既往研究顯示，5羥色胺再攝取抑製劑(SSRIs)可能改善睡眠相關呼吸障礙(SRBD)，但是尚未在沒有中至重度SRBD 受試者中評估SSRI對呼吸的影響。而且抑鬱的許多症狀與SRBD發生重疊，因此，廣東省人民醫院、廣東省精神衛生中心的學者們對呼吸與SSRI治療抑鬱期間精神病理學的相互作用進行了研究，結果表明，舍曲林在一定程度上可改善SRBD，更常見於相對更嚴重的睡眠障礙性呼吸患者[呼吸障礙指數(RDI)≥ 10]。雖然舍曲林引起的SRBD改善似乎沒有重大臨床效果，但伴RDI 得分率減少50%及以上的SRBD改善組受試者主觀和客觀睡眠情況均優於非改善組。因此，在抗抑鬱治療中，SSRI相關性SRBD改善可能具有潛在臨床益處。相關論文2015 年3月11日在線發表於《睡眠呼吸》(Sleep Breath)雜誌。

        研究者們從一項為期8周有關舍曲林治療抑鬱患者的開放標簽試驗中提取了數據，涉及31例伴失眠的抑鬱患者，並在試驗期間予其如下方案：第一天上午8點舍曲林50mg，隨後在8周試驗期間劑量增加至最大量200mg/d。在基線時和第1、14、28、56天多次測定患者的多導睡眠圖(PSG)，將睡眠障礙性呼吸事件分為窒息、低通氣和呼吸事件相關的覺醒(RERA)。

        結果顯示，在8周試驗期間臨床應答和PSG特征有持續地改善。從第14天起，整夜和非快速眼動(NREM)睡眠RERA指數變得穩定，並且明顯高於基線時和第1天的(RERA指數：基線7.3 ± 2.2，第1天7.3 ± 2.5，第14天4.4 ± 1.9，第28天3.9 ± 1.3，第56天4.2 ± 2.0，F = 5.71，P = 0.02;NREM-RERA指數在上述相應時期分別為6.2 ± 2.0、6.3 ± 2.3、3.2 ± 1.5、3.5 ± 0.9、3.2 ± 1.7，F = 4.92，P = 0.03)。

        另外，NREM-窒息指數呈現出與RERA指數相似的模式，並且在基線和14天間達到顯著差異(P = 0.047)。

        與非改善組相比，伴RDI評分降低率≥50%的改善組受試者慢波睡眠(SWS)正評分降低率更大(P = 0.04)，且覺醒指數(P = 0.01)、匹茲堡睡眠質量指數(PSQI)評分(P = 0.05)和Epworth睡眠量表(ESS)評分(P = 0.02)的負評分降低率較大。

        參考文獻：Zhang B，et al. Sleep Breath.2015 Mar 11. [Epub ahead of print]

Effect of sertraline on breathing in depressed patients without moderate-to-severe sleep-related breathing disorders. 

BACKGROUND:
Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) might improve sleep-related breathing disorders (SRBDs). However, the effects of SSRIs on breathing are not evaluated in subjects without moderate-to-severe SRBDs. Further, many symptoms of depression and SRBDs overlap, and so, it is interesting whether there are interactions between breathing and psychopathologic symptoms duringSSRI treatment for depression.
METHODS:
Data were taken from an open-label 8-week trial of sertraline in depressed patients with insomnia (n = 31). The depressed patients were administered 50 mg sertraline at 8 AM on the first day, and the dosage was subsequently titrated up to a maximum of 200 mg/day during the 8-week trial. All the patients were tested by repeated polysomnography (PSG) (baseline, 1st day, 14th day, 28th day, and 56th day). Sleep-disordered breathing events were categorized as apneas, hypopneas, and respiratory event-related arousals (RERAs).
RESULTS:
The clinical responses and PSG characteristics improved continuously during the 8-week trial. From the 14th day on, the RERA index during all-night and non-rapid eye movement (NREM) sleep became stable and significantly higher than baseline and the first day (RERA index 7.3 ± 2.2 at baseline, 7.3 ± 2.5 on the 1st day, 4.4 ± 1.9 on the 14th day, 3.9 ± 1.3 on the 28th day, 4.2 ± 2.0 on the 56th day, F = 5.71, P = 0.02; NREM-RERA index 6.2 ± 2.0 at baseline, 6.3 ± 2.3 on the 1st day, 3.2 ± 1.5 on the 14th day, 3.5 ± 0.9 on the 28th day, 3.2 ± 1.7 on the 56th day, F = 4.92, P = 0.03).
Additionally, the NREM-apnea index showed a similar pattern to that of the RERA index and reached a significant difference between baseline (1.0 ± 0.5) and the 14th day (0.5 ± 0.4) (KW = 4.28, P = 0.047).
Compared to the no-improvement group, the improvement group with a decreasing score rate of the respiratory disturbance index (RDI) greater than or equal to -50 % had a more positive decreasing score rate of slow wave sleep (SWS) (439.0 ± 78.2 vs 373.2 ± 77.9 %, T = 3.46, P = 0.04) and a more negative decreasing score rate on the arousal index (-43.7 ± 16.7 vs -26.6 ± 9.7 %, T = 9.16, P = 0.01), Pittsburgh Sleep Quality Index (PSQI) scores (-65.1 ± 33.7 vs -49.6 ± 21.4 %, T = 4.74, P = 0.05), and Epworth Sleepiness Scale (ESS) scores (-55.7 ± 21.3 vs -36.4 ± 17.5 %, T = 6.44, P = 0.02).
DISCUSSION:
This research indicates that SRBDs could be improved to some extent by sertraline treatment, which might be more common in patients with relatively more severe sleep-disordered breathing (e.g., RDI ≥ 10 in the current study). Although the sertraline-induced SRBD improvement seems not to have a significant clinical effect, the SRBD improvement group with decreasing score rate of RDI greater than or equal to -50 % has better subjective and objective sleep aspects than the no-improvement group. Thus, the fact that the SRBDs' improvement was related to SSRIs might have a potential clinical benefit in the antidepressant treatment.