阻塞性睡眠呼吸暂停患者过度嗜睡严重程度与焦虑抑郁的相关性:一项大样本临床研究

doi:10.6040/j.issn.1671-7554.0.2024.0919

摘要/Abstract

摘要： 目的探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)患者白天过度嗜睡(excessive daytime sleepiness, EDS)的严重程度对焦虑、抑郁症状的影响,分析EDS严重程度在焦虑抑郁风险评估中的潜在临床价值。方法选取2022年1月7日至2024年12月25日期间就诊于西安交通大学第二附属医院睡眠医学中心,经多导睡眠监测诊断为OSA的1 185例患者作为研究对象。根据Epworth嗜睡量表评估将患者分为无EDS组(n=498)及EDS组(n=687)。采用焦虑自评量表(self-rating anxiety scale, SAS)和抑郁自评量表(self-rating depression scale, SDS)评估焦虑及抑郁情况,采用χ2检验、Fisher精确检验、Mann-Whitney U检验、kruskal-Wallis检验、Pearson相关分析及多变量logistic回归分析对嗜睡水平与临床症状、多导睡眠监测相关指标、SAS评分和SDS评分之间进行统计学分析。结果 EDS组患者的抑郁和焦虑症状发生率分别为36.35%、17.07%,高于非EDS组患者的抑郁和焦虑症状发生率27.94%和8.15%,差异有统计学意义(P<0.01)。随EDS严重程度的增加,焦虑抑郁风险呈剂量依赖性升高:轻度、中度、重度EDS患者的抑郁症状发生率分别为26.79%、39.45%、54.03%,焦虑症状分别为12.45%、21.10%、23.39%。多变量回归分析显示,中度EDS(OR=1.894, 95%CI: 1.170~3.067)、重度EDS(OR=3.184, 95%CI: 1.974~5.137)显著增加抑郁症状发生风险;同时,焦虑风险亦随EDS严重程度升高(中度OR=2.032,95%CI: 1.114~3.705;重度OR=2.435,95%CI: 1.340~4.425)。结论 OSA合并EDS的患者发生焦虑抑郁症状的风险显著升高,且EDS严重程度是抑郁及焦虑症状发生的独立影响因素,即较重的EDS能够增加OSA患者出现抑郁及焦虑症状的风险,应将EDS分层纳入个性化干预策略中。

关键词: 阻塞性睡眠呼吸暂停, 白天过度嗜睡, 精神合并症, 焦虑, 抑郁

Abstract: Objective To investigate the association between excessive daytime sleepiness(EDS)severity and anxiety/depression symptoms in obstructive sleep apnea(OSA)patients, and to evaluate the clinical value of EDS stratification in psychiatric risk assessment. Methods A total of 1,185 OSA patients diagnosed by polysomnography(PSG)at the Sleep Medicine Center of the Second Affiliated Hospital of Xian Jiaotong University(January 2022-December 2024)were enrolled. Participants were categorized using the Epworth Sleepiness Scale(ESS)into non-EDS and EDS groups. Psychological symptoms were assessed using the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS). Statistical analyses included χ2 test, Fishers exact test, Mann-Whitney U test, Pearson correlation, and multivariate logistic regression to examine relationships between EDS levels, PSG parameters, and psychiatric symptoms. Results The EDS group(n=498)showed significantly higher prevalence rates of depression(36.35% vs 27.94%, P<0.01)and anxiety(17.07% vs 8.15%, P<0.01)compared to non-EDS group(n=687). A dose-dependent relationship was observed: depression prevalence increased from 26.79%(mild), 39.45%(moderate)to 54.03%(severe EDS); anxiety rates progressed from 12.45% to 21.10% and 23.39% respectively. Multivariate regression analysis revealed that moderate EDS(OR=1.894, 95%CI: 1.170-3.067)and severe EDS(OR=3.184, 95%CI: 1.974-5.137)significantly increased depressive symptom risk. Similarly, anxiety risk increased with EDS severity(moderate: OR=2.032, 95%CI: 1.114-3.705; severe: OR=2.435, 95%CI: 1.340-4.425). Conclusion EDS severity independently predicts anxiety and depression risks in OSA patients, demonstrating clinically significant dose-response effects. Stratified EDS assessment should be incorporated into personalized therapeutic strategies for comprehensive OSA management.

Key words: Obstructive sleep apnea, Excessive daytime sleepiness, Psychiatric complications, Anxiety, Depressed

中图分类号:

R766.7

冯雅妮,牛晓欣,麻莉娜,施叶雯,苏永龙,谢雨杉,袁钰淇,朱思敏,周雅诺,刘郝羽,刘海琴,任晓勇. 阻塞性睡眠呼吸暂停患者过度嗜睡严重程度与焦虑抑郁的相关性:一项大样本临床研究[J]. 山东大学学报 (医学版), 2026, 64(1): 19-27.

FENG Yani, NIU Xiaoxin, MA Lina, SHI Yewen, SU Yonglong, XIE Yushan, YUAN Yuqi, ZHU Simin, ZHOU Yanuo, LIU Haoyu, LIU Haiqin, REN Xiaoyong. Association of excessive daytime sleepiness severity with anxiety and depressive symptoms in obstructive sleep apnea patients: a large-scale clinical study[J]. Journal of Shandong University (Health Sciences), 2026, 64(1): 19-27.

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