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舍曲林可改善抑郁患者的睡眠相关呼吸障碍

作者:小田 译 来源:医学论坛网 日期:2015-04-01
导读

         既往研究显示,5羟色胺再摄取抑制剂(SSRIs)可能改善睡眠相关呼吸障碍(SRBD),但是尚未在没有中至重度SRBD 受试者中评估SSRI对呼吸的影响。而且抑郁的许多症状与SRBD发生重叠,因此,广东省人民医院、广东省精神卫生中心的学者们对呼吸与SSRI治疗抑郁期间精神病理学的相互作用进行了研究,结果表明,舍曲林在一定程度上可改善SRBD,更常见于相对更严重的睡眠障碍性呼吸患者[呼吸障碍指数(R

        既往研究显示,5羟色胺再摄取抑制剂(SSRIs)可能改善睡眠相关呼吸障碍(SRBD),但是尚未在没有中至重度SRBD 受试者中评估SSRI对呼吸的影响。而且抑郁的许多症状与SRBD发生重叠,因此,广东省人民医院、广东省精神卫生中心的学者们对呼吸与SSRI治疗抑郁期间精神病理学的相互作用进行了研究,结果表明,舍曲林在一定程度上可改善SRBD,更常见于相对更严重的睡眠障碍性呼吸患者[呼吸障碍指数(RDI)≥ 10]。虽然舍曲林引起的SRBD改善似乎没有重大临床效果,但伴RDI 得分率减少50%及以上的SRBD改善组受试者主观和客观睡眠情况均优于非改善组。因此,在抗抑郁治疗中,SSRI相关性SRBD改善可能具有潜在临床益处。相关论文2015 年3月11日在线发表于《睡眠呼吸》(Sleep Breath)杂志。

        研究者们从一项为期8周有关舍曲林治疗抑郁患者的开放标签试验中提取了数据,涉及31例伴失眠的抑郁患者,并在试验期间予其如下方案:第一天上午8点舍曲林50mg,随后在8周试验期间剂量增加至最大量200mg/d。在基线时和第1、14、28、56天多次测定患者的多导睡眠图(PSG),将睡眠障碍性呼吸事件分为窒息、低通气和呼吸事件相关的觉醒(RERA)。

        结果显示,在8周试验期间临床应答和PSG特征有持续地改善。从第14天起,整夜和非快速眼动(NREM)睡眠RERA指数变得稳定,并且明显高于基线时和第1天的(RERA指数:基线7.3 ± 2.2,第1天7.3 ± 2.5,第14天4.4 ± 1.9,第28天3.9 ± 1.3,第56天4.2 ± 2.0,F = 5.71,P = 0.02;NREM-RERA指数在上述相应时期分别为6.2 ± 2.0、6.3 ± 2.3、3.2 ± 1.5、3.5 ± 0.9、3.2 ± 1.7,F = 4.92,P = 0.03)。

        另外,NREM-窒息指数呈现出与RERA指数相似的模式,并且在基线和14天间达到显著差异(P = 0.047)。

        与非改善组相比,伴RDI评分降低率≥50%的改善组受试者慢波睡眠(SWS)正评分降低率更大(P = 0.04),且觉醒指数(P = 0.01)、匹兹堡睡眠质量指数(PSQI)评分(P = 0.05)和Epworth睡眠量表(ESS)评分(P = 0.02)的负评分降低率较大。

        参考文献:Zhang B,et al. Sleep Breath.2015 Mar 11. [Epub ahead of print]

Effect of sertraline on breathing in depressed patients without moderate-to-severe sleep-related breathing disorders. 

BACKGROUND:
Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) might improve sleep-related breathing disorders (SRBDs). However, the effects of SSRIs on breathing are not evaluated in subjects without moderate-to-severe SRBDs. Further, many symptoms of depression and SRBDs overlap, and so, it is interesting whether there are interactions between breathing and psychopathologic symptoms duringSSRI treatment for depression.
METHODS:
Data were taken from an open-label 8-week trial of sertraline in depressed patients with insomnia (n = 31). The depressed patients were administered 50 mg sertraline at 8 AM on the first day, and the dosage was subsequently titrated up to a maximum of 200 mg/day during the 8-week trial. All the patients were tested by repeated polysomnography (PSG) (baseline, 1st day, 14th day, 28th day, and 56th day). Sleep-disordered breathing events were categorized as apneas, hypopneas, and respiratory event-related arousals (RERAs).
RESULTS:
The clinical responses and PSG characteristics improved continuously during the 8-week trial. From the 14th day on, the RERA index during all-night and non-rapid eye movement (NREM) sleep became stable and significantly higher than baseline and the first day (RERA index 7.3 ± 2.2 at baseline, 7.3 ± 2.5 on the 1st day, 4.4 ± 1.9 on the 14th day, 3.9 ± 1.3 on the 28th day, 4.2 ± 2.0 on the 56th day, F = 5.71, P = 0.02; NREM-RERA index 6.2 ± 2.0 at baseline, 6.3 ± 2.3 on the 1st day, 3.2 ± 1.5 on the 14th day, 3.5 ± 0.9 on the 28th day, 3.2 ± 1.7 on the 56th day, F = 4.92, P = 0.03).
Additionally, the NREM-apnea index showed a similar pattern to that of the RERA index and reached a significant difference between baseline (1.0 ± 0.5) and the 14th day (0.5 ± 0.4) (KW = 4.28, P = 0.047).
Compared to the no-improvement group, the improvement group with a decreasing score rate of the respiratory disturbance index (RDI) greater than or equal to -50 % had a more positive decreasing score rate of slow wave sleep (SWS) (439.0 ± 78.2 vs 373.2 ± 77.9 %, T = 3.46, P = 0.04) and a more negative decreasing score rate on the arousal index (-43.7 ± 16.7 vs -26.6 ± 9.7 %, T = 9.16, P = 0.01), Pittsburgh Sleep Quality Index (PSQI) scores (-65.1 ± 33.7 vs -49.6 ± 21.4 %, T = 4.74, P = 0.05), and Epworth Sleepiness Scale (ESS) scores (-55.7 ± 21.3 vs -36.4 ± 17.5 %, T = 6.44, P = 0.02).
DISCUSSION:
This research indicates that SRBDs could be improved to some extent by sertraline treatment, which might be more common in patients with relatively more severe sleep-disordered breathing (e.g., RDI ≥ 10 in the current study). Although the sertraline-induced SRBD improvement seems not to have a significant clinical effect, the SRBD improvement group with decreasing score rate of RDI greater than or equal to -50 % has better subjective and objective sleep aspects than the no-improvement group. Thus, the fact that the SRBDs' improvement was related to SSRIs might have a potential clinical benefit in the antidepressant treatment.

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