合併失眠的重鬱症患者之大腦皮質過度激發現象

目的：重鬱症患者經常伴隨失眠症狀，主訴白天想睡但卻睡不著，而大腦皮質過度激發(cortical hyperarousal)現象可能是失眠的神經心理病理機制之一。過去研究多探討原發性失眠患者、合併失眠的重鬱症患者在入睡與睡眠階段之大腦皮質活動，以及探討慢性失眠者在白天的生理過度激發現象，但較少研究釐清合併失眠的重鬱症患者之心理病理機制。本研究目的探討合併失眠的重鬱症患者在白天是否呈現大腦皮質過度激發現象。方法：本研究招募50名重鬱症患者為重鬱組，35名健康人為控制組，填寫匹茲堡睡眠品質量表(Pittsburgh Sleep Quality Index, PSQI)、貝克憂鬱量表第二版(Beck Depression Inventory-II, BDI-II)與貝克焦慮量表(Beck Anxiety Inventory, BAI)；並以19頻道腦波儀測量5分鐘閉眼休息狀態的腦波，透過頻譜分析呈現額葉(Fz)與中央區域(Cz)位置的高頻率腦波beta波(13-32Hz )來反映大腦皮質激發指標。結果：本研究發現：(1) 控制BZD的影響後，重鬱組的PSQI總分與Fz、Cz位置的beta波呈正相關；(2)控制BZD的影響後，重鬱組的憂鬱程度與Fz、Cz位置的beta波呈正相關；(3)重鬱組在Fz、Cz位置的beta波顯著高於控制組；(4) 以PSQI將重鬱組分成高低睡眠困擾兩組(PSQI ≥ 12與PSQI < 12)，在控制藥物影響後，高睡眠困擾重鬱組在Fz、Cz位置的相對beta波高於低睡眠困擾重鬱組。結論：合併失眠的重鬱症患者之睡眠困擾、憂鬱程度越高，在額葉和中央區域有越多的beta波，此現象可能反映了重鬱症合併失眠患者，白天大腦皮質呈現過度激發現象。

關鍵字

重鬱症合併失眠患者；大腦皮質激發；腦波

並列摘要

Purpose: Insomnia are common in patients with major depressive disorder (MDD), they complain fall asleep and awakens in the daytime. One of neuropsychopathological mechanism of insomnia is cortical hyperarousal. Previous studies were explored cortical activities at pre-sleep and sleep stages among patients with primary insomnia and MDD, as well as the physiological arousal in the daytime among patients with chronic insomnia. A lack of studies explore clearly the psychopathological mechanism among patients comorbid with MDD and insomnia. The purpose of this study was explored the daytime cortical arousal among patients comorbid with MDD and insomnia. Methods: Fifty of patients comorbid with MDD and insomnia were as the MDD group, and thirty healthy participants as the control group. All of participants filled out Pittsburgh Sleep Quality Index(PSQI), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). The resting electroencephalogram (EEG) with eye-closed were measured for five minutes via 19-channal BrainMaster equipment (BraniMaster Technologies, Inc., Bedford, Ohio), the spectrum analyses showed the beta power (13-32Hz; as a cortical hyperarousal index) at Fz and Cz sites. Results: This study found that: (1) After controlling the medication effect ,there are positive correlations between PSQI total score and beta at Fz and Cz. (2) After controlling the medication effect,the depression were correlated positively with beta at Fz and Cz. (3) There were higher beta at Fz and Cz in MDD group than that of in control group. (4) After controlling the medication effect, combined high sleep disturbance group and MDD group had higher relative beta at Fz and Cz than that of combined low sleep disturbance group and MDD group. Conclusion: This study indicated that the higher sleep disturbance, and depression among patients with comorbid MDD and insomnia had higher beta power at the frontal and central areas. These phenomena may reflect the daytime cortical hyper arousal among patients comorbid with MDD and insomnia.