我们要感谢 Wanting Li 女士提供的数字技术支持。这项工作得到了内蒙古医学基金 （2022QNWN0010， 2023SGGZ047， 2023SGGZ0010） 的支持。

该研究得到了中国呼和浩特市内蒙古心理健康中心（内蒙古自治区第三医院、内蒙古自治区脑科医院）学术伦理委员会的批准。所有研究参与者都签署了知情同意书。
1. PSG 程序
<ol><li>数据采集<ol><li>包括根据 DSM-V 诊断的 MDD 患者。 注意：本研究包括 22 名根据 DSM-V 诊断的 MDD 患者。由于受教育程度低，2 例 MDD 患者拒绝参加。因为他们都发现，在认知筛选工具中完成 TMT-B 时，阅读汉字并不容易。</li>
		<li>排除被诊断患有严重痴呆、焦虑、谵妄和其他疾病的参与者，这些疾病使他们无法整晚完成 PSG。</li>
		<li>收集参与者的人口统计数据，包括姓名、国籍、性别、年龄、出生日期、结婚、主诉、症状、主要诊断、病史、科室、体温、脉搏、呼吸频率、血压、身高、体重、体重指数、腹围和上胸围。</li>
		<li>每个参与者都被指示完成 Epworth 睡眠量表16。</li>
	</ol></li>
	<li>连接派生<ol><li>收集参与者的信息后，引导参与者进入睡眠监测室。</li>
		<li>逐步收集脑电图 （EEG）、眼电图 （EOG）、下巴肌电图 （EMG） 和心电图 （ECG） 的所有推导。 注意：参与者应保持他/她的面部、皮肤和头发清洁干燥。</li>
		<li>根据国际 10-20 电极放置系统连接 15 个脑电图电极（图 1）17。</li>
		<li>连接 EOG 的两个派生 （E1， E2），如图 2 所示。</li>
		<li>连接下巴肌电图的三个推导（Chin1、Chin2、ChinZ），如图 3 所示。</li>
		<li>连接 ECG 的两个推导 （+， −），如图 4 所示。</li>
	</ol></li>
	<li>启动数据采集系统<ol><li>双击 设备管理器 启动软件。</li>
		<li>双击 Room 选项并添加参与者的个人信息。 注意：个人信息包括姓名、性别、出生日期、文件名、文件路径等。可以根据需要添加更多详细信息（例如，身高、体重、颈围、医生、技术人员、医院、地址、婚姻状况、职业和监护人 [如果参与者是儿童]）。</li>
		<li>点击 OK 按钮。</li>
		<li>点击 开始录制 按钮。</li>
		<li>单击 校准 按钮并指示参与者根据分步校准程序执行（参见 补充图 1）。 注意： 表 1 中列出了校准分步程序。在校准过程中，应打开远程呼叫系统，以便指导参与者按照医生的指示进行操作。</li>
	</ol></li>
	<li>整夜收集数据<ol><li>整晚将导数保持在正确的位置。 注意：这将由值班技术人员完成。值班技术人员应接受过哮喘、不稳定型心绞痛等疾病的应急管理培训。</li>
	</ol></li>
	<li>后校准<ol><li>唤醒参与者并打开睡眠监测室的灯。</li>
		<li>起床时间通常是早上 6：00。如果参与者在早上 6：00 之前醒来并且不想继续，请停止监控。</li>
		<li>如果参与者在上午 6：00 处于快速眼动 （REM） 睡眠期，请继续监测直到 REM 睡眠期结束。</li>
		<li>再次重复步骤 1.3.5 进行后校准。</li>
		<li>点击 关闭 按钮停止录制。</li>
	</ol></li>
	<li>轻轻去除所有衍生物，以避免皮肤损伤。</li>
	<li>得分<ol><li>双击 ProFusion PSG4 按钮以启动评分系统。</li>
		<li>双击参与者的姓名以选择参与者。</li>
		<li>单击 Scoring 按钮，然后选择 Scoring Automatically 选项，以对睡眠阶段和觉醒进行评分。 注意：睡眠阶段和觉醒根据 AASM 睡眠和相关事件评分手册：规则、术语和技术规范18 进行评分。技术人员也可以手动修改评分。</li>
		<li>单击 Create 按钮并布局结果（图 5）。</li>
	</ol></li>
	<li>定义和方程<ol><li>根据 PSG 数据和波形（如 表 2 所示），获取变量，包括卧床时间 （TIB）、总睡眠时间 （TST）、睡眠潜伏期 （SL）、睡前觉醒 （WASO）、睡眠效率（SE，等于 TST/TB）和 REM 潜伏期。</li>
	</ol></li>
</ol>2. 使用认知筛查工具
<ol><li>双击 THINC-it 按钮，在计算机上启动软件，输入个人信息，并指导参与者逐步完成每个子测试。<ol><li>单击 Chinese 按钮以选择简体中文版本。</li>
		<li>单击 加 按钮以添加新参与者。</li>
		<li>在相应的空白处输入姓名、年龄、性别、惯用手、教育水平和位置。</li>
		<li>单击 BEGIN TEST 按钮逐步开始子测试（参见 补充图 2）。</li>
	</ol></li>
	<li>完成感知缺陷问卷（PDQ-5，主观认知缺陷）。<ol><li>大声朗读“在过去 7 天内，您多久一次难以组织事情”，并指导参与者选择 5 个回答选项之一：过去 7 天内从不、很少（一次或两次）、有时（3 - 5 次）、经常（大约每天一次）和非常频繁（每天一次以上）。</li>
		<li>大声朗读“在过去 7 天内，您多久难以集中精力阅读的内容”， 并指导参与者从步骤 2.2.1 中描述的 5 个回答选项中选择一个。</li>
		<li>大声朗读“在过去 7 天内，除非您查阅，否则您多久忘记一次日期”， 并指示参与者从步骤 2.2.1 中描述的 5 个回答选项中选择一个。</li>
		<li>大声朗读“在过去 7 天内，您多久忘记一次电话交谈后所说的内容”， 并指示参与者从步骤 2.2.1 中描述的 5 个回答选项中选择一个。</li>
		<li>大声读出：「在过去的 7 天里，你多久觉得自己的大脑完全空白了？」 并指示参与者从步骤 2.2.1 中描述的 5 个响应选项中选择一个。</li>
		<li>单击 OK 按钮开始其他子测试。</li>
	</ol></li>
	<li>完成观察者测试（SPO，注意力反射）。<ol><li>点击 教程 按钮和 下一步 按钮阅读分步说明。</li>
		<li>单击 Start （开始） 按钮开始 SPO 测试。 注意：SPO 测试用于评估注意力;参与者需要尽快触摸突然出现的符号。 注意：该软件将自动在屏幕上显示最佳反应时间（毫秒）、正确响应、最长连胜和索引。</li>
		<li>单击 OK 按钮开始下一个子测试。</li>
	</ol></li>
	<li>完成符号检查测试（SC，工作记忆的反射）。<ol><li>单击 Tutorial 和 Next 按钮阅读分步说明。</li>
		<li>点击 Start 开始 按钮开始 SC 测试。 注意：SC 测试用于评估工作记忆。参与者需要在计时器用完之前识别隐藏的符号，并调用下一个隐藏的符号。该软件将自动在屏幕上显示 最快反应时间（毫秒）、正确答案、最长连胜 和 索引 。</li>
		<li>单击 OK 按钮开始下一个子测试。</li>
	</ol></li>
	<li>完成密码破译器测试（CB，反映信息处理速度）。<ol><li>单击 Tutorial 和 Next 按钮阅读分步说明。</li>
		<li>点击 Start 开始 按钮开始 CB 测试。 注意：CB 测试用于评估信息处理速度。参与者需要点击正确的符号以适合指定的圆圈（每个符号都被标识为圆圈内的某个数字）。该软件将在屏幕上自动显示 最快反应时间（毫秒）、正确的节点、最长的条纹以及 索引 。</li>
		<li>点击 OK 按钮进入下一个子测试。</li>
	</ol></li>
	<li>完成 TMT-B（轨迹，执行功能的反映）。<ol><li>单击 Tutorial 和 Next 按钮阅读分步说明。</li>
		<li>点击 Start 开始 按钮开始 CB 测试。 注意：Trails 测试用于评估执行功能。参与者需要在不抬起手指的情况下从一个字符开始画一条线到数字 1，然后从数字 1 继续到另一个字符，然后从这个字符继续到数字 2，一直持续到数字 9，尽可能快。该软件会自动在屏幕上显示 完成时间（毫秒）、错误、最长条纹和索引。</li>
		<li>单击 OK 按钮完成最后一个子测试。 注意：软件将自动显示参与者在每次测试中的表现;下载这些结果。</li>
	</ol></li>
</ol>3. 统计分析
<ol><li>使用学生 t 检验来评估组差异。执行 Pearson 相关性分析以评估睡眠质量与认知功能之间的关系。将 P < 0.05 视为具有统计显著性。 注：所有统计分析均使用 SPSS 25.0 版进行。</li>
</ol>

评估重度抑郁症患者的睡眠质量和认知功能

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作者没有什么可披露的。

这个由两部分组成的协议包含需要注意的关键步骤。对于 PSG 来说，得分是最重要的一步;因此，PSG 技术人员需要获得认证和经验。此外，在 PSG 之前，技术人员和参与者之间的沟通是必要的，因为患者在 PSG 期间可能会感到不舒服并退出。对于认知筛查工具，关键步骤是使用数字化设备评估认知功能。医生需要逐步介绍这些程序，以确保参与者理解它们。此外，如果参与者表现不佳是由于不熟悉?...

重度抑郁症 （MDD） 是一种严重的情绪障碍，会导致严重的发病率和死亡率，影响全球超过 3 亿人1。MDD 的特征是情绪低落、驱动力减退、失去兴趣以及自残或自杀的想法2。认知症状和睡眠障碍 （SD） 是 MDD 的两种非情绪相关症状 3,4。先前的研究表明，MDD 患者 SD 的患病率为 60-90%，而中国人群中这些患者的睡眠障碍患病率为 85.22%5。
尽管很少有研究调查认知症状与 SD 之间的因果关系，但初步证据表明 MDD6 个体的睡眠障碍与认知症状之间存在显着关联。例如，Cha 等人 3 发现，主观睡眠质量可以预测主观认知表现和客观认知障碍，这部分是由抑郁严重程度介导的。Biddle 等人 7 还发现，在患有 MDD 的老年男性中，通过活动记录仪测量的睡眠效率 （SE） 不佳与认知功能较差相关，与抑郁严重程度无关。观察到的差异可能是由方法学差异引起的。 
在这些文献中，研究人员使用了各种工具来评估睡眠和认知。匹兹堡睡眠质量指数 （PSQI） 通常被选为主观工具。还使用了体动图设备。然而，PSG 被认为是检测睡眠障碍8 （sleep disorders） 的金标准，是一种敏感、客观的 SD 评估9。据我们所知，在关于 MDD 患者睡眠与认知之间关系的研究中，很少有人使用 PSG 来评估睡眠质量。
MDD 中的认知症状可能是多维的，在某些情况下通过新的药理学策略来解决10,11。近年来出现了几种适用于 MDD 的认知评估工具12。THINC集成工具（THINC-it，以下简称认知筛查工具）是由Hou et al.13开发的经过验证的认知筛查工具，由一份主观问卷（感知缺陷问卷，PDQ-5）和四项客观认知测试（选择反应时间、1-back、数字符号替换和Trail making part-B）组成。它被认为是检测 MDD14 患者认知缺陷的一种省时、可接受的方法。还有另外两种常用工具用于评估 MDD 患者的认知功能：精神病学认知障碍筛查 D （SCIP-D） 和双相情感障碍评定中的认知主诉 （COBRA）12。前者是缺乏自我指导测试的客观工具，后者是缺乏客观版本的主观工具。这些工具之间的构成测试也有所不同。SCIP-D 由五个客观测试组成：语言学习、工作记忆、语言流利度、延迟记忆和处理速度。COBRA 包括执行功能、处理速度和注意力、语言学习和记忆以及视觉记忆12。最近开发的中文版认知筛查工具已被证实是评估中国 MDD15 患者认知缺陷的良好工具。因此，使用认知筛查工具软件和 PSG，目前的研究试图揭示 MDD 患者认知症状与 SD 之间的关系。

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association between sleep quality and cognitive symptoms in patients with major depressive disorder

认知症状和睡眠障碍 （SD） 是重度抑郁症 （MDD） 的常见非情绪相关症状。在临床实践中，认知症状和 SD 都与 MDD 进展有关。然而，只有少数研究调查了 MDD 患者认知症状与 SD 之间的联系，并且只有初步证据表明情绪障碍患者的认知症状与 SD 之间存在显着关联。本研究调查了重度抑郁症患者的认知症状与睡眠质量之间的关系。纳入 MDD 患者 （n = 20）;他们的平均汉密尔顿抑郁量表 17 评分为 21.95 （±2.76）。使用金标准多导睡眠图 （PSG） 评估睡眠质量，并使用经过验证的 THINC 集成工具 （认知筛查工具） 评估 MDD 患者的认知功能。总体而言，结果显示认知筛查工具的总分与睡眠潜伏期、睡后觉醒和睡眠效率之间存在显着相关性。这些发现表明，认知症状与 MDD 患者的睡眠质量差有关。

Major depressive disorder (MDD), a serious mood disorder that causes significant morbidity and mortality, affects over 300 million people worldwide1. MDD is characterized by low mood, reduced drive, loss of interest, and thoughts of self-harm or suicide2. Cognitive symptoms and sleep disturbance (SD) are two non-mood-related symptoms of MDD3,4. Previous studies have shown that the prevalence of SD is 60-90% in patients with MDD, while the prevalence of sleep disorders among these patients in the Chinese population is 85.22%5. 
Although few studies have investigated the causal relationship between cognitive symptoms and SD, preliminary evidence suggests a significant association between sleep disorders and cognitive symptoms in individuals with MDD6. For example, Cha et al.3 found that subjective sleep quality predicted both subjective cognitive performance and objective cognitive impairments, which were partially mediated by depression severity. Biddle et al.7 also found that among older men with MDD, poor sleep efficiency (SE), measured by actigraphy, was associated with worse cognitive function independent of depression severity. The observed discrepancies may be caused by methodological differences. 
Within this literature, researchers have used various tools to evaluate sleep and cognition. The Pittsburgh Sleep Quality Index (PSQI) was commonly selected as a subjective tool. Actigraphic devices have also been used. However, PSG, regarded as the gold standard for detecting sleep disorders8, is a sensitive, objective SD assessment9. To our knowledge, among the studies of the relationship between sleep and cognition in patients with MDD, few have used PSG to evaluate sleep quality.
Cognitive symptoms in MDD might be multidimensional and addressed in some cases by new pharmacological strategies10,11. Several cognitive assessment tools suitable for MDD have emerged in recent years12. THINC-integrated tool (THINC-it; henceforth referred to as the cognitive screening tool), a validated cognitive screening tool developed by Hou et al.13, is composed of a subjective questionnaire (perceived deficits questionnaire, PDQ-5) and four objective cognitive tests (choice reaction time, 1-back, digit symbol substitution, and trail making part-B). It is considered a time-efficient, acceptable method for detecting cognitive deficits in patients with MDD14. There are two other tools commonly used to assess cognitive function in patients with MDD: the Screen for Cognitive Impairments in Psychiatry-D (SCIP-D) and Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA)12. The former is an objective tool lacking self-instructed testing, and the latter is a subjective tool lacking an objective version. The constituent tests also differ between these tools. The SCIP-D is comprised of five objective tests: verbal learning, working memory, verbal fluency, delayed memory, and processing speed. The COBRA includes executive function, processing speed and attention, verbal learning and memory, and visual memory12. The recently developed Chinese version of the cognitive screening tool has been confirmed to be a good tool for evaluating cognitive deficits in Chinese patients with MDD15. Thus, using the cognitive screening tool software and PSG, the current study tried to reveal the relationship between cognitive symptoms and SD in MDD patients.

作者聚焦：揭示睡眠障碍与抑郁症认知症状之间的联系

重度抑郁症患者睡眠质量与认知症状的相关性

In this study, gold standard polysomnography was used to assess sleep quality and the validated cognitive screening tool was used to evaluate cognitive function in major depressive disorder patients. Thinking to recently developed Chinese version of the connecting screening tools has been confirmed to be a good tool for evaluation connective defects in Chinese patients with major depressive disorder. The current study reveals the close relationship between cognitive symptoms and sleep disorders in major depressive disorder patients.

参与者的男女比例为 11/9。所有个体的年龄在 35.35 ± 6.83 岁之间，受教育程度在 14.80 ± 3.29 岁之间，汉密尔顿抑郁量表-17 （HAMD-17） 评分为 21.95 分± 2.76 分，SE 为 76.71 ± 8.57%。关于认知筛查工具得分，PDQ-5、SPO、SC、CB、TMT-B 和总分分别为 1756.35 ± 395.49、2046.75 ± 684.45、852.15 ± 651.81、845.75 ± 641.15、911.45 ± 619.13 和 4140.80 ± 1298.14 分（表 2）。
图 5</stron...

Read this Scientific Article Protocol about Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression at JoVE.com

在这里，我们提出了一个方案，用于调查重度抑郁症患者认知症状与睡眠质量之间的关系。使用 THINC 集成工具和多导睡眠图评估认知症状和睡眠质量。

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both ...

在这项研究中，金标准多导睡眠图用于评估睡眠质量，经过验证的认知筛查工具用于评估重度抑郁症患者的认知功能。思考最近开发的中文版连接筛查工具已被证实是评估中国重度抑郁症患者结缔缺陷的良好工具。目前的研究揭示了重度抑郁症患者的认知症状与睡眠障碍之间的密切关系。

association-between-sleep-quality-cognitive-symptoms-patients-with

Research

JoVE Journal

Medicine

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

385 次观看.  Sleep Medicine Center of Inner Mongolia Mental Health Center (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region). 在这项研究中，金标准多导睡眠图用于评估睡眠质量，经过验证的认知筛查工具用于评估重度抑郁症患者的认知功能。思考最近开发的中文版连接筛查工具已被证实是评估中国重度抑郁症患者结缔缺陷的良好工具。目前的研究揭示了重度抑郁症患者的认知症状与睡眠障碍之间的密切关系。

视频: 作者聚焦：揭示睡眠障碍与抑郁症认知症状之间的联系

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both cognitive symptoms and SD are related to MDD progression. However, there are only a few studies investigating the connection between cognitive symptoms and SD in patients with MDD, and only preliminary evidence suggests a significant association between cognitive symptoms and SD in patients with mood disorders. This study investigates the relationship between cognitive symptoms and sleep quality in patients with major depressive disorder. Patients (n = 20) with MDD were enrolled; their mean Hamilton Depression Scale-17 score was 21.95 (&plusmn;2.76). Gold standard polysomnography (PSG) was used to assess sleep quality, and the validated THINC-integrated tool (the cognitive screening tool) was used to evaluate cognitive function in MDD patients. Overall, the results showed significant correlations between the cognitive screening tool's total score and sleep latency, wake-after-sleep onset, and sleep efficiency. These findings indicate that cognitive symptoms are associated with poor sleep quality among patients with MDD.

Here, we present a protocol that investigates the relationship between cognitive symptoms and sleep quality in patients with major depressive disorder. The THINC-integrated tool and polysomnography were used to evaluate cognitive symptoms and sleep quality.

科研

医学

Polysomnography Procedure to Assess Sleep Quality in Patients with MDD

To begin, collect the participant's demographics and instruct them to complete the Epworth Sleeping Scale. Lead the participant to the sleep monitoring room. Next, connect 15 electrodes of the electroencephalogram according to the International 1020 system of electrode placement.Also, connect the two derivations of Electrogram near the participant's eyes. Three derivations of Chin electromyogram, and two derivations of electrocardiogram. To acquire data, start the software by double clicking on device manager.Double click the room option, add the personal information of the participant and click OK.Click start recording, followed by the calibration button. Instruct the participant to perform according to the step-by-step calibration procedure. Keep the derivations in the correct position and collect the data for the entire night.On the next day, wake the participant by turning on the light of the sleep monitoring room. For post calibration, click the calibration button and instruct the participant to repeat the step-by-Step calibration procedure. Then click the close button to stop recording.After recording, remove all the derivations, avoiding skin damage. Next, start the scoring system by double clicking the profusion PSG four button. Select the participant and click the scoring button.Select the scoring automatically option to score sleep phases and arousals. Click the create button and lay out the results. Review the variables like time in bed, total sleep time, sleep latency, wake after sleep onset, sleep efficiency, and REM latency according to the PSG data and waves.

评估 MDD 患者睡眠质量的多导睡眠图程序

Evaluating Cognitive Function in Patients with MDD Using a Cognitive Screening Tool

To begin, explain the procedure to the Then double click the THINC-it button to start the software. Enter the name, age, gender, dominant hand, educational level, and location. And click the begin test button.To evaluate subjective cognitive deficits, guide the patient to complete the perception deficits questionnaire. Read aloud, During the past seven days, how often did you have trouble getting things organized? And instruct the participant to choose one of the five response options.Read the next question. During the past seven days, how often did you have trouble concentrating on what you were reading? And instruct the participant to choose one of the five response options.Again, read the question, During the past seven days, how often did you forget the date unless you looked it up? And allow the participant to choose their response. Read the question, During the past seven days, how often did you forget what you talked about after a telephone conversation?And let the participant choose their response. Finally, read aloud, During the past seven days, how often did you feel like your mind went totally blank? And instruct the participant to choose one of the five response options.Click the Okay button to finish the assessment. Using this protocol, 20 participants were evaluated for cognitive function using cognitive screening scores, such as PDQ-5, SPO, SC, CB, and TMT-B.