Vaziri Harami Roya, Keyvanfar Amirreza, Semnani Yousef, Najafiarab Hanieh
Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2024 May 13;38:53. doi: 10.47176/mjiri.38.53. eCollection 2024.
Many patients with bipolar disorder (BD) experience sleep problems. Sleep abnormalities are associated with immune dysfunction, which may be reflected by hematological indices. Purpose: This study aimed to investigate the association between sleep quality and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients with BD.
This cross-sectional study was performed at Imam Hossein Hospital, Tehran, Iran, from March to September 2023. Hospitalized patients newly diagnosed with BD were interviewed to complete questionnaires. Sleep quality and manic and depressive symptoms of the participants were assessed using the Pittsburg Sleep Quality Index (PSQI), the Young Mania Rating Scale (YMRS), and the Hamilton Depression Rating Scale (HDRS), respectively. Furthermore, blood samples were taken from each patient to investigate hematological indices. Continuous and categorical variables were compared between groups using an independent-sample t test and chi-square/Fisher's exact tests, respectively. The Poisson regression model was also used to investigate predictors of the PSQI score.
Of 305 patients included in the study, 78.7% and 21.3% were experiencing manic and depressive episodes, and 90.20% had poor sleep quality. The prevalence of poor sleep quality was significantly higher in depressed patients than in manic patients (100% vs. 87.5%; = 0.003). Depressed patients had significantly higher platelet counts (mean difference [MD], 34.09 [95% CI, 9.35-58.83]; = 0.007) and PLR (MD, 38.14 [95%CI, 10.25-66.02]; = 0.008) and lower lymphocyte counts (MD, 266.04 [95% CI, [14.41-517.67]; = 0.038) compared with manic patients. The Poisson regression model with adjustment revealed that men (risk ratio [RR], 1.113; = 0.025), those with lower educational levels (RR, 1.164; = 0.001), and those with higher HDRS scores (RR, 1.370; < 0.001) had significantly deteriorated sleep quality.
Most bipolar patients have poor sleep quality, particularly those with depressive episodes. Depressed patients had significantly higher platelet counts and PLR. Also, depressed patients with male sex, lower educational levels, and more severe depressive symptoms had poorer sleep quality.
许多双相情感障碍（BD）患者存在睡眠问题。睡眠异常与免疫功能障碍有关，这可能通过血液学指标反映出来。目的：本研究旨在探讨BD患者睡眠质量与中性粒细胞与淋巴细胞比值（NLR）及血小板与淋巴细胞比值（PLR）之间的关联。
本横断面研究于2023年3月至9月在伊朗德黑兰的伊玛目侯赛因医院进行。对新诊断为BD的住院患者进行访谈以完成问卷。分别使用匹兹堡睡眠质量指数（PSQI）、杨氏躁狂评定量表（YMRS）和汉密尔顿抑郁评定量表（HDRS）评估参与者的睡眠质量以及躁狂和抑郁症状。此外，采集每位患者的血样以检测血液学指标。连续变量和分类变量分别使用独立样本t检验和卡方检验/费舍尔精确检验进行组间比较。泊松回归模型也用于研究PSQI评分的预测因素。
在纳入研究的305例患者中，78.7%和21.3%分别处于躁狂发作和抑郁发作状态，90.20%睡眠质量较差。抑郁患者睡眠质量差的患病率显著高于躁狂患者（100%对87.5%；P = 0.003）。与躁狂患者相比，抑郁患者的血小板计数（平均差值[MD]，34.09[95%置信区间，9.35 - 58.83]；P = 0.007）和PLR（MD，38.14[95%置信区间，10.25 - 66.02]；P = 0.008）显著更高，而淋巴细胞计数（MD，266.04[95%置信区间，14.41 - 517.67]；P = 0.038）更低。经调整的泊松回归模型显示，男性（风险比[RR]为1.113；P = 0.025）、教育水平较低者（RR为1.164；P = 0.001）以及HDRS评分较高者（RR为1.370；P < 0.001）的睡眠质量显著恶化。
大多数双相情感障碍患者睡眠质量较差，尤其是那些处于抑郁发作期的患者。抑郁患者的血小板计数和PLR显著更高。此外，男性、教育水平较低且抑郁症状更严重的抑郁患者睡眠质量更差。
