Buysse D J, Tu X M, Cherry C R, Begley A E, Kowalski J, Kupfer D J, Frank E
Depression and Manic-Depression Prevention Program, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Biol Psychiatry. 1999 Jan 15;45(2):205-13. doi: 10.1016/s0006-3223(98)00198-x.
We compared pretreatment subjective and electroencephalographic sleep measures among depressed patients who remitted with psychotherapy alone and those who did not remit.
Patients were 111 midlife women with recurrent major depressive disorder. Baseline psychiatric ratings and sleep studies were conducted prior to treatment with weekly interpersonal psychotherapy. Remission was defined as a score of < or = 7 for 3 consecutive weeks on the Hamilton Depression Rating Scale. Clinical and sleep measures were compared between remitters (n = 62) and nonremitters (n = 49) using t tests and random regression. Linear discriminant function analyses were used to categorize remitters and nonremitters on the basis of sleep measures.
Treatment nonremitters had significantly worse subjective sleep quality and significantly elevated phasic REM sleep as measured by multivariate and univariate analyses. The linear accumulation of REM activity during sleep occurred at a significantly higher rate in nonremitters than in remitters. Linear discriminant function analyses based on subjective sleep quality and REM activity correctly identified 68.3% of nonremitters and 68.5% of remitters.
These findings highlight the role of subjective and REM sleep measures as correlates of short-term psychotherapy treatment response in major depressive disorder. Disturbed sleep may be a physiological indicator of increased limbic and brain stem arousal.
我们比较了仅通过心理治疗缓解的抑郁症患者与未缓解的抑郁症患者治疗前的主观睡眠和脑电图睡眠指标。
患者为111名患有复发性重度抑郁症的中年女性。在每周进行人际心理治疗之前，进行了基线精神科评定和睡眠研究。缓解的定义为汉密尔顿抑郁量表连续3周得分≤7分。使用t检验和随机回归比较缓解者（n = 62）和未缓解者（n = 49）之间的临床和睡眠指标。线性判别函数分析用于根据睡眠指标对缓解者和未缓解者进行分类。
通过多变量和单变量分析，治疗未缓解者的主观睡眠质量明显更差，相位快速眼动睡眠明显升高。睡眠期间快速眼动活动的线性积累在未缓解者中发生的速率明显高于缓解者。基于主观睡眠质量和快速眼动活动的线性判别函数分析正确识别了68.3%的未缓解者和68.5%的缓解者。
这些发现突出了主观睡眠和快速眼动睡眠指标作为重度抑郁症短期心理治疗反应相关因素的作用。睡眠障碍可能是边缘系统和脑干觉醒增加的生理指标。
