| Objectives:1.To comprehend changes in sleep structure and the secretion of hypothalamus pituitary thyroid(HPT)axis,hypothalamus pituitary adrenal(HPA)axis,hypothalamus hypophysis growth hormone(HPGH)axis and hypothalamus pituitary gonadal(HPG)axis in patients with first-episode depressive disorder.2.To comprehend the correlation between sleep structure and above hormone levels in patients with first episode depressive disorder.Methods:50 cases of first-episode depressive disorder were selected as case group,and 20 patients with sleep disorders were selected as control group.Polysomnography was performed in the two groups at the first night after admission.On the second day of admission,blood samples were taken for thyroid hormone(include thyroid stimulating hormone,triiodothyronine,thyrine,free triiodothyronine,free thyroxine),adrenocorticotrophic hormone,cortisolgrowth hormone and sex hormone(include follicle stimulating hormone,luteinizing hormone,estradiol.progesterone.testosterone.prolactin)at 8 o'clock in the morning.Hamilton Depression Scale and Hamilton Anxiety Scale were used to assess depressive disorder.Results:1.The characteristics of sleep structure in patients with depression and sleep disorder:(1)Sleep latency was prolonged(42%of depressive disorder and 30%of sleep disorder),N1%increased(68%of depressive disorder and 90%of sleep disorder),and the percentage of slow wave sleep(SWS%)decreased(36%of depressive disorder and 45%of sleep disorder).(2)N2%is increasing(30%of depressive disorder and 15%of sleep disorder)or decreasing(56%of depressive disorder and 70%of sleep disorder),which is related to total sleep time.(3)In most patients,the percentage of rapid eye movement sleep(RT%)was decreased(86%of depressive disorder and 75%of sleep disorder),and a few patients' RT%was increased(4%of depressive disorder and 5%of sleep disorder).(4)N1%in patients with depression or sleep disorders associated with obstructive sleep apnea hypopnea syndrome(OSAHS)is increased compared with patients without OSAHS(P<0.05).SWS%in patients with sleep disorders with OSAHS decreased compared with those without OSAHS(P<0.05),but no such phenomenon was found in patients with depression.2.Patients with depression and sleep disorders had the following changes in hormone secretion:(1)46%of the patients had hypothyroidism,54%of them had hypersecretion of ACTH and Cor,and a decrease of ACTH and Cor was seen in a few patients(for 4%).(2)The secretion of GH was mainly reduced(8%),while a few patients had increased GH secretion(4%).(3)Sexual hormone secretion was significantly different between men and women,but PRL all expressed as increased(38%).3.Correlation between hormones and correlativity between hormone and disease severity:(1)In depression patients,FSH(r=0.705,P<0.01)and LH(r=0.500,P<0.01)were positively correlated with age,E2(r=-0.466,P<0.01),P(r=-0.435,P<0.01)and PRL(r=-0.337,P<0.01)were negatively correlated with age.T3(r=-0.308,P<0.01)and Cor(r=-0.302,P<0.05)were negatively correlated with the severity of depression.r=-0.337,P<0.01)were negatively correlated with age,T3 was positively correlated with ACTH(r=0.280,P<0.05).FT3 was negatively correlated with age(r=-0.440,P<0.01),FSH(r=-0.524,P<0.05),LH(r=-0.481,P<0.01).(2)In sleep disorders,FT4 was negatively correlated with age(r=-0.600,P<0.01),ACTH was negatively correlated with LH(r=-0.511,P<0.05),and positively correlated with T(r=0.495,P<0.05),GH was positively correlated with LH(r=-0.536,P<0.05).4.The correlation between sleep structure and hormone:(1)In patients with depression without OSAHS,there was a negative correlation between TSH and N2%(r=-0.377,P<0.05),T3(r=0.393,P<0.05)and PRL(r=0.528,P<0.01)were positively correlated with SWS%.(2)In patients with depressive disorder with OSAHS,T4 was positively correlated with N2%(r=0.587,P<0.05),ACTH was negatively correlated with SWS%(r=-0.585,P<0.05),PRL was negatively correlated with N1(r=-0.832,0.01).(3)In patients with sleep disorders without OSAHS,FSH was negatively correlated with N2%(r=-0.645,P<0.05),P was positively correlated with N2%(r=0.805,P<0.05),RT%(r=0.708,P<0.05).Conclusions:1.The sleep characteristics of the depressive disorder patients are the prolongation of the sleep latency,the increase of N1%,the decrease of SWS%,N2%and RT%,the less deep sleep and the lower sleep efficiency of the older depressive disorder patients.2.OSAHS will increase the N1%of patients,but it has no significant effect on neuroendocrine in patients with depressive disorder.3.HPT axis is hyposecretion and HPA axis is hypersecretion in depressive disorder patients,the FT3 gradually decreases with age.The decrease of FT3 in females are more obvious than that of males,and the HPA axis is more pronounced in males than in females.4.The secretion of sex hormones in male patients with depression are different from females,male patients are mainly the increase of P,while female patients are mainly the reduction of E2.5.The relationship between GH and depression is not clear.because the secretion of GH is influenced by many factors.6.Neuroendocrine and sleep structure in patients with sleep disorders are similar to those in depressive disorders.There is no significant difference in hormone secretion and sleep related indicators.7.In patients with depressive disorder,T3 and T4 have a certain improvement in sleep,while TSH and ACTH can aggravate the sleep disorder.In patients with sleep disorders.P has a certain improvement in sleep,and FSH will aggravate the sleep disorder. |
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