples. These findings have implications, given prior studies in general samples linking RAR fragmentation with future depression and dementia risk. Research is needed to establish the potential consequences, mechanisms, and modifiability of RAR fragmentation in stroke survivors.
探究 24 小时休息-活动节律（RAR）特征与中风幸存者抑郁症状之间的关系。
这是一项横断面观察性研究，通过调整年龄、性别、种族和合并症等因素，研究 RAR 特征与抑郁症状存在的相关性。
社区环境。
中风幸存者：（1）在当地招募（女性 35 名，男性 28 名）；（2）全国代表性概率样本（国家健康和营养检查调查[NHANES]；女性 156 名，男性 124 名）。
无。
使用加速度计记录获得客观 RAR 特征，包括活动起始/结束时间和 RAR 强度（相对幅度）、稳定性（日间稳定性）和碎片化（日内变异性）的非参数测量。抑郁症状的存在通过患者健康问卷评分进行分类。
在两个样本中，唯一与抑郁症状相关的 RAR 特征是日内变异性（碎片化）：当地样本，优势比=1.96[95%置信区间=1.05-3.63]；NHANES 样本，优势比=1.34[95%置信区间=1.01-1.78]）。在包括轻度和中度/重度抑郁的 NHANES 样本中，24 小时睡眠-觉醒碎片化与抑郁症状之间的关联主要由中度/重度病例驱动。
在两个样本中，RAR 碎片化程度较高的中风幸存者更有可能出现抑郁症状。鉴于先前在一般人群中进行的研究表明 RAR 碎片化与未来抑郁和痴呆风险有关，这些发现具有一定意义。需要进一步研究来确定中风幸存者 RAR 碎片化的潜在后果、机制和可变性。
