Study On Sleep Characteristics Of Three Subtypes Of Major Depressive Disorder

OBJECTIVE: The status of diagnosis and treatment of major depressive disorder is not optimistic.The reason is that the complex clinical features of depression and its various comorbidities hinder individualized treatment based on clinical pathological features.Therefore,researchers have developed many clinical description subtypes in an attempt to accurately focus MDD.According to DSM-5,MDD can be devided into several subtypes according to its clinical characteristics,including anxious,melancholic,and atypical features.Other researchers have found a strong two-way relationship between depressive disorder and sleep disorders,and treating insomnia can improve the prognosis of patients with depressive disorder.Therefore,this study aims to explore the differences in sleep monitoring indicators of three subtypes of depression and its relationship with clinical symptoms through a new cardiopulmonary coupling technique,and to understand the sleep characteristics of three subtypes of depression.METHODS: Patients with DSM-5 major depressive disorder with melancholic,anxious,and atypical features were enrolled.The 17 Hamilton Depression Scale(HAMD-17)and 30 the self-report version of the Inventory of Depressive Symptomatology were used to assess subtypes.Demographic data questionnaire,clinical characteristics data questionnaire,Hamilton Anxiety Scale(HAMA),Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI)And the Sleep Personal Beliefs and Attitudes Scale(DBAS-16)collects basic patient information and monitors the patient’s objective sleep status through a cardiopulmonary coupling analysis(CPC)sleep detection system.RESULTS: A total of 111 patients with major depressive disorder were enrolled in the study,including 41 patients with melancholic depression,accounting for 36.9%;56 patients with anxious depression,accounting for 50.5%;14 patients with atypical depression,accounting for 12.6%.There were no significant differences in general demographic and clinical characteristics between the three subtypes.In terms of emotional status,patients with melancholic depression scored significantly higher on the IDSSR30 scale than those with anxious depression(p<0.05).In terms of subjective sleep,PSQI-sleep quality score and PSQI-day dysfunction score of melancholic depression were significantly higher than anxious depression(p<0.05),while melancholic depression had a significantly higher DBASexpectation score for sleep than atypical depression(p<0.05).In terms of objective sleep,about CPC-the number of times you get up halfway,melancholic depression was significantly lower than that of atypical depression(p<0.05).Compared with melancholic depression,the time of light sleep and the number of midway waking were proportional to the probability of atypical depression(p<0.05),and the REM sleep time and AHI were inversely proportional to the probability of atypical depression(p<0.05).The time of light sleep was proportional to the probability of anxious depression(p<0.05);the time of sleep,REM sleep time,AHI was inversely proportional to the probability of anxious depression(p<0.05).Factors affecting the severity of subjective insomnia in patients with melancholic depression were: PSQI-sleeping time,age at first onset of depressive symptoms,PSQI-day dysfunction,marital status,current occupational status,substance use status,and current depressive status(p< 0.05).The factors influencing the severity of subjective insomnia in patients with anxious depression were gender,PSQI-sleep quality and BMI(p<0.05).Factors affecting the severity of subjective insomnia in atypical depression patients were gender,PSQI-sleep time,CPC-AHI,depressive symptoms at the first age,and CPC-deep sleep time(p<0.05).CONCLUSIONS: Three subtypes of depression with insomnia have abnormal sleep perception,lower sleep perception,and tend to underestimate their sleep.Patients with melancholic depression have higher initial sleep time,less light sleep,more REM sleep,and a higher AHI(more likely to have sleep apnea),and tend to judge the quality of sleep overnight with the beginning of their own sleep.Depressive symptoms and mental anxiety in patients in melancholic depression with insomnia are more serious.Subjectively,they think their sleep is worse and their cognition of sleep is more unreasonable.Objectively,they have more sleep latency and REM sleep,less deep sleep.However,whether or not accompanied by insomnia does not affect the daytime function of patients with melancholic depression.Anxious depression patients have less deep sleep and their concerns about insomnia affect the whole process of sleep,and tend to remain high awakening during sleep.Anxious depression patients with insomnia symptoms have more severe mental anxiety and subjectively believe that their sleep is worse and their perception of sleep is more unreasonable.However,whether or not accompanied by insomnia does not affect the daytime function of patients with anxious depression,and there is no significant difference in objective sleep between anxiety depression patients with insomnia symptoms and anxiety depression patients without insomnia symptoms.The total sleep time of atypical depression is higher,and the number of wake-ups is more in the middle,which has more unreasonable expectations for sleep.Unlike melancholic depression and anxious depression,there is no difference in the severity of depressive symptoms,severity of anxiety,subjective sleep disorder,and objective sleep in patients with atypical depression with or without insomnia.