失眠症患者的脑电非线性动力学初步研究

目的探讨失眠症患者在不同认知作业状态下脑电非线性动力学的初步特点。方法应用日本光电1518K脑电图和地形图系统,以及关联维数（D2）、点关联维数（PD2）方法对75例失眠症和64名正常成人在安静闭眼、安静睁眼、闭眼心算作业、睁眼记忆和数字划消五种状态下的脑电数据进行了分析。结果 （1）在D2和PD2上,正常和失眠症睁闭眼实验中差异均未达到显著性。（2）在D2上,与正常对照组比较,失眠症在心算和数字划消两个认知心理测试中均见降低。（3）在PD2上,与正常对照组比较,失眠症在心算、汉字记忆和数字划消三个认知心理测试中也见降低（P〈0.05或P〈0.01）。结论非线性动力学分析为临床提供了一种处理分析脑电信号的新思路,有助于进一步了解失眠症认知过程中大脑的工作机制。     

耳穴贴压治疗中风后失眠32例

目的观察辩证耳穴贴压对中风后失眠患者睡眠质量的影响。方法将中风后失眠患者64例,随机分为实验组和对照组各32例,对照组给予口服艾司唑仑治疗,实验组给予耳穴贴压治疗,治疗前后采用匹兹堡睡眠质量指数量表（PSOI）、脑卒中专用生活质量量表（SS-QOL）进行评分并比较2组患者疗效。结果2组患者治疗前PSQI,SS-QOL评分无差别,治疗后比较,实验组PSQI评分低于对照组,而SS-QOL评分高于对照组（P〈0．05）;实验组的总有效率为90．6％,对照组为81．2％,2组比较差异有统计学意义（x2=4．153,P〈0．05）。结论耳穴贴压可以有效治疗中风后失眠,提高患者的生活质量。     

脾肾同调法治疗老年不寐的临床研究

目的：为观察脾肾同调法治疗老年不寐心脾两虚证的临床疗效.方法：符合不寐心脾两虚证诊断标准的患者60例,年龄在50~78岁之间,随机分成两组.治疗组30例,予补脾益肾汤（方药组成：白术、山萸肉、远志、龙眼肉、五味子、炒枣仁、茯神、夜交藤、熟地、煅龙骨、煅牡蛎）汤口服.对照组30例,予安神补脑液口服.结果：结果表明治疗组总有效率73.3%;对照组总有效率56.6%,经统计学处理,P〈0.05,有统计学意义.结论：脾肾同调法是治疗老年不寐证的有效方法.     

Efectividad de una intervención educativa breve en pacientes con insomnio en atención primaria

ObjetiveTo evaluate the effectiveness of providing an educational intervention in primary care (PC) alongside a pharmacological treatment for insomnia.DesignSingle blinded non randomised clinical trial.LocationTwo urban primary health centers in Gijón (Asturias, Spain).ParticipantsPatients who consulted for insomnia between July 2012-January 2013 and met the inclusion criteria (n = 50) were assigned systematically to the control group (CG) or intervention group (IG). All patients initiated treatment with lorazepam 1 mg in the evenings and had four weekly 15 min visits plus a follow-up visit after another month.InterventionsThe IG received training for control of stimuli, sleep hygiene and respiration and relaxation techniques in the four visits. The CG had only non invasive measures taken.MeasurementsConsidering as cured those who reached a Pittsburgh Sleep Quality Index PSQI < 6 or a 50% reduction from baseline level. It was also analyzed the change in the PSQI from baseline to final visit and to follow-up visit, and voluntary interruption of lorazepam. Analysis by Bayesian inference.ResultsTwelve out of recoveries after intervention against one out of 24 among control group. Mean change in PSQI to final visit and follow-up visit was: –4.7 (95%CrI:–5.9 to –3.5) and –6,3 (95%ICred: –7.5 to –5.1) in IG; –1.8 (95%ICred: –3 to –0.5) and –1.7 (95%ICred: –2.9 to –0.4) in CG. Interruption of lorazepan: in 4 controls (16,7%) and 9 (34,6%) in IG. Twenty nine patients in GI and 17 in GC completed the trial. Per protocol analysis showed similar results.ConclusionsThe educational intervention in PC improves sleep quality and reduces the need of treatment with benzodiacepines.     

经颅重复磁刺激辅助治疗老年焦虑症继发睡眠障碍的效果观察

目的 探讨米氮平合用经颅重复磁刺激法治疗伴睡眠障碍的老年焦虑症的疗效.方法 将100例符合“老年焦虑症”诊断标准并伴有失眠的患者随机分为研究组（米氮平合并经颅重复磁刺激法）和对照组（单用米氮平）各50例.观察8周.治疗前及治疗后第2,4,8周采用汉密尔顿焦虑量表（HAMA）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评定焦虑和抑郁症状;治疗前及治疗第8周采用多导睡眠监测技术（PSG）和匹兹堡睡眠质量指数量表（PSQI）评定睡眠状况.结果 （1）两组临床疗效有效率分别为87.23％和68.89％,两组比较差异有统计学意义（x2=4.55,P＜0.05）;（2）治疗后4、8周后,研究组HAMA、SAS及SDS分值量表分值与对照组比较较低,且差异有统计学意义（t分别为3.997 3,4.937 7,3.359 9;P＜0.05）;（3）治疗后研究组实际睡眠总时间、睡眠潜伏期、REM潜伏期、REM睡眠比例、夜间觉醒次数、觉醒总时间评分结果与对照组比较差异有统计学意义（t分别为3.565 6,3.105 7,2.705 7,2.699 1,3.614 9,19.898 8;P＜0.05）;（4）治疗后研究组PSQI评分低于对照组,两组比较差异有统计学意义（t=3.327 8,P＜ 0.05）;（5）两组不良反应的发生率分别为10.64％和17.78％,经比较差异无统计学意义（x2=0.97,P＞0.05）.结论 米氮平合用经颅重复磁刺激法治疗老年焦虑症伴发的睡眠障碍有较好的效果.     

Effects of different sleep deprivation protocols on sleep perception in healthy volunteers

Objectives

To investigate whether different protocols of sleep deprivation modify sleep perception.

Methods

The effects of total sleep deprivation (TD) and selective rapid eye movement (REM) sleep deprivation (RD) on sleep perception were analyzed in normal volunteers. Thirty-one healthy males with normal sleep were randomized to one of three conditions: (i) normal uninterrupted sleep; (ii) four nights of RD; or (iii) two nights of TD. Morning perception of total sleep time was evaluated for each condition. Sleep perception was estimated using total sleep time (in hours) as perceived by the volunteer divided by the total sleep time (in hours) measured by polysomnography (PSG). The final value of this calculation was defined as the perception index (PI).

Results

There were no significant differences among the three groups of volunteers in the total sleep time measured by PSG or in the perception of total sleep time at baseline condition. Volunteers submitted to RD exhibited lower sleep PI scores as compared with controls during the sleep deprivation period (P < 0.05). Both RD and TD groups showed PI similar to controls during the recovery period.

Conclusion

Selective REM sleep deprivation reduced the ability of healthy young volunteers to perceive their total sleep time when compared with time measured by PSG. The data reinforce the influence of sleep deprivation on sleep perception.     

Excitatory versus inhibitory impairments in insomnia patients: An ERP study

According to the neurocognitive perspective on insomnia, conditioned arousal results in impairment of information processing, as such interfering with normal sleep processes. In the present study, evening event-related potentials N100 and P200 were evaluated to assess hyperarousal in patients with insomnia and controls. 13 patients (mean age = 40.8) with polysomnographically verified sleep disruptions and 11 good sleepers (mean age = 45.4) were included. An auditory oddball paradigm was administered the evening of the polysomnography. N100 and P200 mean amplitudes and peak latencies at Fz and Cz were analyzed as a measure of respectively general arousability and inhibition of information processing. Patients experiencing insomnia were characterized by decreased P200 amplitudes compared to good sleepers. No significant differences were found for N100 amplitudes and latencies of both ERP waves.     

Sleep misperception,EEG characteristics and Autonomic Nervous System activity in primary insomnia: A retrospective study on polysomnographic data

Misperception of Sleep Onset Latency, often found in Primary Insomnia, has been cited to be influenced by hyperarousal, reflected in EEG- and ECG-related indices. The aim of this retrospective study was to examine the association between Central Nervous System (i.e. EEG) and Autonomic Nervous System activity in the Sleep Onset Period and the first NREM sleep cycle in Primary Insomnia (n = 17) and healthy controls (n = 11). Furthermore, the study examined the influence of elevated EEG and Autonomic Nervous System activity on Stage2 sleep-protective mechanisms (K-complexes and sleep spindles). Confirming previous findings, the Primary Insomnia-group overestimated Sleep Onset Latency and this overestimation was correlated with elevated EEG activity. A higher amount of beta EEG activity during the Sleep Onset Period was correlated with the appearance of K-complexes immediately followed by a sleep spindle in the Primary Insomnia-group. This can be interpreted as an extra attempt to protect sleep continuity or as a failure of the sleep-protective role of the K-complex by fast EEG frequencies following within one second. The strong association found between K-alpha (K-complex within one second followed by 8–12 Hz EEG activity) in Stage2 sleep and a lower parasympathetic Autonomic Nervous System dominance (less high frequency HR) in Slow-wave sleep, further assumes a state of hyperarousal continuing through sleep in Primary Insomnia.     

认知行为治疗对失眠症患者心理健康状况的影响

目的探讨认知行为治疗对失眠症患者心理健康状况的影响。方法选取丰台区右安门社区卫生服务中心全科门诊就诊的60例失眠症患者作为研究对象,将其随机分为干预组和对照组,干预组接受药物治疗和为期6周的认知行为治疗,对照组只接受药物治疗,使用症状自评量表对患者进行干预前、后的测量。结果干预后,干预组的SCL总分(t=-2.494,P0.05)、躯体化(t=-2.705,P0.01)、人际敏感(t=-2.119,P0.05)、抑郁(t=-3.469,P0.01)、焦虑(t=-2.552,P0.05)、附加因子(t=-2.749,P0.01)得分明显低于对照组。结论认知行为治疗可以明显提高失眠症患者的心理健康水平。