脑梗死患者睡眠质量与梗死部位及神经功能缺损程度的关联探究

目的探究脑梗死患者睡眠质量与梗死部位及神经功能缺损程度的关联,分析改善脑梗死患者睡眠质量的干预方法。方法将我院2017年6月-2018年6月收治的113例急性脑梗死患者纳入观察组,并选取同期80名健康体检者纳入对照组。使用多导睡眠图(PSG)检测两组受试者睡眠质量,并比较不同梗死部位、不同神经功能缺损程度急性脑梗死患者睡眠质量的差异,总结临床干预思路。结果观察组TST、SE、REM低于对照组,其SL、觉醒时间高于后者,差异有统计学意义(P0.05)。观察组睡眠障碍发生率为100.00%,高于对照组的26.25%,差异有统计学意义(P=0.000)。大脑皮质梗死患者TST、SE、REM、S3+S4低于其他部位急性脑梗死患者,其SL、RL、觉醒时间、S1均高于后者,差异有统计学意义(P0.05)。随着急性脑梗死患者神经功能缺损程度的进展,其TST、SE、REM逐渐下降,SL逐渐升高,重度神经功能缺损者TST、SE、REM、S3+S4均低于轻、中度患者,其SL、RL、觉醒时间、S1均高于后者,差异有统计学意义(P0.05)。结论脑梗死患者普遍存在睡眠障碍,梗死部位位于大脑皮质者睡眠质量较差,且随着神经功能缺损程度的加剧,患者睡眠质量进一步恶化;强调针对梗死部位及神经功能缺损的个体化干预,有望成为改善患者睡眠质量与预后质量的重要手段。     

老年期抑郁症患者睡眠结构的性别差异

目的:研究老年期抑郁症患者的睡眠状况有无性别差异.方法:对20例老年男性组(年龄≥61岁)与24例老年女性组(年龄≥60岁)抑郁症患者以及20例正常对照(年龄≥60岁)进行多导睡眠监测检查.结果:与正常对照组比较,老年抑郁症男性组与女性组总睡眠时间(TST)、实际睡眠时间(AST)、睡眠效率(SE)、快速动眼睡眠潜伏期(REML)、快速动眼睡眠时相(REM)、快速动眼时相睡眠百分比(REM％)出现降低,睡眠潜伏期(SL)升高;在非快速动眼时相睡眠(NREM)中,老年男性组与女性组N1、N1％、N3、N3％与NREM较正常对照组降低,而N2与N2％升高.与老年男性组比较,老年女性组AST、SE、N2、N2％、NREM下降,SL、REML、N3及N3％增加.组间差异有统计学意义.结论:性别是影响老年期抑郁症患者睡眠结构的重要因素.     

保护REM睡眠为主的护理在冠心病患者睡眠中的应用及其对夜间突发病变的影响

目的探讨保护REM睡眠为主的护理在冠心病患者睡眠中的应用及其对夜间突发病变的影响。方法选取2016年4月至2019年1月于我院住院的冠心病患者96例,根据患者意愿和病情分为对照组(n=50)和观察组(n=46)。对照组行常规护理,观察组行保护REM睡眠为主的护理。对比两组护理前后睡眠时间和夜间病情突变情况。结果护理后,两组睡眠潜伏期缩短,Ⅰ期和Ⅳ期睡眠时间延长(P均<0.05);与对照组比较,观察组的睡眠潜伏期较短,Ⅰ期和Ⅳ期睡眠时间较长(P均<0.05)。观察组护理后的REM睡眠时间短于护理前(P<0.05),而对照组护理前后的REM睡眠时间比较差异无统计学意义(P>0.05)。观察组护理后的夜间心律失常发生率低于护理前(P<0.05)。结论保护REM睡眠为主的护理能够缩短冠心病患者的睡眠潜伏期和REM睡眠时间,延长睡眠总时长,降低夜间心律失常发生率,值得临床应用。     

卡比多巴-左旋多巴控释片治疗帕金森病合并睡眠障碍患者的疗效观察

目的探讨卡比多巴-左旋多巴控释片治疗帕金森病合并睡眠障碍患者的疗效。方法应用卡比多巴-左旋多巴控释片治疗46例帕金森病合并睡眠障碍患者,分别于治疗前后连续2次全夜PSG监测,取第2晚PSG结果进行比较,对比治疗前后全PSG监测参数、PQSI评分及ESS评分,评定UPDRS-Ⅲ评分及H&Y分期评分的改变。结果治疗后ESS评分、UPDRS-Ⅲ评分明显下降(P﹤0.05);而PQSI评分、H&Y分期评分、卧床时间、总睡眠期变化、总睡眠时间、睡眠潜伏期、睡眠效率、微觉醒指数、睡眠中觉醒次数、入睡后觉醒时间、S1(min)、S2(min)、S3+S4(min)、REM(min)、S1(%)、S2(%)、S3+S4(%)、REM(%)均差异无统计学意义(P﹥0.05)。结论卡比多巴-左旋多巴控释片既可改善帕金森病运动症状又能改善患者日间嗜睡状态,同时具有改善帕金森病患者夜间睡眠质量的趋势。     

心理干预对慢性失眠症患者睡眠质量的影响

目的 观察心理干预对慢性失眠症患者睡眠质量的改善效果.方法 对63例符合CCMD-3诊断标准的慢性失眠症患者,随机分入研究组32例(药物治疗和常规宣教+心理干预)和对照组31例(药物治疗+常规宣教),治疗药物采用小剂量米氮平,为期4周,在入组时及4周末采用多导睡眠监测(PSG)通过前后多导睡眠脑电图的变化,评价睡眠质量和效果.结果 研究组与的总睡眠时间(TST)、入睡潜伏期、觉醒次数、睡眠效率显著优于治疗组(P＜0.05).结论 心理干预能改变慢性失眠症患者对睡眠的歪曲认知,提高睡眠质量.     

注意缺陷多动障碍儿童事件相关电位的对照研究

【目的】探讨事件相关电位(event related potential,ERP)在儿童注意缺陷多动障碍(attention deficit hy-peractivity disorder,ADHD)诊断中的应用。【方法】应用意大利Amplaid MK-15诱发电位系统,采用听觉Oddball刺激序列测定ADHD儿童与正常儿童P300潜伏期和波幅变化。【结果】病例组靶刺激P300潜伏期为(428.27±19.22)ms,对照组为(341.83±17.72)ms,两组差异有统计学意义(P0.05);病例组靶刺激P300波幅为(12.89±6.10)μV,对照组为(11.75±6.76)μV,两组差异有统计学意义(P0.05);病例组综合反应控制商数和综合注意力商数分别为73.27±13.99和67.93±15.93,对照组分别为104.83±16.11和102.00±15.39,两组差异有非常统计学意义(P0.01);事件相关电位P300潜伏期与综合反应控制商数之间无显著性意义(r=-0.3677,P0.05),但与综合注意力商数之间呈负相关,且具有显著性意义(r=-0.4347,P0.05)。【结论】事件相关电位P300潜伏期测定可协助儿童ADHD的临床诊断。     

糖尿病患者事件相关电位P300的变化及相关因素研究

目的探讨2型糖尿病患者事件相关电位P300的改变及其相关危险因素,并评价P300在糖尿病脑病中的诊断价值。方法对50例2型糖尿病患者和30例健康对照者进行事件相关电位P300检测,并分析P300波的潜伏期及波幅与糖尿病的病程、血脂及血压的关系。结果(1)糖尿病患者P300的潜伏期较对照组明显延长(P<0.01);且P300的波幅较对照组明显降低(P<0.05)。(2)糖尿病合并高血压组P300的潜伏期较对照组和糖尿病无高血压合并症组明显延长(P<0.01)。(3)随糖尿病病程的延长P300的潜伏期逐渐延长。(4)P300的潜伏期与糖尿病患者的血脂水平呈正相关。结论糖尿病患者存在明显认知功能障碍,事件相关电位P300可作为一项较客观、有价值的评价糖尿病患者认知功能的指标,并有助于糖尿病慢性脑病的早期诊断。     

职业性钒暴露对事件相关电位P300的影响

对97例钒职业接触工人及50例对照工人进行事件相关电位P300检测,记录其潜伏期、波幅及按键反应时间等指标。结果显示,在控制了年龄及文化程度的影响后,接钒组P300潜伏期及按键错误次数均大于对照组(P<0.05);接钒工龄与P300潜伏期呈正相关关系(r=0.244,P<0.05)。提示职业性钒暴露可引起事件相关电位P300的改变,降低钒职业接触人群的认知功能。 更多还原     

多发性抽动症患儿睡眠结构与认知行为关系研究

【目的】探讨多发性抽动症(tourette syndrome,TS)患儿的睡眠结构改变与认知行为关系异常的关系。【方法】对52例TS患儿进行全夜睡眠多导监测,瑞文测试及划消试验测试其智商和注意力评价其认知能力及Achen-bach量表评估其行为状态,应用秩相关系数分析睡眠与注意力、行为的相关性,并与40名正常儿童(作为正常对照组)进行比较。【结果】与正常对照组相比,TS组睡眠效率(SE)、慢波睡眠百分比较对照组低,睡眠潜伏期(ST)延长,NREMⅠ期睡眠百分比较对照组高,觉醒次数(WASO)多;TS组划消试验注意力各项参数较对照组明显升高;TS组患儿CBCL评分总分及内向行为评分均较对照组高;注意力划消总指数与NREMⅠ呈正相关(r=0.72,P0.01),行为问题总分与REM百分比呈正相关(r=0.59,P0.05)。【结论】TS患儿睡眠结构异常,其与患儿认知及行为异常有关。     

失眠对大学生认知功能影响的研究

目的探讨失眠对大学生认知功能的影响。方法应用CCMD-3对认为存在失眠的大学生进行诊断,对确诊的310位失眠大学生进行统计学调查,另选取同一院校310名大学生为对照组,采用匹兹堡睡眠质量指数(PSQI)对大学生的睡眠质量进行初步调查评估,结合事件相关电位(P300)和认知能力筛查量表(CASI)对结果进行综合评定。结果实验组大学生的PSQI总分及各成分均高于对照组大学生,且在主观睡眠质量、入睡时间、睡眠障碍及日间障碍4个成分上的得分差异有统计学意义(P<0.01);2组大学生均未发现使用药物帮助睡眠的情况。实验组大学生P300中的N2、P3的潜伏期(PL)有所延长,P3有所波幅下降,潜伏期与认知障碍程度呈正相关,差异有统计学意义(P<0.05或P<0.01);失眠的大学生认知能力筛查量表(CASI)测验4项评分较差,与对照组比较,差异有统计学意义(P<0.01)。结论有失眠现象的大学生存在一定的认知障碍,我们应该重视大学生的睡眠问题,有针对性的加强他们的健康教育。     

不同年龄阻塞性睡眠呼吸暂停低通气综合征患儿临床表现及睡眠结构比较分析

目的 分析学龄前期及学龄期阻塞性睡眠呼吸暂停低通气综合征(OSAHS)儿童的临床及睡眠结构特点。方法 纳入2016年12月-2019年11月于苏州大学附属儿童医院呼吸科就诊,经多导睡眠监测诊断为OSAHS的123例患儿为研究对象,选择同期诊断为鼾症(PS)的313例患儿为对照组,根据年龄将两组患儿分为学龄前期组及学龄期组,收集临床资料及多导睡眠监测(PSG)结果。结果 学龄前期及学龄期OSAHS患儿夜间及日间症状均较对照组显著(P<0.05)。学龄前OSAHS患儿快动眼睡眠期(REM)比例高于对照组(Z=2.467,P＜0.05);学龄期OSAHS患儿总睡眠时间(TST)及睡眠效率低于学龄前OSHAS患儿(t=2.518,Z＝1.527),NREM 2期比例升高(t＝4.080),NREM 3期比例下降(Z＝1.832),氧减指数(ODI)升高(Z=1.653,P<0.05)。呼吸暂停低通气指数(AHI)与学龄前期患儿NREM 1期睡眠比例呈正相关(r=0.217),与REM期比例呈负相关(r=-0.220),体重指数(BMI)与学龄期OSAHS患儿NREM 3期比例呈负相关(r=-0.429,P<0.05)。结论 OSAHS患儿临床表现与鼾症患儿不同,且不同年龄症状有所差异;学龄期OSAHS患儿睡眠结构改变较学龄前期患儿明显;学龄前期、学龄期OSAHS患儿睡眠结构改变分别与AHI、BMI有关。     

The effect of noise on sleep--changes in hypnograms of subjects exposed to repeated truck-passing sound]

The effect of traffic noise on sleep was evaluated in an experimental room using repeated recorded truck-passing sounds. The peak sound level was 55, 60 or 65 dB (A) with frequencies of three times per hour. The background noise of the exposure night was Leq 42 dB (A) and that of the control night was Leq 35 dB (A). The subjects were five students 23 to 24 years old. The sleep stage of each epoch with a 20-second duration was judged visually based on the criteria of Rechtschaffen & Kales and the data of the second night of noise-exposure and the control night were used. The sleep parameters used were total sleep time (TST), each sleep stage, % of sleep stage against TST, sleep efficiencies, sleep latency, REM latency, REM cycle, REM duration, waking from sleep, number of stage shifts, and subjective sleep judged by the OSA sleep inventory. A paired t test was used for the statistical analysis. TST, REM stage in minutes, and % of REM stage against TST of the exposure night were significantly decreased compared with those of the control night. Other objective and subjective parameters showed no changes during noise exposure. Dividing the all-night into halves, the amount and % of each sleep stage were compared between the exposure and control night. There was no change of sleep stage in the former half, but the % and amount of REM sleep in the latter half were significantly decreased as a result of the noise exposure. The decreases of REM sleep and % REM against TST, especially in the latter half of all-night sleep, were caused by the intermittent truck-passing sounds 20 to 30 times per night.     

恢复期老年抑郁症伴轻度认知障碍患者执行功能及事件相关电位的关系研究

目的研究恢复期老年抑郁症伴轻度认知障碍患者执行功能及事件相关电位的关系。方法选取2017年1月至2019年12月期间我院收治的恢复期老年抑郁症患者78例,采用MoCA量表评估其认知功能,将认知功能正常(MoCA评分≥26分)的58例患者纳入对照组,将轻度认知功能障碍(15≤MoCA评分<26分)的20例患者纳入观察组,测定两组患者事件相关电位及执行功能,分析执行功能与事件相关电位的相关性。结果观察组P300波幅低于对照组,P300潜伏期长于对照组,错误应答数、持续性错误数、持续性反应数均高于对照组(P<0.05)。Pearson相关性分析显示,P300潜伏期与错误应答数、持续性错误数、持续性反应数呈正相关(r>0,P<0.05);P300波幅与错误应答数、持续性错误数、持续性反应数呈负相关(r<0,P<0.05)。结论恢复期老年抑郁症伴轻度认知障碍患者执行功能与事件相关电位关系密切,可用事件相关电位来判断患者的执行功能障碍。     

Effects of noise on sleep. Part 2. A case report of the effects of three levels of stationary sound on sleep parameters

The effect of steady noise on sleep was examined experimentally for 24 nights by sleep polygraphy of a twenty-eight-year-old man. The parameters used for sleep polygraphy were sleep stage, sleep latency, frequency of sleep stage shift per hour, average sleep depth, the gradient and intercept of a regression line of sleep depth against time, and subjective sleep. The sleep stage was judged and estimated based on the criteria of Rechtschaffen & Kales by the authors' original system using a microcomputer. For the calculation of sleep depth at a given time, stages W (waking), 1, REM, 2, 3 and 4 were weighted to be 0, 1, 1.5, 2, 3 and 4, respectively. Sleep parameters were compared between the data of non-noise and noise-exposed nights. The noise exposure was overnight stationary pink noise of 40, 50 and 60 dB (A). General findings were a decreased REM stage, an increased stage 2, and deepened average sleep depth of the 60 dB (A)-night sleep compared with the control and 40 dB(A) exposure nights. When the control nights were excluded and parameters were compared between the three levels of stationary noise exposure, stage 2, the intercept of the regression line, and average sleep depth were increased almost in proportion to the increased noise exposure. In contrast, sleep latency, frequencies of sleep stage shift, stages W, 1, 3, MT, and REM, as well as the gradient of the regression line were decreased with increased noise exposure.(ABSTRACT TRUNCATED AT 250 WORDS)     

3种联合运动方案对睡眠障碍大学生睡眠质量改善效果评价

目的 探讨3种联合运动方案对睡眠障碍大学生睡眠质量的改善效果,为睡眠障碍运动干预方案的构建提供参考.方法 以招募的35名存在睡眠障碍的大学生为实验对象,随机分为有氧联合抗阻运动组(AR组)(10名)、有氧联合身心运动组(AM组)(8名)、抗阻联合身心运动组(RM组)(9名)和对照组(CG组)(8名).运动组进行为期8周...     

帕金森病患者听觉P300测试及治疗前后的对比研究

目的　探讨帕金森病 (PD)智能障碍及应用左旋多巴等治疗后听觉P3 0 0 (P3 )各项参数的变化。方法　对 3 0例特发性PD患者在治疗前及治疗 6个月后进行常规P3测试 ,并以健康查体者为对照 ,对组间P3各参数进行对比分析。结果　PD患者经过左旋多巴等治疗后 ,除反应时 (RT)有显著 (P <0 0 5 )缩短外 ,其潜伏期 (PL)及波幅 (Amp)均无显著变化 ;PD患者与健康对照组相比 ,无论左旋多巴等治疗前或治疗后 ,其PL及RT均明显延长 (P <0 0 5 ) ,Amp无显著变化。结论　特发性PD患者PL及RT延长 ,提示其存在智能障碍 ,而左旋多巴等治疗后 ,虽然PD患者的运动功能有明显改善 ,但PL及Amp无改善 ,只有RT的改善 ,提示PD患者智能障碍与中枢性多巴胺能神经机制关系不大     

Acute effects of alcohol on cognitive function and central nervous system assessed by auditory event-related potentials.

To clarify which sites of the central nervous system are influenced by acute administration of alcohol at an early stage, auditory event-related potentials (ERP) using a target-selection paradigm were measured in 13 healthy volunteers. In the recorded waveforms of ERPs, the N100, P165, N200 and P300 latencies for the target tone and the N100 and P200 latencies for the non-target tone were determined in each subject before and 1- and 2-hr after ingestion of 200 ml of alcohol (containing 25% ethanol) or of 200 ml of water, for a total of six times on two different days. The P300 latency was significantly prolonged at 1- and 2-hr after alcohol ingestion; and, the N200 latency was significantly prolonged at 2-hr after alcohol ingestion. The 2-hr alteration in the P300 latency after alcohol ingestion was positively correlated with the ethanol dose per body weight. These data suggest that ethanol, in proportion to its dose, affects cognitive function estimated by the P300 latency earlier than other lower central nervous system functions. Evaluating subclinical effects on central nervous function, using the ERPs, of environmental neurotoxins such as organic solvents, researchers should pay particular attention not only to the degree of the drinking habit but also to the interval between the measurement and alcohol intake.     

对阻塞性睡眠呼吸暂停低通气综合征患者多导睡眠图常用指标间的相关性分析

目的 探讨能够更加全面反映阻塞性睡眠呼吸暂停低通气综合征(OSAHS)缺氧程度的多导睡眠图指标.方法 回顾性分析确诊的63例OSAHS患者多导睡眠图,收集其呼吸紊乱指数(AHI)、呼吸暂停占总睡眠时间百分比(AM)、低通气时间占总睡眠时间百分比(HM)、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)和最长呼吸暂停时间(LAT)等资料.结果 OSAHS患者的AHI与AM、HM、LAT呈正相关(P＜0.01或＜0.05),与MSaO2、LSaO2呈负相关(P＜0.01).AHI与AM、HM和LSaO2呈线性回归关系(F=202.264,P＜0.01).结论 OSAHS患者AM与AHI密切相关,AM、HM较LSaO2等多导睡眠图指标能更准确地反映OSAHS患者缺氧程度.

Abstract：

Objective To study the polysomnography(PSG) indexes which can reflex the severity of anoxia in obstructive sleep apnea-hypopnea syndrome(OSAHS) more comprehensively. Methods Sixtythree OSAHS patients' PSG indexes, including the apnea-hypopnea index (AHI), apnea time/total sleeping time (AM), hypoventilation time/total sleeping time (HM), mean oxygen saturation (MSaO2),the lowest oxygen saturation (LSaO2) and the longest apnea time (LAT) were analyzed retrospectively. Results In patients with OSAHS,the AHI was positively correlated with AM, HM and LAT(P ＜ 0.01 or ＜ 0.05 ), and was negatively correlated with MSaO2 and LSaO2(P ＜ 0.01 ). The AHI had linear regression relationship with AM,HM and LSaO2 (F =202.264,P ＜0.01). Conclusions Among the PSG indexes,AM is intimately associated with AHI. Therefore,compared with LSaO2,AM and HM can reflex the severity of anoxia in patients with OSAHS more accurately.