伴自杀行为的抑郁发作患者和精神分裂症患者睡眠脑电功率谱密度比较

Comparison of sleep EEG power spectral density between depressive episode patients and schizophrenia patients with suicidal behavior

中文关键词:  抑郁发作  精神分裂症  自杀行为  多导睡眠监测  功率谱密度

英文关键词:Depressive episode  Schizophrenia  Suicidal behavior  Polysomnography  Power spectral density

中文摘要:

      背景 抑郁发作患者和精神分裂症患者存在较高的自杀风险，伴自杀行为的抑郁发作患者和精神分裂症患者睡眠脑电功率谱密度特征可能存在不同，但目前尚缺乏对这两类患者的直接比较研究。目的 比较伴自杀行为的抑郁发作患者和伴自杀行为的精神分裂症患者睡眠脑电功率谱密度的差异，为探索自杀行为的预测指标提供参考。方法 选取2018年6月—2020年12月在深圳市康宁医院门诊就诊和住院治疗的、近一个月存在自杀行为的抑郁发作患者和精神分裂症患者各20例，均符合《国际疾病分类（第10版）》（ICD-10）抑郁发作或精神分裂症诊断标准。通过随机抽样方法，在深圳市翠平社区选取与患者组性别和年龄相匹配的志愿者20例为对照组。采用失眠严重程度指数量表（ISI）、睡眠信念与态度量表（DBAS）、梦魇严重程度指数（DDNSI）以及Epworth嗜睡量表（ESS）评定患者的主观睡眠情况；采用多导睡眠监测评估患者的客观睡眠情况；对所有受试者通过睡眠脑电滤波器分析和处理脑电功率谱密度。比较两组患者的主观睡眠和客观睡眠情况，比较患者组与对照组的睡眠脑电功率谱密度。结果 伴自杀行为的抑郁发作患者和伴自杀行为的精神分裂症患者的主观睡眠和客观睡眠情况比较，差异均无统计学意义（P均>0.05）。伴自杀行为的抑郁发作患者和伴自杀行为的精神分裂症患者以及对照组的睡眠脑电功率谱密度W期（α波平均功率、δ波总功率、δ波平均功率、θ波平均功率），N1期（β波平均功率、α波总功率、δ波总功率），N2期（α波总功率、α波平均功率、δ波总功率、δ波平均功率），N3期（α波平均功率、δ波平均功率）以及R期（α波总功率、α波平均功率、δ波总功率、δ波平均功率）比较，差异均有统计学意义（P<0.05或0.01）。伴自杀行为的抑郁发作和伴自杀行为的精神分裂症患者W期δ波总功率均高于对照组，N1期β波平均功率、δ波总功率均高于对照组，N2期α波总功率、α波平均功率均低于对照组，δ波平均功率均高于对照组，N3期α波平均功率均低于对照组，δ波平均功率均高于对照组，R期α波总功率和α波平均功率均低于对照组，δ波总功率和δ波平均功率均高于对照组，差异均有统计学意义（P<0.05或0.01）。伴自杀行为的抑郁发作患者W期α波平均功率、δ波平均功率和θ波平均功率均高于对照组，N1期α波总功率低于对照组，差异均有统计学意义（P均<0.05）。结论 伴自杀行为的抑郁发作患者和精神分裂症患者具有高度重叠的睡眠脑电异常模式，主要表现为α波功率（N2、N3、R期）的普遍降低和δ波功率（W、N1、N2、N3、R期）及N1期β波功率的普遍增高。同时，伴自杀行为的抑郁发作患者还表现出特异性改变，包括清醒期（W期）的α波和θ波平均功率增高，以及N1期α波总功率降低。

英文摘要:

      Background Patients with depressive episode and schizophrenia have a high risk of suicide. The sleep electroencephalogram power spectral density characteristics of patients with depressive episode accompanied by suicidal behavior and those with schizophrenia may be different， but there is currently a lack of direct comparative studies on these two groups of patients.Objective To compare the sleep electroencephalogram power spectral density between depressive episode and schizophrenic patients with suicidal behavior， in order to provide references for exploring predictive indicators of suicidal behavior.Methods From June 2018 to December 2020， 20 patients with depressive episode and 20 patients with schizophrenia who had committed suicide within the past month and were treated at the outpatient department of Shenzhen Kangning Hospital were selected. All of them met the diagnostic criteria for depressive episode or schizophrenia as defined in the International Classification of Diseases， tenth edition （ICD-10）. Using a random sampling method， 20 volunteers with matching gender and age to the patient groups were selected from the Cuiping community in Shenzhen as the control group. The subjective sleep of the patients was evaluated using the Insomnia Severity Index （ISI）， the Dysfunctional Belief and Attitude about Sleep （DBAS）， the Disturbing Dreams and Nightmare Severity Index （DDNSI）， and the Epworth Somnolence Scale （ESS）. The objective sleep of the patients was assessed using polysomnography. The sleep electroencephalogram was filtered and the power spectral density of the brain wave was analyzed and processed for all the subjects. The subjective and objective sleep conditions of the two patient groups were compared， and the sleep electroencephalogram power spectral density of the patient groups and the control group were also compared.Results A comparison of subjective and objective sleep conditions between patients with depressive episode accompanied by suicidal behavior and patients with schizophrenia accompanied by suicidal behavior showed no statistically significant differences （P>0.05）. Comparisons of sleep electroencephalogram power spectral density in the W stage （average power of α wave， total power of δ wave， average power of δ wave， average power of θ wave）， N1 stage （average power of β wave， total power of α wave， total power of δ wave）， N2 stage （total power of α wave， average power of α wave， total power of δ wave， average power of δ wave）， N3 stage （average power of α wave， average power of δ wave）， and R stage （total power of α wave， average power of α wave， total power of δ wave， average power of δ wave） between patients with depressive episode accompanied by suicidal behavior， patients with schizophrenia accompanied by suicidal behavior， and the control group showed statistically significant differences （P<0.05 or 0.01）. The total power of δ wave in the W stage and the average power of β wave and δ wave in the N1 stage were higher in two patient groups were higher than those of the control group. The total power of α wave and the average power of α wave in the N2 stage were lower than those of the control group， while the average power of δ wave was higher than that of the control group. The average power of α wave in the N3 stage of both patient groups were lower than that of the control group， while the average power of δ wave was higher than that of the control group. The total power and average power of α wave in the R stage were lower than those of the control group， while the total power and average power of δ wave were higher than those of the control group. All the differences were statistically significant. Patients with depressive episode accompanied by suicidal behavior had higher average powers of α wave， δ wave， and θ wave in the W stage compared with the control group， while the total power of α wave in the N1 stage was lower in the former group. All these differences were statistically significant （P<0.05）.Conclusion The depressive episode patients accompanied by suicidal behavior have highly overlapping sleep electroencephalogram abnormal patterns with those of schizophrenia patients， mainly manifested as a general decrease in α wave power （N2， N3， R stage） and a general increase in δ wave power （W， N1， N2， N3， R stage） as well as β wave power in N1 stage. At the same time， patients with depressive episode accompanied by suicidal behavior also show specific changes， including an increase in the average power of α and θ waves during the wakefulness period （W stage）， and a decrease in the total power of α wave in N1 stage. ［Funded by Guangdong Province High-level Clinical Key Specialty （with supporting funds from Shenzhen City） （number， SZGSP013）； Shenzhen Key Medical Discipline （number， SZXK041）； Shenzhen Clinical Medicine Research Center Project （number， 20210617155253001）］