| BackgroundDepression has become the fourth largest dieases in the world,which has the high morbidity and the high fatality rate.20 percent of the adults may experience depression in some stage of life. It is expected that depression may the second largest dieases after cardiovascular diseases in global.So far,it is unclear that the causes and the pathogensis of depression.Altough most researchers think the pathogensisi of depression may be genetic causes,psychological reasons and biology causes,the antidepressants is diffcult in treating the disease.There is a little progress in drug research.There exists some drawbacks in the drug treatments such as work slowly,withdrawal could rebound and side effects and so on.Many researches find that there is close relationship between depression and day and night activities,even some researchers present that depression is a biological rhythms turbulence diseases.Depressive episode may changes the biological rhythms of people.These changes may include shortened sleep time,more rapid eyes movement(REM) consistency and shortend REM latency and so on.If we undersand the relationship between depression and day and night activities clearly,the depression can be treat and prevent effectively.A lot of researches find the close relationship between depression and circadian rhythm,but it still unclear about its relationship.On one hand,depression is diagnosed through patients’told and doctors’evaluation,which are subjective or partly objective method of evaluation,and can not fully or quantifily reflect the severity of dieases.On the other hand,the estimation of patients’circadian rhythm are mostly preformed in the laboratory,like analysising patients’ sleep structure by polysomnography(PSG),point sampling patients’ melatonin and so on.These reseaches usually observe the patients’circadian rhythm in a period of time,but not in the nature state,so that they can not fully reflect the patients’state.Actiwatch has become one of the main tools in the domain of sleep medicine in the past 20 decades.Actiwatch is wearing on wrist,which is like watch,and using conveniently. We can use it to monitor reaching 180 days,which overcomes defects PSG has.Patients can wear it in familiar circumstance such as home,which eliminates the EEG monitoring of suffering.In this study, actiwatch is used to monitor circadian rhythm in depressive patients. According to the principle of people in sleep activity decreases and the awakening increased activity. Actiwatch indirectly correlation between mental disorders and circadian rhythm through accelerometer monitoring subjects within a set time body movement. Studies have shown that patients with depressive disorder movement patterns and health people have obvious difference through the activity monitoring found that the depressive symptoms after treatment decreased activity improved. Vanderlin through the body movement to monitor health people sleep with analysis of biological clock gene, found that the biological clock gene polymorphism can reduce the quality of sleep and the influence of cognitive increased depressive symptoms. Through a small sample of long time melatonin secretion pattern of depression in patients with more variability, a longitudinal comparative study report the secretion level higher than health. Another study also found that elevated melatonin levels in depressive patients.The study showed the depressive symptoms and circadian rhythm change sexist complex relationships. Methods using actigraphy long time continuous monitoring of changes can be found in depressive patients circadian rhythm, combined with related to depression scale evaluation can be found in the relationship. However, due to the complexity of the disease itself, especially bipolar depression symptoms and unipolar depression period is very similar, clinical on can judge according to some characteristic depressive symptoms after all, unipolar depression and bipolar disorder are different, however, this distinction is difficult to distinguish, usually clinical in the manic and depressive symptoms before they are two-phase exact diagnosis, lack of diagnostic markers for early characteristic, resulting in delayed diagnosis and treatment.AIM:Before and after antidepressant treatment, the circadian rhythm of activity recorder with long time dynamic monitoring in depressive patients, and the combination of depression related assessment assessment scale, to carry out the relevant research on circadian rhythms and depression and its reactivity. There is a correlation helps clear circadian rhythms and depression and its response to treatment in this study, provide a more objective index for early intervention and effect evaluation of clinical depression.METHOD:According to Hamilton Depression Scale (HAMD) assessment, diagnosis in line with the United States diagnostic and Statistical Manual of mental disorders Fifth Edition (DSM-V) diagnostic criteria for depressive episode in the Guangdong General Hospital (Guangdong mental health center) inpatients Department of psychology and psychiatry, a random sample of 20 people, including 14 males.6 women, aged between 18-65 years old, the average age was 40.6±16.15 years.A face-to-face questionnaire interview in patients hospitalized for first days or second days, patients signed the informed consent, began to wear on actigraphy for at least 3 days as the baseline data, observation of treatment after a week for at least 3 days to wear control circadian rhythm in patients with depressive disorder treatment the same before and after the. At the same time worn actigraphy asked subjects to record sleep diary. At the same time worn actigraphy asked subjects to record sleep diary. And inform the matters needing attention, such as life waterproof, ask patient to as much as 24 hours to wear.Actigraphy, scale (including morning and evening types of self rating scale (MEQ), Hamilton rating scale for depression (HAMD) scale, Pittsburgh sleep quality index(PSQI), the Epworth sleepiness scale (ESS), Chinese University Hong Kong formulary sleep assessment questionnaire, a sleep diary, etc. weight and height instrument.Two groups of categorical data were compared using the chi square test, measurement data were compared using independent samples T test was. Event recorders before and after treatment were analyzed with a sleep diary data analysis, take the paired T test, analysis of variance of repeated measurement. When P<0.05 think the difference had statistical significance.RESULT:Among 20 subjects,4 subjects were dropped out group (1 subject being due to changes in condition,2 subjects being due to no adhere actiwatch,1 subject feeling actigraphy having unhealthy impact. Finally,16 (80%) subjects were valid in this study. The general demographic characteristics, height, weight, BMI, sleep pattern, insomnia diagnosis, the first interview of vital signs, the baseline Hamilton Depression Scale score, baseline Epworth sleepiness scale score, and baseline differences in Pittsburgh sleep quality index scores were not statistically significant. However, compared the patients and a group of patients first onset form, find out cases for sub-acute onset (2 weeks-3 months), the patients for chronic onset (3 months) (75% vs 12.5%;χ2=6.667, P<0.05).Amongst 16 patients, men and women have statistical difference in age, height, weight, weekend time to get up, the most recent year average nightly sleep length difference. Self evaluation of morning and evening types (MEQ) score statistically significant, but for moderate morning, males more absolute morning, women tend to be more moderate morning. However, other general demographic information, such as height and weight, sleeplessness, diagnosis, the first interview of vital signs, the baseline Hamilton Depression Scale (HAMD) score, baseline Epworth sleepiness scale (ESS) score, baseline Pittsburgh sleep quality index (PSQI) scores showed no significant differences.The results of circadian rhythm before and after antidepressant treatment showed, there was significant difference in the scores before and after antidepressant treatment Hamilton Depression Rating Scale (t=10.813,<0.01), after antidepressant treatment in patients with Hamilton Depression Scale score was lower. There are also statistical significance of Pittsburgh sleep quality index score (t=5.102, p<0.01), treatment with antidepressant, Pittsburgh sleep quality index scores of patients also reduced. In patients after antidepressant treatment time, time to get up, go to bed every night, actual sleep time, sleep latency difference no significant statistical significance. Compared to the same in depressive patients and the antidepressant treatment after 14 days of actigraphy data collected, such as the total time in bed (TIB), total sleep time (TST), total number of awakening sleep (WASO), sleep efficiency (SE), the results showed the same patient total time in bed (TIB) during be in hospital second dayslonger than fifteenth days, the total number of sleep wakefulness (WASO) seventeenth days more than sixteenth days(P16-17=0.021)to more than fifteenth days, more than sixteenth days (P15-16=0.022), and sleep efficiency (SE) of sixteenth days more than fifteenth days(P 15-16<0.05), total sleep time (TST) and depression no significant difference in attack before and after treatment. Considering the different individual daily sleep situation may be affected by many factors, so it is also a comparison with the three days before and three days after the average sleep related indicators such as total value, in bed time, total sleep time, sleep in the total number of awakening, sleep efficiency, the results showed no significant difference.A sleep diary data and compared to the same in depressive patients and the antidepressant treatment after 14 days of recording, the results have no significant statistical difference.CONCLUSION:According to the results of this study, in depressive patients before and after treatment in patients with the sleep quality improvement can be obtained. In the treatment period, patients awakening number increase, which may be because drug factors or the condition fluctuation. The total reduction in bed time, sleep efficiency and better with recovery of depressive episodes, the results suggest that depressive episodes in patients with sleep disorder may be because of the depression cure to improve sleep problems, reduce the occurrence of sleep disorders. In this study, whether it is from the analysis of activity recorder data, or analysis of patients with what he remembers a sleep diary, not confirmed significant sleep phase to move forward or backward, this and previous studies are not consistent, probably because of this research is the observational study, the number of samples is small, and the hospitalized days short so that the wear actigraphy for too short a time. Male patients were more prone to be absolute morning type, while femal patients were more tend to be more moderate morning. |
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