癫痫伴或不伴抑郁症状患者的失眠症状相关因素的差异。
Differences in factors associated with insomnia symptoms between patients with epilepsy with and without depressive symptoms.
机构信息
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Epilepsy Behav. 2024 Jul;156:109781. doi: 10.1016/j.yebeh.2024.109781. Epub 2024 May 23.
OBJECTIVE
To determine if insomnia-related factors differ depending on the presence of depression in patients with epilepsy.
METHODS
This cross-sectional multicenter study collected data on depressive symptoms, insomnia symptoms, and excessive daytime sleepiness, which were defined as a Patient Health Questionnaire-9 (PHQ-9) score of ≥ 10, an Insomnia Severity Index (ISI) score of ≥ 15, and an Epworth Sleepiness Scale (ESS) of ≥ 11, respectively. Further, uncontrolled seizures were defined as one or more seizures per month during antiseizure medications treatment. A stepwise logistic regression analysis was conducted, with a logistic regression with interaction terms performed to identify differences in insomnia-related factors depending on depressive symptoms.
RESULTS
Of 282 adults with epilepsy (men, 58 %; mean age, 40.4 ± 13.9 years), a PHQ-9 score ≥ 10, an ISI score ≥ 15, an ESS score ≥ 11 were noted in 23.4 % (n = 66), 20.2 % (n = 57), and 12.8 % (n = 36), respectively. More patients with depressive symptoms had an ISI score ≥ 15 (56.1 % vs. 9.3 %; p < 0.001) than those without. In multiple logistic regression, uncontrolled seizures (odds ratio [OR], 4.896; p < 0.01), daytime sleepiness (OR, 5.369; p < 0.05), and a history of psychiatric disorders (OR, 3.971; p < 0.05) were identified as significant factors that were more likely to be associated with an ISI score ≥ 15; however, this was only true in patients without depressive symptoms. In contrast, use of perampanel (OR, 0.282; p < 0.05) was less likely associated, while female sex (OR, 3.178; p < 0.05) was more likely associated with an ISI score ≥ 15 only in patients with depressive symptoms.
CONCLUSIONS
Insomnia-related factors in patients with epilepsy may differ between patients with and without depression. Our findings of different insomnia-related factors based on the presence of depression may facilitate the management of patients with epilepsy.
目的
确定在癫痫患者中，与失眠相关的因素是否因抑郁的存在而不同。
方法
本横断面多中心研究收集了抑郁症状、失眠症状和日间嗜睡的数据，分别定义为患者健康问卷-9（PHQ-9）评分≥10、失眠严重指数（ISI）评分≥15 和Epworth 嗜睡量表（ESS）评分≥11。此外，未控制的癫痫发作被定义为抗癫痫药物治疗期间每月发作一次或多次。进行逐步逻辑回归分析，并进行具有交互项的逻辑回归分析，以确定与抑郁症状相关的失眠相关因素的差异。
结果
在 282 名成年人癫痫患者（男性，58%；平均年龄，40.4±13.9 岁）中，23.4%（n=66）、20.2%（n=57）和 12.8%（n=36）分别存在 PHQ-9 评分≥10、ISI 评分≥15 和 ESS 评分≥11。有抑郁症状的患者中，ISI 评分≥15 的患者更多（56.1% vs. 9.3%；p<0.001）。在多变量逻辑回归中，未控制的癫痫发作（比值比[OR]，4.896；p<0.01）、日间嗜睡（OR，5.369；p<0.05）和精神疾病史（OR，3.971；p<0.05）被确定为与 ISI 评分≥15 更相关的显著因素；然而，这仅在无抑郁症状的患者中成立。相比之下，使用吡仑帕奈（OR，0.282；p<0.05）与 ISI 评分≥15 的相关性降低，而女性（OR，3.178；p<0.05）与 ISI 评分≥15 的相关性增加仅在有抑郁症状的患者中成立。
结论
癫痫患者中与失眠相关的因素在有抑郁和无抑郁的患者中可能不同。我们基于抑郁的存在发现的不同与失眠相关的因素可能有助于管理癫痫患者。
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