雙相症病人主客觀睡眠品質與情緒症狀相關性之縱貫性研究

The Associations of Subjective and Objective Sleep Quality and Mood Symptoms among Patients with Bipolar Disorder: A Longitudinal Study

潘安妮(An-Nie Pan) ； 林靜蘭(Esther Ching-Lan Lin) ； 許倍甄(Pei-Chen Hsu) ； 陳幸琪(Hsin-Chi Chen)

《精神衛生護理雜誌》 17卷3期 (2022/12) Pp. 26-36

https://doi.org/10.6847/TJPMHN.202212_17(3).04

摘要

背景：睡眠問題經常為雙相症病人情緒不穩及復發之主因，持續監測其睡眠情形可早期預測症狀變化，並提供早期介入，但有關睡眠品質與情緒症狀之間動態關係的實證知識仍欠缺。目的：探討雙相症病人主客觀睡眠與情緒症狀之間的相關性及時間變化。方法：採縱貫性研究設計，採方便取樣，選取南台灣某醫學中心精神科病房及社區復健中心104位雙相症病人，評量其收案時、收案後一個月及三個月之主客觀睡眠品質、時數及情緒症狀。評量工具包括：基本資料、匹茲堡睡眠品質量表、穿戴式手環、楊氏躁症評估量表、漢氏憂鬱量表、憂鬱－焦慮－壓力量表及Altman躁症評量表。結果：各時間點之主客觀平均睡眠時數介於7-8小時，多數病人主觀睡眠品質差，呈現輕度憂鬱及躁症緩解期。各時間點之睡眠品質與主客觀焦慮、壓力及躁鬱情緒症狀之間呈現低度至中度相關，主觀睡眠品質（p = .009）、主客觀躁症症狀（p ＜ .001）及主觀壓力症狀（p = .012）三者呈現顯著時間變化。而收案後一個月，主觀睡眠時數與主觀焦慮症狀（b = .834, p = .022）、壓力症狀（b = .082, p = .007）及憂鬱症狀（b = .931, p = .003）之變化具有顯著相關性，顯示睡眠時數隨症狀改善而增加；主觀睡眠品質的變化與整體焦慮（b = .246, p ＜ .001）、壓力症狀（b = .236, p ＜ .001）及主客觀憂鬱（b = .220, p = .001; b = .179, p = .005）均有顯著相關性。結論：雙相症病人之睡眠與情緒症狀之間有密切相關性，收案一個月主觀睡眠時數及品質的變化，與主觀焦慮及憂鬱之症狀變化之間也存在顯著相關性。建議未來運用睡眠紀錄或穿戴式裝置，以監測病人睡眠變化、穩定其情緒症狀及預防復發。

關鍵字

雙相症 ； 睡眠 ； 躁症 ； 憂鬱 ； 穿戴式手環 ； 縱貫性研究

並列摘要

Background: Sleep problems often increase the recurrence of mood dysregulation and relapse among patients with bipolar disorder. Continually monitoring sleep quality may predict mood symptoms for the provision of early intervention. However, the dynamic relationship between sleep quality and mood symptoms remains unclear. Purpose: This study examined the associations between subjective and objective sleep quality and mood symptom severity among patients with bipolar disorder. Methods: This longitudinal study with a convenience sample of 104 inpatients with bipolar disorder was conducted in a medical center in southern Taiwan. Their subjective and objective sleep quality and mood symptom severity were assessed at the first appointment, 1 month after the first appointment, and 3 months after the first appointment. Their demographics were collected, and wearable devices were used to monitor sleep quality; the Pittsburgh Sleep Quality Index; the Young Mania Rating Scale; Hamilton Depression Rating Scale; Self-reported Depression, Anxiety, and Stress Scales; and the Altman Mania Scale were all used to assess patients. Results: The means of subjective and objective sleeping hours at the 3 time points ranged from 7 to 8 hours. Most patients reported poor sleep quality with mild depression and a remission of manic symptoms. Sleep quality total scores at the 3 time points were weakly and moderately correlated with subjective and objective anxiety, stress, and mood symptoms. Subjective sleep quality (P = 0.009), stress symptoms (P = 0.012), and subjective and objective manic symptoms (P ＜ 0.001) changed over time. After a month, subjective sleep hours and subjective anxiety symptoms (b = .834, p = .022), stress symptoms (b = .082, p = .007) and depression symptoms (b = .931, p = .003) were significantly correlated, showing that sleep hours increased with symptomatic improvement. Additionally, subjective sleeping hours were associated with patients' perceived anxiety (b = 0.246, P ＜ 0.001), stress (b = 0.236, P ＜ 0.001), and both subjective and patients' perceived depression symptoms (b = 0.220, P = 0.001; b = 0.179, P = 0.005, respectively). Conclusions: The sleep quality of patients with bipolar disorder is highly correlated with their mood symptoms. Dynamic associations across 1 month of subjective sleeping hours and sleep quality with their subjective anxiety and depression symptoms were observed. Maintaining a self-monitor diary or using wearable devices to record patients' sleep changes are suggested to stabilize the mood symptoms and prevent relapse.

並列關鍵字

bipolar disorder ； sleep ； manic ； depression ； wearable wristband ； longitudinal research

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