体动记录仪评估抑郁症昼夜节律：一项系统综述和meta分析

doi:10.3969/j.issn.1674-8115.2024.05.009

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (5): 606-616.doi: 10.3969/j.issn.1674-8115.2024.05.009

• 论著 · 循证医学 • 上一篇

体动记录仪评估抑郁症昼夜节律：一项系统综述和meta分析

孙晨寅(), 吴百川, 张慧凤, 方贻儒(), 彭代辉()

上海交通大学医学院附属精神卫生中心心境障碍科，上海 200030

收稿日期:2023-11-08 接受日期:2024-02-23 出版日期:2024-05-28 发布日期:2024-05-28
通讯作者: 方贻儒,彭代辉 E-mail:1185161632@qq.com;yirufang@aliyun.com;pdhsh@126.com
作者简介:孙晨寅（1998—），女，硕士生；电子信箱：1185161632@qq.com。
基金资助:
科技创新2030—“脑科学与类脑研究”重大项目(2021ZD0200600);上海市中央引导地方科技发展资金资助项目(YDZX20213100001003)

Evaluation of circadian rhythms in depression by using actigraphy: a systematic review and meta-analysis

SUN Chenyin(), WU Baichuan, ZHANG Huifeng, FANG Yiru(), PENG Daihui()

Department of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

Received:2023-11-08 Accepted:2024-02-23 Online:2024-05-28 Published:2024-05-28
Contact: FANG Yiru,PENG Daihui E-mail:1185161632@qq.com;yirufang@aliyun.com;pdhsh@126.com
Supported by:
MOST 2030 Brain Project(2021ZD0200600);Central Funds Guiding Local Science and Technology Development of Shanghai(YDZX20213100001003)

摘要/Abstract

摘要：

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。

关键词: 抑郁症, 体动记录仪, 昼夜节律, meta分析, 系统综述

Abstract:

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.

Key words: depression, actigraphy, circadian rhythm, meta-analysis, systematic review

中图分类号:

R749

孙晨寅, 吴百川, 张慧凤, 方贻儒, 彭代辉. 体动记录仪评估抑郁症昼夜节律：一项系统综述和meta分析[J]. 上海交通大学学报（医学版）, 2024, 44(5): 606-616.

SUN Chenyin, WU Baichuan, ZHANG Huifeng, FANG Yiru, PENG Daihui. Evaluation of circadian rhythms in depression by using actigraphy: a systematic review and meta-analysis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(5): 606-616.

图/表 11

参考文献 51

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Study	Research area	Depression				Control			Actigraphy		Outcome
Study	Research area	Sample size/n	Age/year	Sex (male/female)/n	Diagnostic criteria	Sample size/n	Age/year	Sex (male/female)/n	Instrument model	Wearing time/d
ROBILLARD, 2015^[17]	Australia	135	20.0±4.4	47/88	DSM	41	25.3±5.8	19/22	Actiwatch-64/L/2, Philips Respironics	4‒22	①③⑥⑦
MERIKANTO, 2017^[18]	Finland	8	16.0±1.1	8/0	K-SADS-PL	9	16.0±0.7	9/0	Actiwatch-Plus®, Cambridge Neurotechnology Ltd, Cambridge, UK	23	①④⑤
SLYEPCHENKO, 2019^[19]	Canada	38	39 (22.75)	13/25	MINI	40	30 (20)	20/20	Actiwatch 2 monitor	15	①②③④⑤
MINAEVA, 2020^[20]	The Netherlands	58	52.34±10.59	22/36	CIDI	63	51.94±12.05	34/29	GENEActiv actigraphy	14	①②③
PYE, 2021^[21]	Australia	27	62.7±8.1	8/19	MINI	47	63.1±8.1	19/28	Respironics Actiwatch Spectrum	14	①②③④⑤⑥⑦
TONON, 2022^[22]	Brazil	39	16.1±0.7	19/20	K-SADS-PL	26	15.4±0.8	16/10	ActTrust Condor	10	②③④⑤⑥⑦
ROBILLARD, 2013^[23]	Australia	46	20.1±4.7	17/29	DSM-IV	20	24.8±2.5	8/12	Actiwatch64, Philips Respironics, OR	7	⑥⑦
ROBILLARD, 2018^[24]	Australia	35	21.1±2.9	14/21	DSM-IV	15	24.3±3.4	7/8	Actiwatch64/L/2, Philips Respironics, USA or GENEActiv, Activinsights, UK	12	⑥⑦
MCGLASHAN, 2019^[25]	Australia	8	24.25±2.12	0/8	DSM-IV-TR	31	21.19±2.65	0/31	Actiwatch Spectrum, PLUS, PRO, 2 or L, Philips Respironics, OR, USA	7	⑥⑦

Study	Research area	Depression				Control			Actigraphy		Outcome
Study	Research area	Sample size/n	Age/year	Sex (male/female)/n	Diagnostic criteria	Sample size/n	Age/year	Sex (male/female)/n	Instrument model	Wearing time/d
ROBILLARD, 2015^[17]	Australia	135	20.0±4.4	47/88	DSM	41	25.3±5.8	19/22	Actiwatch-64/L/2, Philips Respironics	4‒22	①③⑥⑦
MERIKANTO, 2017^[18]	Finland	8	16.0±1.1	8/0	K-SADS-PL	9	16.0±0.7	9/0	Actiwatch-Plus®, Cambridge Neurotechnology Ltd, Cambridge, UK	23	①④⑤
SLYEPCHENKO, 2019^[19]	Canada	38	39 (22.75)	13/25	MINI	40	30 (20)	20/20	Actiwatch 2 monitor	15	①②③④⑤
MINAEVA, 2020^[20]	The Netherlands	58	52.34±10.59	22/36	CIDI	63	51.94±12.05	34/29	GENEActiv actigraphy	14	①②③
PYE, 2021^[21]	Australia	27	62.7±8.1	8/19	MINI	47	63.1±8.1	19/28	Respironics Actiwatch Spectrum	14	①②③④⑤⑥⑦
TONON, 2022^[22]	Brazil	39	16.1±0.7	19/20	K-SADS-PL	26	15.4±0.8	16/10	ActTrust Condor	10	②③④⑤⑥⑦
ROBILLARD, 2013^[23]	Australia	46	20.1±4.7	17/29	DSM-IV	20	24.8±2.5	8/12	Actiwatch64, Philips Respironics, OR	7	⑥⑦
ROBILLARD, 2018^[24]	Australia	35	21.1±2.9	14/21	DSM-IV	15	24.3±3.4	7/8	Actiwatch64/L/2, Philips Respironics, USA or GENEActiv, Activinsights, UK	12	⑥⑦
MCGLASHAN, 2019^[25]	Australia	8	24.25±2.12	0/8	DSM-IV-TR	31	21.19±2.65	0/31	Actiwatch Spectrum, PLUS, PRO, 2 or L, Philips Respironics, OR, USA	7	⑥⑦

Study	Selection				Comparability		Outcome			Quality score
Study	①	②	③	④	①	②	①	②	③	Quality score
ROBILLARD, 2015^[17]	1	1	1	1	1	1	1	1	1	9
MERIKANTO, 2017^[18]	1	1	1	1	1	1	1	1	0	8
SLYEPCHENKO, 2019^[19]	0	1	1	1	1	1	1	1	0	7
MINAEVA, 2020^[20]	0	1	1	1	1	1	1	1	1	8
PYE, 2021^[21]	0	1	0	1	1	0	1	1	1	6
TONON, 2022^[22]	0	1	1	1	0	1	1	1	0	6
ROBILLARD, 2013^[23]	1	1	0	0	0	1	1	1	1	6
ROBILLARD, 2018^[24]	0	1	1	1	0	1	1	1	1	7
MCGLASHAN, 2019^[25]	0	0	1	1	0	1	1	1	1	6

Study	Selection				Comparability		Outcome			Quality score
Study	①	②	③	④	①	②	①	②	③	Quality score
ROBILLARD, 2015^[17]	1	1	1	1	1	1	1	1	1	9
MERIKANTO, 2017^[18]	1	1	1	1	1	1	1	1	0	8
SLYEPCHENKO, 2019^[19]	0	1	1	1	1	1	1	1	0	7
MINAEVA, 2020^[20]	0	1	1	1	1	1	1	1	1	8
PYE, 2021^[21]	0	1	0	1	1	0	1	1	1	6
TONON, 2022^[22]	0	1	1	1	0	1	1	1	0	6
ROBILLARD, 2013^[23]	1	1	0	0	0	1	1	1	1	6
ROBILLARD, 2018^[24]	0	1	1	1	0	1	1	1	1	7
MCGLASHAN, 2019^[25]	0	0	1	1	0	1	1	1	1	6

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体动记录仪评估抑郁症昼夜节律：一项系统综述和meta分析

Evaluation of circadian rhythms in depression by using actigraphy: a systematic review and meta-analysis

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