精神科药物对睡眠结构的影响：一项回顾性 多导睡眠图研究

The Impact of Psychiatric Drugs on Sleep Architecture: A Retrospective Polysomnography Study

摘要: 目的：失眠是精神科患者常见症状之一，临床常用苯二氮䓬受体激动剂、抗抑郁药、抗精神病药改善睡眠，但缺乏这些药物对于睡眠结构影响的研究，本研究旨在探讨精神科常用改善睡眠的药物对睡眠结构的影响，指导更合理安全的失眠用药。方法：本研究回顾性分析了2024年1月1日至2025年9月30日在武汉市精神卫生中心睡眠实验室接受多导睡眠图(PSG)监测的患者资料。根据患者用药情况，共纳入152例符合纳排标准的受试者，并将受试者分为五组：抗精神病药物组、苯二氮䓬类药物组、抗抑郁药物组、非苯二氮䓬类药物组及无药组。采用Kruskal-Wallis检验方法对各组间人口学特征、药物使用情况及睡眠结构参数进行成对比较，并采用多重检验校正方法控制统计偏倚。结果：组间比较结果显示，苯二氮䓬类药物组的N2期(时长及比例)显著高于非苯二氮䓬类药物组(p = 0.001)和无药组(p = 0.025)，其他精神科药物组与无药组之间未见显著差异。结论：精神科药物中苯二氮䓬类对睡眠结构的改变尤以N2期延长最为显著。在老年患者中的使用需综合考虑其对睡眠结构的影响与潜在风险，临床上应加强个体化用药管理与随访监测。

Abstract: Aims: Psychotropic medications are commonly used to treat insomnia in psychiatric patients, yet their specific impacts on sleep architecture remain under-characterized. This study investigated the effects of common psychiatric medications on sleep architecture to inform safer pharmacological management. Methods: This retrospective study analyzed polysomnography (PSG) data from 152 patients at the Wuhan Mental Health Center (January 2024~September 2025). Participants were categorized into five groups based on medication use: antipsychotics, benzodiazepines, antidepressants, non-benzodiazepine hypnotics, and drug-free controls. Sleep architecture parameters were compared across groups using Kruskal-Wallis tests followed by post hoc pairwise comparisons. Results: Overall group comparisons revealed significant statistical differences in N2 sleep parameters. Subsequent post hoc analyses demonstrated that the benzodiazepine group exhibited significantly higher N2 sleep (both in duration and proportion) compared to the non-benzodiazepine hypnotic group (p = 0.001) and the drug-free control group (p = 0.025). No significant differences were observed between the other psychiatric medication groups and the drug-free controls. Conclusions: Among the examined medications, benzodiazepines exerted the most pronounced effect on sleep architecture, specifically by prolonging N2 sleep. Clinicians should carefully weigh these architectural impacts against potential risks, particularly in older adults, and prioritize individualized medication management.