不佳的睡眠與產後憂鬱症有獨立關聯

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　July 8, 2009 — 根據發表於7月睡眠期刊的一篇橫斷面、族群基礎研究結果，不佳的睡眠與產後憂鬱症有獨立相關。
　　
　　主要作者、挪威Stavanger大學醫院的Signe Karen D?rheim博士在新聞稿中表示，詢問一個新手媽媽是否有因為睡眠不佳的倦怠感而影響日間生活功能、生活中是否有其他因素使她缺乏活力是重要的。另外也有有助於諮商的憂鬱篩檢問卷。醫師與其他健康工作者應提供產後婦女討論這些困境的適當機會。
　　
　　本研究的目標是評估產後母親睡眠問題與憂鬱症狀的風險因素與發生率，以釐清與各狀況相關的獨立關聯因素，檢視特定產後睡眠狀況與憂鬱之間的關聯。
　　
　　從2005年10月至2006年9月，總共有4,191名婦女在Stavanger大學醫院生產，產後7天郵寄問卷給她們，回覆率為68%(2,830人)。回覆者在回覆當時的平均年紀為30歲。
　　
　　使用匹茲堡睡眠品質指數(PSQI)評估睡眠特徵，有睡眠問題定義為PSQI分數大於5。使用愛丁堡產後憂鬱量表(EPDS)評估憂鬱症狀，憂鬱定義為EPDS分數大於等於10。
　　
　　睡眠問題的發生率為57.7%，憂鬱的發生率為16.5%。自我報告的平均夜間睡眠時間為6.5小時，睡眠效率為73%。
　　
　　與產後睡眠品質不佳有關的因素包括憂鬱、曾有睡眠問題、初產婦、未完全哺餵母奶、家有幼童或者生的是男嬰。校正與憂鬱有關的已知風險，如不佳的伴侶關係、憂鬱病史、懷孕期間憂鬱、生活壓力等因素之後，不佳的睡眠依舊與憂鬱有關。特別與憂鬱有關的睡眠問題是睡眠干擾與主觀的睡眠品質。
　　
　　研究作者寫道，不佳的睡眠與憂鬱有獨立關聯。不佳的睡眠會增加某些婦女的憂鬱風險，但是如同原本已知的其他風險因素，診斷有產後憂鬱的母親不會只有長期睡眠不佳的症狀。
　　
　　研究限制包括，橫斷面設計而無法確認因果關係，且依賴的是自我報告的症狀。
　　
　　研究作者結論表示，憂鬱病史婦女的睡眠對於生育相關的生理心理因素(荷爾蒙、免疫、心理與社會)的變化更敏感。睡眠是這些憂鬱風險因素之間的調節劑，產後睡眠不佳會使這些婦女容易發生憂鬱。需要縱向研究以評估治療母親睡眠問題是否可以降低憂鬱，治療母親憂鬱是否可以改善睡眠品質。
　　
　　西挪威地區健康當局資助本研究。研究作者之一宣告與Lundbeck AS、sanofi-aventis、Pfizer、Wyeth和NycoMed藥廠有各種的財務關係。其他研究作者宣告無相關資金上的往來。

Poor Sleep Independently Linked to Postpartum Depression

By Laurie Barclay, MD
Medscape Medical News

July 8, 2009 — Poor sleep is linked to postpartum depression independently of other risk factors, according to the results of a cross-sectional, population-based study reported in the July issue of Sleep.

"It is important to ask a new mother suffering from tiredness about how poor sleep affects her daytime functioning and whether there are other factors in her life that may contribute to her lack of energy," lead author Signe Karen Dorheim, MD, PhD, a psychiatrist at Stavanger University Hospital in Stavanger, Norway, said in a news release. "There are also helpful depression screening questionnaires that can be completed during a consultation. Doctors and other health workers should provide an opportunity for postpartum women to discuss difficult feelings."

The goals of this study were to assess the prevalence of and risk factors for concurrent postpartum maternal sleep problems and depressive symptoms, to identify factors independently associated with either condition, and to examine associations between specific components of postpartum sleep and depression.

From October 2005 to September 2006, a total of 4191 women delivered at Stavanger University Hospital and were mailed a questionnaire 7 weeks after delivery, with a response rate of 68% (n = 2830). Mean maternal age at the time of reply was 30 years.

The Pittsburgh Sleep Quality Index (PSQI) evaluated sleep characteristics, with sleep problems defined as a PSQI score of more than 5. The Edinburgh Postnatal Depression Scale (EPDS) evaluated depressive symptoms, with depression defined as an EPDS score of 10 or higher.

The prevalence of sleep problems was 57.7%, and the prevalence of depression was 16.5%. Self-reported mean nightly sleep duration was 6.5 hours, and sleep efficiency was 73%.

Factors associated with poor postpartum sleep quality were depression, history of sleep problems, primiparity, not exclusively breast-feeding, or having a younger or male infant. After adjustment for other known risk factors for depression, including poor partner relationship, history of depression, depression during pregnancy, and stressful life events, poor sleep remained associated with depression. The aspects of sleep most strongly associated with depression were sleep disturbances and subjective sleep quality.

"Poor sleep was associated with depression independently of other risk factors," the study authors write. "Poor sleep may increase the risk of depression in some women, but as previously known risk factors were also associated, mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation."

Limitations of this study include cross-sectional design precluding determination of causality and reliance on self-reported symptoms.

"The sleep of women with a history of depression may be more sensitive to the psychobiological (hormonal, immunological, psychological, and social) changes associated with childbirth," the study authors conclude. "Sleep could act as a moderator between these risk factors for depression and the precipitation of depression in women vulnerable to such sleep changes during the postpartum period. Longitudinal studies are needed to evaluate whether treatment of maternal sleep problems reduces depression and whether treatment of maternal depression improves sleep quality."

The Western Norway Regional Health Authority funded this study. One of the study authors has disclosed various financial relationships with Lundbeck AS, sanofi-aventis, Pfizer, Wyeth, and NycoMed. The other study authors have disclosed no relevant financial relationships.

Sleep. 2009;32:847-855.