Depression score changes in response to sleep disordered breathing treatment with positive airway pressure in a large clinic-based cohort.
Depression score changes in response to sleep disordered breathing treatment with positive airway pressure in a large clinic-based cohort.
复制标题
在大型临床队列中，使用气道正压通气治疗睡眠呼吸障碍后，抑郁评分发生变化。
DOI：
10.1007/s11325-018-1626-6
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Walia,HarneetK
中科院分区：
文献类型：
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作者：
Relia,Sachin;Thompson,NicolasR;Mehra,Reena;Moul,Douglas;Katzan,Irene;Foldvary-Schaefer,Nancy;Walia,HarneetK
目的探讨正压通气(PAP)对睡眠障碍呼吸(SDB)患者抑郁症状的临床人群影响，有待进一步研究。我们假设，在大规模的临床环境中，抑郁症状随着PAP治疗的反应而改善，较低的社会经济地位对完全治疗反应构成障碍。方法我们对2010年1月1日至2015年12月31日期间在三级门诊睡眠中心就诊的SDB患者进行了一项回顾性队列研究。从电子健康记录中提取的数据包括患者健康问卷-9(PHQ-9)得分、人口统计特征、PAP依从性和病史。根据PAP依从性，使用配对和两个样本测试来评估PHQ-9评分的变化。结果队列中包括1981例SDB患者(56.4 ± 13.3岁；女性45.7%；高加索人76.2%)。无论依从性如何，PAP治疗都改善了PHQ-9评分(− 2.4PQ2± 4.6p<； 0.0001)，在基线PHQ-9评分和GT； 10( 4.8P4.8± 5.7；p<； 0.0001)的患者中反应更有力。依从性患者的改善明显更大(− 2.8 ± 4.4vs 1.6 + 4.2，p<； 0.0001)，如果基线PHQ-9为>； 10(−6.0 ± 5.3 vs− 3.8 ± 4.9，p<； 0.001)，获益更大。社会经济状况较低和抑郁症状较重的患者在PAP治疗后PHQ-9评分较差。结论在本临床队列中，PAP治疗和坚持治疗与抑郁症状严重程度的改善有关。社会经济地位较低的患者获得的治疗收益较少，这表明他们在治疗有效性方面面临着额外的障碍。
ObjectiveThe clinical-population impact of positive airway pressure (PAP) on depressive symptoms in sleep disordered breathing (SDB) awaits clear documentation. We hypothesized that depressive symptoms improve in response to PAP treatment in a large clinical setting, and that lower socio-economic status poses barriers to full therapeutic response.MethodWe performed a retrospective cohort study of SDB patients attending a tertiary ambulatory sleep center between January 1, 2010 and December 31, 2015. Data extracted from electronic health records included Patient Health Questionnaire-9 (PHQ-9) scores, demographic characteristics, PAP adherence, and medical history. Paired- and two-samplettests were utilized to assess changes in PHQ-9 score according to PAP adherence. Linear regression models were constructed to evaluate the association of socioeconomic status (SES) and other clinical variables on PHQ-9 scores.ResultsThe cohort consisted of 1981 SDB patients (56.4 ± 13.3 years; 45.7% female; 76.2% Caucasian). Regardless of adherence, PAP therapy improved PHQ-9 scores (− 2.4 ± 4.6,p< 0.0001), with more robust responses in patients with baseline PHQ-9 scores > 10 (− 4.8 ± 5.7;p< 0.0001). Adherent patients had significantly greater improvement (− 2.8 ± 4.4 vs. 1.6 + 4.2,p< 0.0001), and even greater benefit if baseline PHQ-9 was > 10 (−6.0 ± 5.3 vs. − 3.8 ± 4.9,p< 0.001). Patients from lower socioeconomic status and greater depressive symptom had worse post-PAP PHQ-9 scores.ConclusionsPAP therapy and adherence were associated with improvement in depressive symptom severity in this clinical cohort. Patients with lower socioeconomic status derived less therapeutic benefit, suggesting that they faced additional barriers to treatment effectiveness.