针灸对失眠症患者睡眠质量的影响及其机制研究

目的:探讨针灸对慢性失眠症患者睡眠质量的影响及其改善睡眠质量的主要临床机制和针灸治疗的安全性。方法:采用治疗前后自身对照法,依据针灸处方原则选穴,主穴加接KWD-808Ⅰ型脉冲电疗仪;配穴结合补泄手法,进行治疗,每次治疗时间为30-40 min,10 d为1个疗程,治疗4个疗程后,利用匹兹保睡眠质量指数积分对睡眠质量进行评判;利用多导睡眠图检测患者睡眠结构的变化;利用自拟不良事件和不良反应表对治疗中、治疗后1个月的安全性进行评估。结果:针灸能明显提高失眠症患者的睡眠质量和白天社会功能,能戒减服用安眠药的次数和用量(P0.05);针灸对断裂破碎的睡眠结构有一定的修复作用(P0.05),同时,针灸相对或绝对地延长了慢波睡眠的时间和快动眼睡眠时间(P0.05);没有发生类似安眠药的宿醉、成瘾性、日间警醒下降等不良反应(发生率0%),但1个月内的失眠反跳率达32.14%。结论:针灸能够一定程度地修复睡眠结构,重构睡眠的连续性,并能延长慢波睡眠时间和快动眼睡眠时间,这是针灸提高睡眠质量的主要临床机制;针灸治疗慢性失眠症是安全的、有效的,但其远期疗效还有待进一步探讨。     

失眠症患者的多导睡眠图改变及应对措施

目的 探讨失眠症患者的多导睡眠图(PSG)改变及应对措施。方法 对29例失眠症患者和22例正常人进行整夜多导睡眠图(PSG)描记并比较,同时对失眠患者指导实施应对措施。结果 失眠症患者有睡眠潜伏期(SL)显著延长,睡眠效率(SE)明显降低,觉醒次数(AT)增多,实际睡眠时间(TST)减少,自我评估与实际睡眠时间相差较大。结论 失眠症患者应采取应对措施,改变睡眠结构,提高睡眠质量。     

主诉失眠的门诊就诊者主客观评估的睡眠质量与生命质量

目的:失眠者的主观睡眠感与实际睡眠情况常有不一致的现象,本研究通过探讨以失眠为主诉的门诊就诊者睡眠质量的主观、客观评估指标与生命质量的相关性,为临床制定失眠的整体治疗方案提供参考依据。方法:连续收集64例以失眠为主诉的接受多导睡眠图(PSG)检查的门诊患者的资料,用匹兹堡睡眠质量指数(PSQI)评估主观睡眠质量,SF-36健康调查量表评估生命质量,用贝克抑郁问卷(BDI)、贝克焦虑问卷(BAI)评估情绪状态。以17例正常人的PSG数据作为客观睡眠质量的基础对照。结果:本组失眠就诊者90%主观评价睡眠质量差,其PSG指标中与正常对照相比睡眠潜伏期延长、清醒次数增加、睡眠效率降低、快动眼睡眠潜伏期延长(均P<0.05)。失眠就诊者PSQI总分与SF-36生理健康总分呈负相关(r=-0.25,P<0.05),但以BDI、BAI分作为控制变量进行偏相关分析显示,PSQI总分及各因子分与SF-36生理健康和心理健康总分相关性无统计学意义;PSG主要指标与SF-36生理健康和心理健康总分相关性无统计学意义。结论:本研究显示失眠者主观感受的睡眠质量更可能与生命质量相关,但与失眠相关的抑郁、焦虑情绪可能起到主要作用,这提示失眠治疗中应重视改善患者的主观睡眠质量,以及识别和处理情绪问题。     

睡眠障碍研究进展

睡眠占了人生命的三分之一,是生命所需。多导睡眠图监测被认为是诊断多种睡眠障碍的金标准。本文对睡眠障碍临床研究现状、分类、快速监测新方法 Quisi,婴儿、儿童、青少年及成人部分睡眠障碍的脑电图和多导睡眠图特征,及诊断治疗做了介绍。认为Quisi技术将多导睡眠图技术简化和延申,判断睡眠障碍多了一个手段,针刺结合中药疗法是治疗失眠的有机统一,效果更佳,具有临床转化价值。     

暗示催眠疗法在卒中后失眠患者的应用及对多导睡眠图、心理状态和生活质量的影响

目的:探究暗示催眠疗法在卒中后失眠患者的应用及对多导睡眠图、心理状态和生活质量的影响。方法:选择医院收治的130例脑卒中后失眠患者以随机数字表法均分为对照组(n=65)与干预组(n=65),对照组患者予以常规治疗,干预组患者在对照组基础上予以暗示催眠疗法干预治疗。于干预前、干预1个月后比较两组患者临床疗效与不良反应发生、多导睡眠图、心理状态以及生活质量的差异。结果:干预1个月后,与对照组的总有效率70.77%比较,干预组总有效率90.77%明显升高(Z=2.116,P0.05),两组干预期间无明显不良反应发生;干预1个月后,干预组TST、SE、S2、S3+S4、REM明显高于对照组(t=6.638,4.647,11.241,4.391,5.422;P0.05),SL、AT、S1明显低于对照组(t=4.023,9.591,8.866;P0.05);干预1个月后,干预组SAS评分、SDS评分均明显低于对照组(t=4.906,4.338;P0.05);干预1个月后,干预组干预后的WHOQOL-100评分高于对照组(t=5.938,P0.05)。结论:暗示催眠疗法干预能够明显提高卒中后失眠患者临床疗效,调整多导睡眠图,改善患者心理状态,提高生活质量。     

慢性失眠者多道睡眠图的观察及定量分析

目的：探讨慢性失眠者的多道睡眠图观察及定量分析对评价睡眠效率的意义。方法：慢性失眠者71例,正常对照组40例,分别进行了睡眠问卷及多道睡眠图检查,结果：主观性失眠与客观性失眠的多道睡眠图观察及定量分析,结果发现失眠患者觉醒后估计与多道睡眠图所记录的一些睡眠参数存在差异。结论：根据多道睡眠图观察及定量分析可区分出主观性失眠与客观性失眠,可以客观测量睡眠效率,睡眠效率是评价失眠严重程度的重要指标,睡眠周期只做参考。     

慢性失眠症临床与多导睡眠图研究

我们对36例慢性失眠症进行了临床调查,心理分析和多导睡眠图检查,对其中31例患者进行了MMPI测定,24例患者进行了EPQ测定。经分析我们认为:1.本组失眠症可分为三类:(1)持续性精神生理性失眠;(2)主观性失眠;(3)伴有情绪障碍的失眠。2.慢性失眠者多表现为悲观、抑郁、易怒、情绪不稳定。     

失眠的评估

失眠是困扰许多人的最常见的睡眠问题。失眠引起白天困倦、疲劳、情绪烦恼、工作效率下降，甚至可造成致命性的结果。虽然失眠发病率很高，但大多数失眠者并未被临床医生所识别。对失眠恰当的评估对患者非常重要。本文将回顾近年来对失眠评定方面的研究，内容包括睡眠史、自评方法、心理评估，心理生理评估、医学评估、多导睡眠图及其它睡眠评估方法。     

针刺结合耳压对失眠患者睡眠质量的临床研究

目的：通过针刺结合耳压对失眠患者的睡眠质量的观察，探求一种安全有效操作方便的治疗方法，为临床治疗提供理论依据。方法将临床60例失眠患者随机分为治疗组和对照组，治疗组运用针刺配合耳压治疗，对照组口服西药舒乐安定治疗，采用匹兹堡睡眠质量指数量表(PSQI)以及WHO颁布的失眠临床疗效判断标准等方面判断其疗效。结果研究结果表明：针刺配合耳穴贴压疗法在治疗失眠方面安全而有效，能有效改善患者睡眠质量。结论治疗时针刺配合耳压，可明显改善了患者的睡眠质量还克服了药物治疗的不足和副作用。     

认知行为治疗慢性失眠症及临床疗效分析

一　失眠的定义Ｃｈａｒｌｅｓ认为失眠症是一个庞杂的症状群 ,它被描述为睡眠质量差 ,睡眠时间短 ,睡眠效率低等一系列症状。有些失眠症患者可能缺乏夜间多导睡眠图(简称ＰＳＧ)记录的证据。失眠症涉及睡眠时间和睡眠状态 ,例如 ,夜间多次醒来和长时间难以再入睡 ,致使患者在早晨感到疲劳、体力恢复不够和整个白天的低工作效率。入睡和保持睡眠困难不是互相独立的 ,各种失眠症类型之间也可能会互相转换[1,2 ] 。失眠症的严重性可以通过睡眠困难的频率、强度、持续时间及对白天工作、生活质量和心境的影响等维度加以判断[3 ] 。有人把失眠症…     

ES-100D失眠治疗仪对椎动脉型颈椎病继发睡眠功能障碍的影响

要目的：探讨ES-100D失眠治疗仪对椎动脉型颈椎病继发睡眠功能障碍的影响。方法：60例椎动脉型颈椎病继发睡眠功能障碍患者，经ES-100D失眠治疗仪治疗14天。观察睡眠功能改善及治疗前后听觉诱发电位变化情况。结果：经ES-100D失眠治疗仪治疗后，患者睡眠功能明显改善，总有效率为86．67％；治疗后听觉诱发电位中的Ⅱ、Ⅲ、Ⅴ波有显著性差异（P〈0．05或P〈0．01）。结论：ES-100D失眠治疗仪对椎动脉型颈椎病继发睡眠功能障碍有明显的疗效，同时明显改善脑干诱发电位。     

多功能音乐电刺激治疗设备的研制及在失眠治疗方面的应用

研制一种用于康复治疗的多功能音乐电刺激治疗设备。利用C8051F340进行数据处理和系统控制,控制MP3芯片播放音乐处方信号和输出由这种音乐信号转换的同步或调制脉冲刺激电流,实现声和电两种物理因子同时作用于人体耳和经穴的一种非药物的自然疗法。对87例失眠症患者进行音乐电刺激治疗,治疗效果明显,可使睡眠总时间增加,入睡时间缩短,夜醒次数减少,睡眠深度明显加深,做梦情况减少,醒后感觉明显改善。优于西药治疗效果。     

European guideline for the diagnosis and treatment of insomnia

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence).     

认知行为与安眠药物治疗慢性失眠症临床效果对比分析

目的：比较认知行为、安眠药物和安慰剂治疗慢性失眠症的临床效果。方法：48名慢性失眠症男女患者自愿受试者，随机分成4组，分别接受认知行为、安眠药物、安眠药物和认知行为结合、安慰剂治疗。记录患者在治疗前后的主观和客观（夜间多导睡眠图，简称PSG）指标。结果：治疗开始后第8天，药物组和结合组的主观记录睡眠潜伏期分别为20分钟和27分钟，睡眠效率80％和82％，睡眠总时间分别为381分钟和356分钟，睡眠状况显著改善，效果好于认知行为组。经8周疗程治疗结束时，认知行为组上述睡眠3项指标好于治疗前，安慰剂组与治疗前无显著差异。治疗结束8个月时，认知行为组PSG记录睡眠潜伏期26分钟，睡眠效率84％，睡眠总时间378分钟，睡眠状态好于药物组和结合组，后两组较治疗刚结束时睡眠指标变差，药物组睡眠又恢复到治疗前的水平。结论：药物对睡眠改善起效快，短期效果好，认知行为治疗对睡眠改善有主观和客观（PSG记录）证明的长期效果，对与患者失眠相关的睡眠心理状态也有改善。安眠药物与认知行为结合治疗远期效果不如单纯认知行为治疗。     

Effects of transcutaneous auricular vagus nerve stimulation on brain functional connectivity of medial prefrontal cortex in patients with primary insomnia

As a representative of acupuncture and nonpharmaceutical therapy, auricular acupuncture has been widely for the treatment of insomnia. Transcutaneous auricular vagus nerve stimulation (taVNS) is a combination of auricular point stimulation and vagus nerve stimulation. It can not only treat primary insomnia effectively, but also is noninvasive, painless, portable and economical. The medial prefrontal cortex (mPFC) is a core region of default mode network (DMN), which is important for maintenance of sleep. However, the mechanism of taVNS in alleviating primary insomnia (PI) remains to be clarified. In this study, we found that taVNS could not only effectively reduce the score of Pittsburgh Sleep Quality Index, but also decreased functional connection (FC) between the left mPFC and bilateral dorsal anterior cingulate gyrus as well as FC between the right mPFC and the occipital cortex in patients with PI. Furthermore, the decrease in FC was positively correlated with the decline of sleep index score. Therefore, we proposed that treatment with taVNS can improve sleep quality and prolong sleep duration in patients with PI by reducing FC within DMN, FC between DMN and salience network, as well as FC between DMN and the occipital cortex. This may be one of mechanisms of taVNS in treating PI.     

NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes

STUDY OBJECTIVES: To determine whether the frequency spectrum of the sleep EEG is a physiologic correlate of 1) the degree to which individuals with persistent primary insomnia (PPI) underestimate their sleep time compared with the traditionally scored polysomnogram (PSG) and 2) the sleep complaints in PPI subjects who have relatively long traditionally scored PSG sleep times and relatively greater underestimation of sleep time. DESIGN: We compared EEG frequency spectra from REM and NREM sleep in PPI subjects subtyped as subjective insomnia sufferers (those with relatively long total sleep time and relative underestimation of sleep time compared with PSG), and objective insomnia sufferers (those with relatively short PSG total sleep time) with EEG frequency spectra in normals. We also studied the correlation between these indices and the degree of underestimation of sleep. Further, we determined the degree to which sleep EEG indexes related to sleep complaints. SETTING: Duke University Medical Center Sleep Laboratory. PARTICIPANTS: Normal (N=20), subjective insomnia (N=12), and objective insomnia (N=18) subjects. INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: Lower delta and greater alpha, sigma, and beta NREM EEG activity were found in the patients with subjective insomnia but not those with objective insomnia, compared with the normal subjects. These results were robust to changes in the subtyping criteria. No effects were found for REM spectral indexes. Less delta non- REM EEG activity predicted greater deviation between subjective and PSG estimates of sleep time across all subjects. For the subjective insomnia subjects, diminished low-frequency and elevated higher frequency non- REM EEG activity was associated with their sleep complaints. CONCLUSIONS: NREM EEG frequency spectral indexes appear to be physiologic correlates of sleep complaints in patients with subjective insomnia and may reflect heightened arousal during sleep.     

重复经颅磁刺激对失眠症患者睡眠的影响

目的观察重复经颅磁刺激(rTMS)对失眠症患者的临床疗效。方法将60例失眠症患者分为rTMS组和对照组,各30例。对照组每晚口服艾司唑仑1~2mg,rTMS组行rTMS治疗,均治疗14d,予多导睡眠检测仪检测治疗前后两组患者睡眠进程和睡眠结构的变化,治疗前后行匹茨堡睡眠质量指数量表(PSQI)评定,比较两组疗效。结果两组PSQI评分较治疗前均降低,差异有统计学意义(t=6.94,6.19;P0.05),治疗后两组PSQI评分差异无统计学意义。治疗后两组患者的睡眠时间、睡眠潜伏期、觉醒时间、睡眠效率等较治疗前均改善,差异有统计学意义(t=2.61~7.14,P均0.05);治疗后rTMS组较对照组相比,S2较短,S3和REMS较多,差异有统计学意义(t=7.09,6.32,4.61;P均0.05)。结论 rTMS能改善失眠症患者的睡眠质量。     

Validity,potential clinical utility and comparison of a consumer activity tracker and a research‐grade activity tracker in insomnia disorder II: Outside the laboratory

Accurate assessment of sleep can be fundamental for monitoring, managing and evaluating treatment outcomes within diseases. A proliferation of consumer activity trackers gives easy access to objective sleep. We evaluated the performance of a commercial device (Fitbit Alta HR) relative to a research‐grade actigraph (Actiwatch Spectrum Pro) in measuring sleep before and after a cognitive behavioural intervention in insomnia disorder. Twenty‐five individuals with DSM‐5 insomnia disorder (M = 50.6 ± 15.9 years) wore Fitbit and Actiwatch and completed a sleep diary during an in‐laboratory polysomnogram, and for 1 week preceding and following seven weekly sessions of cognitive‐behavioural intervention for insomnia. Device performance was compared for sleep outcomes (total sleep time, sleep latency, sleep efficiency and wake after sleep onset). The analyses assessed (a) agreement between devices across days and pre‐ to post‐treatment, and (b) whether pre‐ to post‐treatment changes in sleep assessed by devices correlated with clinical measures of change. Devices generally did not significantly differ from each other on sleep variable estimates, either night to night, in response to sleep manipulation (pre‐ to post‐treatment) or in response to changes in environment (in the laboratory versus at home). Change in sleep measures across time from each device showed some correlation with common clinical measures of change in insomnia, but not insomnia diagnosis as a categorical variable. Overall, the Fitbit provides similar estimates of sleep outside the laboratory to a research grade actigraph. Despite the similarity between Fitbit and Actiwatch performance, the use of consumer technology is still in its infancy and caution should be taken in its interpretation.     

Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia

BACKGROUND: Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia. METHODS: Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment. RESULTS: The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups. CONCLUSION: Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning.