目的·系统评价体动记录仪对于抑郁症患者昼夜节律特征的评估效果.方法·检索PubMed、Embase、Web of Science、Cochrane Library、PsycINFO、中国知网(CNKI)、万方数据知识服务平台(WanFang)、中国生物医学文献数据库(Chinese biomedical literature database,CBM),检索文献发表时间为从各数据库建库开始至2023年05月05日,收集使用体动记录仪评估抑郁症患者的昼夜节律并与健康对照进行比较的横断面研究.由2名研究者根据纳入与排除标准独立筛选文献,并采用Newcastle-Ottawa Scale(NOS)文献质量评价量表对纳入的文献进行质量评价,最后使用RevMan5.4软件进行meta分析.结果·共纳入9篇文献,包括抑郁症患者390名,健康对照288名.Meta分析结果显示,抑郁症患者昼夜节律余弦函数的中值(midline statistic of rhythm,MESOR)(SMD=-0.29,95%CI-0.51～-0.07,P=0.009)小于健康对照;抑郁症患者的入睡时间(sleep onset)(MD=33.06,95%CI 14.90～51.23,P=0.000)和觉醒时间(sleep offset)(MD=53.80,95%CI 22.38～85.23,P=0.000)晚于健康对照;抑郁症患者和健康对照1 d中最活跃的10 h的活动量(activity during the 10 most active hours,M10)(SMD=-0.26,95%CI-0.52～0.01,P=0.060)间差异无统计学意义,但抑郁症患者的活动量有小于健康对照的趋势;抑郁症患者和健康对照昼夜节律余弦函数的峰值相位(acrophase)(MD=25.33,95%CI-12.41～63.06,P=0.190)间差异无统计学意义;抑郁症患者和健康对照昼夜节律余弦函数的振幅(amplitude)(SMD=-0.14,95%CI-0.42～0.14,P=0.340)以及 1 d中最不活跃的 5 h的活动量(activity during the 5 least active hours,L5)(SMD=0.31,95%CI-0.10～0.71,P=0.140)间差异的统计学意义并不明确.结论·体动记录仪能够在一定程度上反映抑郁症患者的昼夜节律紊乱,但因纳入研究数量有限,研究人群及方法不一致,对分析质量和结果产生了一定影响,需要更多高质量的临床试验提供证据.
Evaluation of circadian rhythms in depression by using actigraphy:a systematic review and meta-analysis
Objective·To systematically review the effectiveness of actigraphy on the evaluation of circadian rhythm characteristics in patients with depression.Methods·A systematic literature search was conducted in PubMed,Embase,Web of Science,Cochrane Library,PsycINFO,CNKI,WanFang Data,and Chinese biomedical literature database(CBM),from the inception of each database to May 5th,2023.Case control studies that used actigraphy to evaluate circadian rhythms in patients with depression and compared them with healthy controls were collected.Literature was screened according to the inclusion and exclusion criteria,and the quality of the included literature was evaluated by using the Newcastle-Ottawa Scale.The meta-analysis was performed by using RevMan 5.4 software.Results·A total of 9 articles were included,including 390 patients with depression and 288 healthy controls.The meta-analysis showed that the MESOR(midline statistic of rhythm)(SMD=-0.29,95%CI-0.51 ‒-0.07,P=0.009)of the circadian cosine function in patients with depression was lower than that in healthy controls;sleep onset(MD=33.06,95%CI 14.90 ‒ 51.23,P=0.000)and sleep offset(MD=53.80,95%CI 22.38 ‒ 85.23,P=0.000)were later in patients with depression than those in healthy controls;no statistical difference was found in the activity level of the most active 10 hours(SMD=-0.26,95%CI-0.52 ‒ 0.01,P=0.060)between patients with depression and healthy controls,although there was a trend for lower activity in patients with depression;no statistical difference was found in the acrophase(MD=25.33,95%CI-12.41 ‒ 63.06,P=0.190)of the circadian cosine function between patients with depression and healthy controls;no clear statistical significance of the difference was found in the amplitude(SMD=-0.14,95%CI-0.42 ‒ 0.14,P=0.340)and the activity level of the least active 5 hours(SMD=0.31,95%CI-0.10 ‒ 0.71,P=0.140)between patients with depression and healthy controls.Conclusion·Actigraphy can reflect circadian rhythm disruption in patients with depression to some extent,but the limited number of included studies and inconsistencies in the study populations and methodologies have affected the quality and results of the analyses.More high-quality clinical trials are needed to provide evidence.
NETL
NSTL
万方数据
