目的 探究心率变异性(HRV)生物反馈训练对不同类型失眠障碍患者的影响。方法 2016年6月至2017年3月,对17例单纯性失眠患者、19例失眠伴焦虑患者及19例失眠伴抑郁患者均进行HRV生物反馈训练及相同的药物治疗(酒石酸唑吡坦,每晚服用10 mg),训练前后采用匹兹堡睡眠质量指数(PSQI)、症状自评量表(SCL-90)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)进行评估并进行HRV数据采集。结果 HRV生物反馈训练后,三类失眠患者PSQI、SCL-90、HAMA、HAMD评分及低频段功率/高频段功率(LF/HF)均降低(t>1.446, P<0.05)。训练后,三组PSQI评分有显著性差异(F=3.537, P=0.038)。失眠伴焦虑、失眠伴抑郁组训练前后PSQI评分差值、LF/HF差值大于单纯性失眠组(P<0.05),失眠伴焦虑与失眠伴抑郁组间差值无显著性差异(P>0.05)。结论 HRV生物反馈训练对三种类型失眠患者均有改善作用,其中,对失眠伴焦虑及失眠伴抑郁组患者睡眠质量改善程度优于单纯性失眠患者。
Objective To investigate the effect of heart rate variability (HRV) biofeedback training on patients with three types of insomnia disorder. Methods From June, 2016 to March, 2017, 17 patients in simple insomnia group, 19 patients in insomnia with anxiety group, and 19 patients in insomnia with depression group were included. All the patients received HRV biofeedback training and same medication (zolpidem tartrate, 10 mg every night). They were assessed with Pittsburgh Sleep Quality Index (PSQI), Symptom Checklist 90 (SCL-90), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), and HRV parameters were tracked before and after training. Results After training, the scores of PSQI, SCL-90, HAMA , HAMD and the ratio of low frequency (LF) and high frequency (HF) (LF/HF) decreased in all groups (t>1.446, P<0.05). There was significant difference in PSQI among three groups (F=3.537, P=0.038). The D-values of the PSQI score and LF/HF before and after training were more in the insomnia with anxiety group and the insomnia with depression group than in the simple insomnia group (P<0.05), however, no significant difference was observed between the insomnia with anxiety group and the insomnia with depression group (P>0.05). Conclusion HRV biofeedback training could improve the symptoms of patients with three types of insomnia disorder, especially for those with anxiety or depression.
[1] Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence [J]. Sleep Med Rev, 2010, 14(1): 19-31.
[2] 赵莉,许晶. 慢性失眠的诊治及思考[J]. 医学与哲学, 2012, 33(14): 31-32, 80.
[3] Reynolds CR, O'Hara R. DSM-5 sleep-wake disorders classification: overview for use in clinical practice [J]. Am J Psychiatry, 2013, 170(10): 1099-1101.
[4] 侯俊霞,林秀孟. 门诊失眠患者伴发焦虑或/和抑郁状况及影响因素分析[J]. 中外医疗, 2015(4): 80-81.
[5] Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia [J]. Chest, 2015, 147(4): 1179-1192.
[6] 张峰菊,王晓雪,刘欣欣. 认知行为疗法治疗原发性失眠的疗效[J]. 中国实用神经疾病杂志, 2016, 19(20): 92-93.
[7] 高月霞,黄敬,刘华丽. 脑电生物反馈在焦虑障碍治疗的应用疗效[J]. 中国健康心理学杂志, 2015, 23(11): 1757-1760.
[8] 林晓玲,宋鲁平. 脑电生物反馈疗法在焦虑障碍中的应用[J]. 中华物理医学与康复杂志, 2015, 37(2): 158-160.
[9] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [M]. 5th ed. Arlington, VA: American Psychiatric Association, 2013.
[10] Peper E. 生物反馈教程——体验性教学和自我训练手册[M]. 宋鲁平,杜晓霞,译 北京: 中国医药科技出版社, 2013.
[11] Al-Ani M, Forkins AS, Townend JN, et al. Respiratory sinus arrhythmia and central respiratory drive in humans [J]. Clin Sci (Lond), 1996, 90(3): 235-241.
[12] 李欣,桑德春,邢春晓,等. 心率变异性生物反馈改善卒中后抑郁压力反应的研究[J]. 中国康复理论与实践, 2016, 22(8): 914-920.
[13] 李清伟,陆峥. 失眠症与焦虑障碍和抑郁障碍的关系及其治疗[J]. 中华全科医师杂志, 2016, 15(7): 505-507.
[14] 王晓艳,伏焱. 失眠患者的心率变异性研究[J]. 中外健康文摘, 2013, 10(12): 91.
[15] Watkins LL, Blumenthal JA, Carney RM. Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction [J]. Am Heart J, 2002, 143(3): 460-466.
[16] 郭静,唐楚英,王麟鹏. 原发性失眠患者的心率变异性与过度觉醒[J]. 临床精神医学杂志, 2016, 26(1): 68-69.
[17] Dodds KL, Miller CB, Kyle SD, et al. Heart rate variability in insomnia patients: A critical review of the literature [J]. Sleep Med Rev, 2017, 33: 88-100.
[18] Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers [J]. Psychosom Med, 1998, 60(5): 610-615.
[19] Farina B, Dittoni S, Colicchio S, et al. Heart rate and heart rate variability modification in chronic insomnia patients [J]. Behav Sleep Med, 2014, 12(4): 290-306.
[20] 马国重,蒋晓江,乐发国,等. 焦虑症伴发失眠与原发性失眠患者觉醒水平比较与分析[J]. 中国医药导报, 2012, 9(29): 29-31.
[21] 刘娜,王秀丽. 焦虑症患者的心率变异性研究[J]. 中国社区医师：医学专业, 2012, 14(29): 55-56.
[22] 马国重,蒋晓江,乐发国,等. 原发性失眠与抑郁症伴发失眠患者觉醒水平比较[J]. 重庆医学, 2013, 42(7): 746-748.
[23] 刘玉芝,侯昊. 原发性失眠与抑郁症伴发失眠患者觉醒水平的分析研究[J]. 中国民康医学, 2015, 27(24): 73-75.
[24] Stein PK, Pu Y. Heart rate variability, sleep and sleep disorders[J]. Sleep Med Rev, 2012, 16(1): 47-66.
[25] 钟意娟,皇甫恩,王家同. 焦虑症患者心率变异性频谱分析的研究[J]. 中华行为医学与脑科学杂志, 2004, 13(3): 55-56.
[26] 王智,董蕊,张伟. 不同反馈形式的生物反馈和音乐放松训练对生理反应和心理指标的影响[J]. 体育科学, 2010, 30(4): 34-42.
[27] Kemp AH, Quintana DS, Gray MA, et al. Impact of depression and antidepressant treatment on heart rate variability: a review and meta-analysis [J]. Biol Psychiatry, 2010, 67(11): 1067-1074.
[28] Lin IM, Ko JM, Fan SY, et al. Heart rate variability and the efficacy of biofeedback in heroin users with depressive symptoms [J]. Clin Psychopharmacol Neurosci, 2016, 14(2): 168-176.
[29] 刘旭峰. 心率变异性等多项生理指标对情绪稳定性的评价研究[D]. 西安:第四军医大学, 2002.
