Association of Baseline Sleep Quality With Trajectories of Depressive Symptoms in Patients Undergoing Interferon Treatment.
Association of Baseline Sleep Quality With Trajectories of Depressive Symptoms in Patients Undergoing Interferon Treatment.
复制标题
接受干扰素治疗的患者的基线睡眠质量与抑郁症状轨迹的关联。
DOI：
10.1097/psy.0000000000000231
复制
发表时间：
2015
影响因子：
3.3
通讯作者：
Lotrich,FrancisE
中科院分区：
文献类型：
--
作者：
Marron,MeganM;Anderson,StewartJ;Garrity,Jessica;Reynolds3rd,CharlesF;Lotrich,FrancisE
目的 一些开始干扰素-α (IFN-α) 治疗的丙型肝炎患者出现抑郁症状，尽管许多患者并未出现抑郁症状。我们发现，睡眠质量不佳与抑郁症状的平均增加有关。目前尚不清楚这种关联是普遍存在的还是由特定的、不同的子群体驱动的。这项调查首先确定抑郁症状的变化模式是否形成有临床意义的不同亚组，然后测试睡眠障碍与不太有利的抑郁轨迹相关的程度。方法对 124 名开始 IFN-α 治疗的丙型肝炎患者使用基于组的轨迹模型。匹兹堡睡眠质量指数 (PSQI) 评估治疗前的睡眠，贝克抑郁量表减去睡眠问题评估一段时间内的抑郁情况，DSM-IV 的结构化临床访谈提供分类诊断。 结果发现了三个不同的亚组，其中每个亚组随着时间的推移具有相似的抑郁症状模式。这些群体的特征是“不抑郁”、“缓慢增加”和“快速增加”。非抑郁亚组（44.4%）的抑郁症状较低，随着时间的推移变化不大。相比之下，所有快速增加者 (11.3%) 在治疗 12 周时均被诊断为患有情绪障碍。 PSQI 与群体成员身份密切相关，与保持非抑郁状态的个体相比，PSQI 每增加一个单位分数，出现快速增加的几率就会增加 39%（比值比 = 1.39，95% 置信区间 = 1.07–1.80，根据基线抑郁症进行调整）。 结论 只有特定的人群在 IFN-α 治疗期间特别容易出现抑郁症状快速增加的情况。这一群体可以通过 IFN-α 治疗前睡眠质量明显不佳来识别。
ObjectiveSome patients with hepatitis C starting interferon-α (IFN-α) therapy experience depression, although many patients do not develop depressive symptoms. We have found that poor sleep is associated with increased depressive symptoms on average. It is unknown whether this association holds generally or is driven by a specific, distinct subgroup. This investigation first determined whether patterns of change in depressive symptoms form clinically meaningful, distinct subgroups and then tested the extent to which sleep disturbances are associated with a less favorable depression trajectory.MethodGroup-based trajectory modeling was used on 124 patients with hepatitis C who started IFN-α therapy. The Pittsburgh Sleep Quality Index (PSQI) assessed pretreatment sleep, the Beck Depression Inventory minus the sleep question assessed depression over time, and the Structured Clinical Interview for DSM-IV provided categorical diagnoses.ResultsThree distinct subgroups were found, where each subgroup shared similar patterns of depressive symptoms over time. The groups were characterized as “nondepressed,”“slow increase,” and “rapid increase.” The nondepressed subgroup (44.4%) experienced low depressive symptoms with little change over time. In comparison, all rapid increasers (11.3%) were diagnosed as having a mood disorder by 12 weeks of treatment. The PSQI was strongly associated with group membership, where the odds of developing a rapid increase was elevated 39% for every unit-score increase in the PSQI compared with individuals who remained nondepressed (odds ratio= 1.39, 95% confidence interval= 1.07–1.80, adjusted for depression at baseline).ConclusionsOnly a distinct subpopulation of people is notably vulnerable to a developing a rapid increase in depression symptoms during IFN-α therapy. This group may be identifiable by their markedly poor sleep before IFN-α therapy.