帕金森病患者睡眠障碍的多导睡眠图研究

目的 了解帕金森病（Parkinson disease，PD）睡眠障碍的多导睡眠图（PSG）监测表现及睡眠结构、进程特点。方法 对42例临床确诊的PD患者和40名健康对照者行全夜PSG监测，分析比较各项睡眠结构、进程参数及快速眼动睡眠（REM）期视频监测特点。结果 经PSG监测发现，PD组入睡困难、睡眠破碎、白天过度嗜睡等的发生率（分别为73．8％、59．5％、46．1％）均高于对照组（P〈0．05）；PD组患者总睡眠时间、非快速眼动睡眠2期、REM潜伏期、睡眠效率、睡眠纺锤波密度较对照组缩短或降低（P值分别为0．000、0．000、0．045、0．000、0．000），睡眠潜伏期、觉醒时间、觉醒次数、〉5min的觉醒次数、Epworth嗜睡量表评分均延长或增加（P值分别为0．022、0．000、0．007、0．001、0．ooo）。另外，监测中发现PD组有6例（14．3％）出现睡眠始发REM时段，而对照组无一例出现。PD组中有36例（85．7％）在REM睡眠中呈现肌电活动不消失（RWA），其中19例出现REM期睡眠行为障碍（RBD）；对照组有6例出现RWA，其中2例出现RBD。统计学分析显示，PD组RWA、RBD的发生率（分别为85．7％、45．2％）与对照组比较差异均有统计学意义（P〈0．01）。结论 研究显示PD患者睡眠结构、睡眠进程等多项睡眠参数改变；PD患者中RBD发生率高，其临床症状表现形式多样，且很多时候RBD可先于PD的其他症状而早期出现。     

帕金森病患者的睡眠异常

目的研究帕金森病患者睡眠障碍发生及其特点和影响因素。方法收集患者病史资料并应用多导睡眠仪对10例帕金森病患者及5名健康对照进行多导睡眠监测。受试者分为3组:对照组、帕金森病Hoehn-Yahr(H&Y)Ⅰ级组及帕金森病H&YⅡ~Ⅳ级组。每组均包括男性3例,女性2例。结果3组年龄分别为(54·4±5·7)岁、(57·6±14·5)岁、(58·2±10·7)岁,年龄之间的差异无统计学意义(F=0·232,P=0·794)。对照组浅慢波睡眠时间为(70·6±7·8)min,而H&YⅠ级组患者浅慢波睡眠时间为(81·4±6·1)min,显著高于对照组(P=0·008);对照组睡眠效率为75·6%±12·8%,快动眼睡眠(REM)潜伏期为(116±48)min,浅慢波睡眠所占比例为70·6%±7·8%,REM所占比例为14·8%±5·5%,总睡眠时间为(372·8±53·4)min,而H&YⅡ~Ⅳ级组患者睡眠效率43·6%±16·0%(P=0·003)、REM所占比例7·3%±6·1%(P=0·003)及总睡眠时间(244·3±103·2)min(P=0·006)均显著低于对照组,REM睡眠潜伏期(281±86)min(P=0·000)及浅慢波睡眠时间(85·3±7·9)min(P=0·000)显著高于对照组。经相关分析,睡眠潜伏期、浅慢波睡眠时间与疾病病程存在显著正相关(r分别为0·889、0·492;P值分别为0·000、0·006),而睡眠效率、深慢波睡眠时间及总睡眠时间与疾病病程有显著负相关(r分别为-0·626、-0·723、-0·728;P值均为0·000)。结论研究结果显示,帕金森病患者在患病早期已经存在夜间睡眠时间减少、睡眠效率下降、睡眠潜伏期延长及睡眠结构的改变等异常,而且有随疾病进展而加重的趋势。     

抑郁症患者睡眠行为及睡眠生理障碍的研究

目的　探讨抑郁症患者睡眠行为及睡眠生理的变化。方法　采用调查表对 32例抑郁症患者的睡眠行为障碍和睡眠生理进行调查 ,检测其全夜多导睡眠图 ,并与 2 1名正常人进行对照。结果　 (1)抑郁症组的入睡困难、早醒、睡眠维持障碍及睡眠过多的发生率高于对照组 (P <0 0 5～0 0 1) ;(2 )与对照组比较 ,抑郁症组存在睡眠潜伏期长 [(36 1± 17 2 )min],醒觉时间、觉醒次数、醒觉睡眠比高 ,睡眠效率和睡眠维持率低 (P <0 0 5～ 0 0 1) ,快速眼动睡眠潜伏期短 [(6 1 8± 31 2 )min]等。结论　抑郁症患者存在睡眠行为与睡眠生理相一致的异常改变 ,其睡眠障碍的病理机制可能同源于抑郁症的发病机制。     

帕金森病患者客观睡眠障碍的特点

目的 研究帕金森病(PD)患者客观睡眠障碍的特点及相关因素.方法 收集患者病史资料,对101例PD患者(PD组)和90名年龄、性别相匹配的健康体检者(对照组)进行多导睡眠图监测,分析睡眠参数及其相关因素.结果 PD组与对照组比较:睡眠潜伏期差异无统计学意义:非快速眼运动睡眠1期比例(％)显著增多(27.9±17.8与21.2±11.7,t=3.034,P=0.003),非快速眼运动睡眠2期比例(％)显著减少(47.8±17.4与54.7±12.9,t=-3.043,P=0.003);睡眠效率下降,慢波睡眠比例、快速眼运动睡眠比例减少,觉醒次数增多,快速眼运动睡眠潜伏期延长,但差异均无统计学意义.PD患者部分睡眠参数与增龄、疾病严重程度、抑郁程度相关.40.6％ (41/101)PD患者睡眠期周期性肢体运动指数( PLMSI)大于15,而未主诉相关症状;PD组PLMSI显著高于对照组,且随年龄增大,PLMSI增高(r=0.261,P＜0.01).PD组呼吸暂停低通气指数、氧减指数较对照组无显著降低,最低血氧饱和度显著高于对照组.82.2％( 83/101) PD患者出现快速眼运动睡眠期肌张力失弛缓现象,其中38例(37.6％)诊断为快速眼运动睡眠期行为障碍;PD组快速眼运动睡眠期行为障碍、肌张力失弛缓的发生率均较对照组[0和8例(8.9％)]明显增高(x2=42.271、102.480,均P＜0.01).结论 PD患者睡眠结构等多项睡眠参数发生改变,其入睡困难不明显,以睡眠维持困难、睡眠结构紊乱为主,睡眠参数与增龄、疾病严重程度、抑郁程度相关;无症状的周期性肢体运动发生率高,不需特殊处理;患者可发生呼吸暂停或低通气,但血氧饱和度降低不严重,快速眼运动睡眠期行为障碍发生率高.     

肌萎缩侧索硬化症患者睡眠障碍及睡眠呼吸障碍特点分析

目的通过多导睡眠图监测肌萎缩侧索硬化症患者睡眠结构和睡眠呼吸事件,探讨其睡眠障碍和睡眠呼吸障碍特点。方法共36例患者根据是否存在延髓症状分为肢体受累组(14例)和延髓麻痹组(22例),记录一般资料以及睡眠障碍和睡眠呼吸障碍相关主诉,包括入睡困难、睡眠维持困难或早醒、呼吸不畅或鼾症、夜尿症、不宁腿综合征、肌肉疼痛等;Appel肌萎缩侧索硬化症量表(AALS)评价延髓功能、呼吸功能、上下肢肌力和肌肉功能;多导睡眠图监测脑电图、眼动图、心电图、肌电图、体位、鼾声、口鼻气流量、胸腹式呼吸和指端脉搏血氧饱和度,以及睡眠相关参数包括总睡眠时间、睡眠效率、睡眠潜伏期、觉醒次数、非快速眼动睡眠期各期和快速眼动睡眠期比例、睡眠呼吸暂停低通气指数。Pearson相关分析评价快速眼动睡眠期睡眠呼吸暂停低通气指数和周期性腿动与临床资料和AALS评分的相关性。结果延髓麻痹组患者AALS总评分(P=0.007)、延髓功能评分(P=0.000)和呼吸功能评分(P=0.000)高于,上肢肌力(P=0.016)低于肢体受累组。两组患者均出现睡眠结构紊乱,表现为睡眠片段化,其中延髓麻痹组觉醒次数多于(P=0.027)、快速眼动睡眠期比例低于(P=0.009)、周期性腿动次数少于(P=0.020)肢体受累组;两组患者睡眠呼吸障碍主要表现为低通气,其中延髓麻痹组睡眠呼吸暂停低通气指数(P=0.038)、快速眼动睡眠期和非快速眼动睡眠期睡眠呼吸暂停低通气指数(P=0.031,0.049)高于肢体受累组。Pearson相关分析显示,快速眼动睡眠期睡眠呼吸暂停低通气指数与病程(r=0.654,P=0.028)以及AALS总评分(r=0.458,P=0.034)、延髓功能评分(r=0.572,P=0.030)、呼吸功能评分(r=0.756,P=0.002)呈正相关,周期性腿动与病程(r=0.574,P=0.030)以及AALS总评分(r=0.321,P=0.042)、上肢肌肉功能(r=0.656,P=0.028)和下肢肌肉功能(r=0.754,P=0.015)评分呈正相关。结论肌萎缩侧索硬化症患者存在失眠、睡眠呼吸障碍、周期性肢体运动障碍等多种形式的睡眠障碍。多导睡眠图可以监测到睡眠呼吸障碍,为尽早进行无创性正压通气提供临床依据。     

癫痫与睡眠

癫痫和睡眠之间相互作用、密切相关。癫痫发作和癫痫样放电对于睡眠结构、睡眠效率等具有显著的影响,同样睡眠觉醒周期也影响癫痫样活动的分布和频率,且纠正睡眠障碍有助于癫痫的治疗。本文简要综述了癫痫和睡眠之间的相互关系和机理。     

抑郁障碍的多导睡眠图监测研究

目的 探讨抑郁障碍患者睡眠生理的变化.方法 应用日本1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图等技术,对19例抑郁障碍患者的多导睡眠图(PSG)进行整夜监测,并与21名正常受试者对照.结果 抑郁障碍组PSG主要指标表现为REM睡眠潜伏期(RL)前移,正常组(84±11)min,抑郁障碍组(61±19)min(P＜0.01);睡眠维持率(SMT)下降(正常组(99±3)%,抑郁障碍组(90±5)%,P＜0.01),第二阶段睡眠降低(正常组(56±4)%,抑郁障碍组(45±17)%,P＜0.05)及REM4个睡眠参数存在变异.结论 抑郁障碍患者具有PSG多项睡眠脑电指标的改变.其中REM睡眠潜伏期前移是本病的特点.     

失眠症患者睡眠质量的主观评估与多导睡眠图参数对比分析

目的 探讨失眠症患者对睡眠质量的主观评估,并通过对多导睡眠图(PSG)睡眠参数的定量分析,对失眠症患者的睡眠状况进行客观评估,进一步将二者进行对比分析.方法 对失眠症患者和健康人各100例运用匹兹堡睡眠质量指数问卷(PSQI)进行评定,并分别进行多导睡眠图的整夜睡眠描记,次日晨起后询问夜间睡眠情况.结果 失眠症组PSQI各成分得分及总分均高于对照组,差异有统计学意义(P＜0.01).与对照组相比,失眠症组的睡眠潜伏期(min)延长(失眠症组43.69±11.54,对照组16.01±10.44)、总睡眠时间(min)减少(失眠症组314.65±91.89,对照组446.41±77.81)、睡眠效率降低(失眠症组64.51%±18.59%,对照组91.32%±3.58%)、快眼动睡眠时间(min)减少(失眠症组33.26±15.61,对照组93.21±21.63),差异有统计学意义(P＜0.01).失眠症组对总睡眠时间的评估较PSG检测值显著减低、对睡眠潜伏期的评估较PSG检测值显著增高,自我评估与实际睡眠情况不一致.结论 失眠症患者睡眠质量较差.失眠症患者的PSG各睡眠参数有特征性的改变,利用PSG检查发现失眠症患者对失眠情况的主客观评估不一致,存在过高估价睡眠潜伏期和过低估价睡眠时间的倾向.     

癫痫的多导睡眠研究

目的:了解癫痫放电在自然睡眠各期及觉醒状态下分布情况,为癫痫的诊断与优化治疗提供客观参考依据。方法:筛选40例全身性强直—阵挛发作尚未用AEDs治疗的癫痫患者,用英国OXFORD Medilog 9200型动态脑电监测仪同时进行多导睡眠记录和动态脑电图记录。结果:40例中有33人记录到典型癫痫波(82.5%),30人记录到慢波阵发(75%),11人记录到α高尖阵发(27.5%)。结论:本研究提示典型癫痫放电和慢波发放主要在W和S_(1,2)较多,其次是在REM,在S_(3,4)相对较少,α高尖阵发主要是在W和S_(1,2),这说明痫样放电在觉醒和睡眠时均有相当的放电时间和次数。本研究还提示通过动态脑电图检测或结合多导睡眠图可详细准确了解痫样放电的24小时分布状况,对指导调整AEDs的用量和服用时间,实现癫痫优化治疗有重要意义。     

三唑仑对失眠症患者睡眠脑电的影响

目的应用多导睡眠图(PSG)探讨三唑仑对失眠症患者睡眠脑电活动的影响.方法对28例失眠症患者连续进行4夜PSG描记,其中第3、4晚上睡前予0.5mg三唑仑,观察用药后PSG的变化.正常对照组33名,作2夜适应和基础PSG监测.结果失眠症患者服用三唑仑后夜间PSG显示睡眠效率提高[基线睡眠值(86±9)%,第3晚服药后(91±8)%,第4晚服药后(92±4)%,F值6.143,P＜0.01],觉醒时间减少[同前,(39±17)min,(29±8)min,(23±7)min,F值13.211,P＜0.01],S1减少[同前,(31±18)%,(23±11)%,(16±6)%,F值9.707,P＜0.01],S2增加[同前,(45±17)%,(59±18)%,(60±6)%,F值10.104,P＜0.01],睡眠潜伏期缩短[同前,(35±18)min,(28±17)min,(21±11)min,t值4.947,P＜0.05].结论短半衰期催眠药三唑仑不仅能改善患者对睡眠的主观评价,还对夜间睡眠脑电有影响.     

多项睡眠图联合长程视频脑电图监测癫(痫)患者夜间睡眠呼吸事件82例报告

目的:探讨癫(痫)患者睡眠中(痫)性放电对睡眠呼吸事件的影响.方法:对临床确诊的82例成人癫(痫)患者进行多项睡眠图(PSG)和长程视频脑电图(V-EEG)监测,分析其夜间睡眠中发作性事件情况,并探讨(痫)性放电及抗癫(痫)药的影响.结果:癫(痫)组入睡潜伏期、快速眼动(REM)睡眠潜伏期增加,浅睡期所占比例增多,深睡期所占比例减少,睡眠效率降低,夜间觉醒次数增多,睡眠呼吸暂停指数增高,与对照组比较差异均有显著意义(P＜0.01).周期性腿动事件与对照组比较无明显差异.(痫)性放电和抗癫(痫)药对睡眠呼吸暂停指数和周期性腿动指数未见明确影响.结论:癫(痫)患者存在睡眠结构紊乱和睡眠呼吸障碍,觉醒事件、呼吸事件、腿动事件三者之间相互影响,采用PSG联合V-EEG同步监测有利于全面分析睡眠结构与癫(痫)呼吸事件之间的关系.     

Sleep disturbance in children with epilepsy

This study employed a validated pediatric sleep questionnaire to evaluate for sleep-disordered symptoms in children with epilepsy (n=14). Results were compared with those for age-matched children (n=14) with known obstructive sleep apnea. Subjects were enrolled from an outpatient epilepsy clinic and a pediatric sleep disorders clinic. We hypothesized that children with epilepsy would (1) report symptoms of sleep disturbance similar to those of children with documented obstructive sleep apnea, and (2) display behavioral disturbances on parent and child behavioral symptom measures. Results indicate that more than 50% of children with epilepsy had behavioral problems (n=14). No differences in snoring, excessive daytime sleepiness, and restless sleep were seen between the two subject groups. Results suggest that neurobehavioral problems in children with epilepsy may in part be attributed to an underlying sleep disturbance.     

睡眠紊乱与躁狂发作

睡眠紊乱作为情感障碍的常见症状已成为共识,在DSM-IV躁狂的诊断标准中[1],睡眠需求减少是七条诊断条目之一,对多导睡眠图的研究表明,睡眠减少的躁狂患者REM潜伏期缩短-而REM与情感功能密切相关[2].近年来许多证据表明睡眠紊乱会导致躁狂发作同时也可以作为躁狂发作的预测指标,同样,在躁狂治疗时改善睡眠质量也是重要的治疗手段,本文就近年来有关双相躁狂睡眠障碍的研究综述如下.     

Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis

ObjectivesChronic pain, with or without an identified diagnosis or cause, is widespread and commonly associated with sleep disturbances. However, research has often used poor quality measures of sleep and focused on specific pain conditions, thereby limiting its reliability and applicability to the wider CP population. This study meta-analysed the findings from studies that used objective polysomnographic measures of sleep or examined diagnosed sleep disorders in people with CP.MethodsThree databases were searched (PubMed, PsychINFO, Embase; inception to June 2017) for case-controlled polysomnography studies and studies that reported the prevalence of diagnosed sleep disorders in adults with CP. Hedge's g effect sizes and prevalence rates were calculated using the data from 37 studies.ResultsPolysomnographic measures of sleep onset latency and efficiency, time awake after sleep onset and awakenings were all significantly worse in those with CP when compared to healthy controls (large effects). Total sleep time, light sleep duration (NREM 1), number of stage-shifts, respiratory-related events and periodic limb-movements were also worse for those with CP, albeit to a lesser extent (small to medium effects). The pooled prevalence of sleep disorders in CP was 44%, with insomnia (72%), restless legs syndrome (32%) and obstructive sleep apnea (32%) being the most common diagnoses.ConclusionsObjective polysomnographic measures indicate that individuals with CP experience significant sleep disturbances, particularly with respect to sleep initiation and maintenance. Clinically diagnosed sleep disorders are also very prevalent. It is imperative that sleep disturbances and disorders be assessed and treated in conjunction with the CP.     

Sleep architecture in children with idiopathic generalized epilepsy

PURPOSE: Children with epilepsy experience sleep disturbances, behavioral and attentional problems at higher rates than their peers. However, the relation between sleep disturbances and the observed behavioral and attentional abnormalities is poorly defined. METHODS: Children with primary generalized epilepsy who were seizure free and between the ages of 5 and 18 years were matched with age- and gender-matched healthy controls and underwent two consecutive nights of nocturnal polysomnography with extended electroencephalography. Connor's Continuous Performance Test (CPT) was administered to assess daytime attentional function. Parents completed the Child Behavior Checklist (CBCL) to assess their emotional-behavioral status. Two sample t tests were used to examine group differences. Spearman correlations were used to examine the relation between sleep variables and behavior and attention variables. Multiple regression analysis was used to identify independent predictors of abnormal behavior and attention among patients. RESULTS: Eleven children with primary generalized epilepsy and eight age- and sex-matched controls participated in the study. Children with epilepsy had longer stage 1 sleep percentage (7.19 +/- 3.2 vs. 4.8 +/- 3.5; p = 0.05) and latency to rapid-eye-movement (REM) sleep (123.5 +/- 40.1 vs. 101.75 +/- 24.3; p = 0.018) compared with controls. Children with epilepsy had worse attention (CPT index, 10.94 +/- 6.55 vs. 3.42 +/- 4.04; p = 0.004) and exhibited significantly higher CBCL Total Behavior and Internalizing Behavior Problem scales. Whereas regression analysis showed no independent predictors of abnormal behavior and attention, a tendency toward association between CBCL total behavior scale and REM percentage (r= 0.55; p = 0.07), and between CPT overall index and stage 1 sleep percentage (r= 0.40; p = 0.10) was noted. CONCLUSIONS: Sleep architecture is abnormal in children with primary generalized epilepsy. Further studies are needed to determine whether abnormalities in sleep architecture contribute to poor daytime behavior and attention.     

Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy

Purpose :  To determine the relative contributions of subjective anxiety, depression, sleep disturbance, and seizure-related variables to quality-of-life scores in adults with epilepsy, and the interrelationships among these factors.
Methods :  Consecutive adult patients with epilepsy attending neurology outpatient clinics were recruited. Patients completed the following scales: Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale, Medical Outcomes Study (MOS) Sleep Scale, Epworth Sleepiness Scale, and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Univariate and multivariate linear regression models were used to identify variables associated with QOLIE-31 overall score. Path analysis model was constructed to test for interrelations between the variables.
Results :  Two hundred forty-seven patients completed the questionnaires. By multivariate analysis, in order of degree of contribution, HADS anxiety subscale score, MOS Sleep Scale Sleep Problems Index score, HADS depression subscale score, number of current antiepileptic drugs used, and seizure freedom in the past 4 weeks, significantly correlated with QOLIE-31 overall score, accounting for 65.2% of the variance. Complex interrelationships were present between these factors. A general linear model to predict QOLIE-31 overall score in the presence of these factors was constructed.
Conclusion :  Subjective anxiety, depression, and sleep disturbance exerted greater effect than short-term seizure control on quality of life scores of patients with epilepsy. These factors should be considered simultaneously when evaluating effects of treatment on quality of life.