阻滞性抑郁症的睡眠脑电图特征

目的　探索阻滞性抑郁症的睡眠脑电图特征。方法　对 8例阻滞性抑郁症、10例非阻滞性抑郁症和 10例正常对照者检测睡眠脑电图。结果　阻滞性抑郁症的REM密度 (2 17± 4 2 6 )比非阻滞性抑郁症的 (188± 111)倾向为高 (P >0 0 5 ) ,比正常对照组的 (12 4± 18 5 )显著为高 (P <0 0 5 )。结论　REM密度可作为阻滞性抑郁症的一个状态指标     

抑郁症患者可乐定快速眼运动睡眠抑制试验的对照研究

目的探讨重性抑郁症患者α2-肾上腺能受体功能状况。方法对15例重性抑郁症患者（抑郁症组）和15名正常人（正常对照组）分别进行多导睡眠脑电图检查。在第1个快速眼运动（REM）睡眠周期结束10min内,向所有被试者静脉注射可乐定（剂量按2mg/kg体重计算,并稀释于9ml生理盐水中）,比较两组的睡眠情况。结果可乐定注射前,抑郁症组的REM比例［（26.8±5.6）%］、REM次数［（6.8±1.2）次］及REM时间［（120.6±25.1）min］较正常对照组增加［分别为（19.2±3.3）%、（4.9±0.8）次、（78.8±14.4）min;P<0.05］,REM潜伏期缩短［（64.1±27.0）min,对照组为（96.1±27.0）min］;可乐定注射后,对两组非快速眼运动睡眠几乎无影响,而抑郁症组和对照组的REM比例［分别为（21.3±4.8）%和（13.6±2.7）%］、次数［分别为（5.3±1.2）次和（3.8±0.6）次］、时间［（101.0±24.0）min和（61.0±10.3）min］分别较注射前减少（P<0.05）,抑郁症组第1次和第2次REM间隔时间的差值小于正常对照组（P<0.01）;而两组REM潜伏期注射前后的差异均无显著性。提示抑郁症患者REM睡眠的可乐定反映较正常对照组迟钝。结论重性抑郁症患者可能存在α2-肾上腺能受体功能低下。     

抑郁症、焦虑症、强迫症患者睡眠脑电图及P300的比较

目的探讨抑郁症、焦虑症、强迫症患者睡眠脑电图的差异及其与事件相关诱发电位P300关系.方法对31例抑郁症、20例焦虑症、20例强迫症患者进行多导睡眠脑电图和P300测定,将3组的多导睡眠脑电图结果与P300各指标进行相关分析.结果 (1)抑郁症、焦虑症、强迫症3组睡眠进程各个指标的差异均无统计学意义;(2)与焦虑症组和强迫症组比较,抑郁症组快速眼动(REM)睡眠的活动量小、强度低、睡眠时间少,睡眠周期数少、睡眠结构中REM睡眠比率均低,而睡眠结构的第1阶段比率高(P<0.01和<0.05);焦虑症组与强迫症组间睡眠脑电图各项指标的差异无统计学意义;(3)各组睡眠脑电图的各项指标与P300存在不同的相关性.结论抑郁症与焦虑症、强迫症睡眠结构比率和REM睡眠的特点不同,关注睡眠特别是REM睡眠的神经机制可能会进一步认识认知功能的改变.     

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。     

卒中后抑郁的长程脑电图研究

目的 探讨卒中后抑郁患者长程脑电图的特点。方法 选取卒中后抑郁患者101例,行长程脑电图,计算睁闭眼实验后第一个10 sec内脑电图δ、θ、α、β波的时间,以及整夜S1、S2、S3、S4睡眠阶段和快动眼睡眠（rapid eye movement sleep,REM）占总睡眠时间的比例,与健康对照组脑电图结构进行比较。结果 卒中后抑郁组较对照组脑电图上慢波（δ和θ波）明显增加（δ波P＝0.001,θ波P＝0.005）,α波明显减少（P＝0.008）,β波无显著差异。和正常对照组睡眠结构比较,卒中后抑郁组睡眠S2、S3和S4阶段比例减少（P值分别为0.008、0.004）,睡眠S1阶段和REM比例增加（P值分别为0.001和0.006）。结论 卒中后抑郁症患者脑电背景慢波增多;卒中后抑郁症患者浅睡眠多,而中到深度睡眠减少。     

脑卒中后抑郁患者与抑郁症患者的睡眠脑电图比较分析

目的分析脑卒中后抑郁患者的睡眠脑电图改变与抑郁症患者之间的差异。方法分别对27例脑卒中抑郁患者和27例抑郁症患者进行多导睡眠图描记,并与21例对照组比较。结果脑卒中抑郁患者和抑郁症比较主要是在慢波睡眠(%)、REM时间(分)、REM睡眠(%)、REM潜伏期、REM强度和REM活动度上有差异。结论 REM睡眠参数改变对PSD的诊断具有一定的参考价值,因此可将REM睡眠参数作为PSD诊断的辅助指标之一。     

曲唑酮和佳静安定治疗抑郁症患者睡眠障碍的疗效观察

目的探讨曲唑酮和佳静安定治疗抑郁症患者睡眠障碍的临床疗效。方法 43例抑郁症伴睡眠障碍患者,随机分为曲唑酮组和佳静安定组,在帕罗西汀治疗的基础上,分别给予曲唑酮和佳静安定,治疗4周。结果治疗前后2组总睡眠时间、早醒延迟时间、夜间觉醒次数均有明显改善(P<0.05)。治疗后2组I期和II期睡眠缩短,III期和IV期睡眠、REM潜伏期明显延长,与治疗前比较差异均有统计学意义(P<0.05),2组比较差异亦有统计学意义(P<0.05)。治疗前后抑郁症患者汉密尔顿抑郁量表评分明显改善(P<0.05)。结论曲唑酮和佳静安定均对抑郁症患者睡眠障碍有明显改善作用,且曲唑酮能显著改善抑郁症患者的深度睡眠。     

抑郁症患者的Quisi试验研究

目的　探讨Quisi在抑郁症辅助诊断中的价值。方法　应用德国Quisi仪 ,对 2 4例抑郁症患者 (抑郁症组 )的睡眠脑电进行 2次全夜测试 ,并与 2 1名正常受试者 (正常对照组 )进行对照。结果　 (1)抑郁症组在第 1夜的各项指标中 ,仅总记录时间短于第 2夜 [分别为 (478 1± 2 7 4 )min和(499 5± 2 5 7)min ;P <0 0 1]。 (2 )抑郁症组与正常对照组比较 ,睡眠潜伏期长 [分别为 (34 5± 17 9)min和 (2 3 9± 17 4 )min ;P <0 0 5 ],觉醒时间长 [分别为 (39 8± 2 1 9)min和 (19 3± 14 9)min],睡眠效率低 [分别为 (83 7± 6 9) %和 (93 3± 5 1) % ],睡眠维持率低 [分别为 (88 8± 9 1) %和 (99 8±4 9) % ],REM睡眠潜伏期短 [分别为 (6 9 9± 16 3)min和 (88 6± 15 9)min],第二阶段百分比高 [分别为 (5 5 3± 11 9) %和 (47 5± 7 8) % ;P <0 0 5 ],第三阶段百分比高 [分别为 (8 9± 6 9) %和 (14 1±6 1) % ],REM睡眠百分比低 [分别为 (10 1± 5 9) %和 (16 9± 5 1) % ],伪迹百分比高 [分别为 (3 9±1 3) %和 (1 9± 0 8) % ],P <0 0 5或P <0 0 1。结论　Quisi适合于全夜监测。在缺乏相关设备的基层医院 ,Quisi技术可用于对抑郁症的检测。     

精神分裂症和抑郁症患者客观睡眠特征的比较

目的:探讨精神分裂症、抑郁症和正常对照者的客观睡眠特征及差异。方法:对35例精神分裂症患者、38例抑郁症患者和20名正常对照者进行多导睡眠监测(PSG)。并采用简明精神病量表(BPRS)和汉密尔顿抑郁量表(HAMD)分别对精神分裂症组和抑郁症组临床症状的严重程度进行评估。结果:精神分裂症组和抑郁症组与正常对照组相比存在显著的总睡眠时间减少(F=4.808,P=0.010),睡眠潜伏期延长(F=4.481,P=0.014),睡眠效率降低(F=9.934,P=0.000),慢波睡眠减少(F=11.309,P=0.000),快速动眼睡眠潜伏期(REML)缩短(F=7.407,P=0.001),更多的觉醒次数(F=10.772,P=0.000)和觉醒时间(F=7.965,P=0.001),而精神分裂症组慢波睡眠时间减少更显著(P=0.022),抑郁症组REML缩短(P=0.006)及REM时间延长(P=0.011)更加显著;抑郁症组REML和REM时间(r=-0.415,0.347;P=0.010,0.033)与其抑郁症状严重程度存在一定的相关性。结论:精神分裂症和抑郁症患者在各睡眠指标上存在一定的特征性表现。精神分裂症患者有更显著的慢波睡眠减少,抑郁症患者在REML缩短和REM时间延长上更加明显。     

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.     

Sleep disorder in children with autism

Abstract Eighty-eight children with autism, living in a suburb of Tokyo, were examined by questionnaire from 21 July to 31 August. Experienced sleep disorders were observed in 56 children; 44 of whom had sleep disorders before 3 years old. The average age when sleep disorders were seen to have stopped was 5 years old. The most common problem was difficulty falling sleep ( n = 23), followed by frequent awakening during sleep time ( n = 19), then early morning awakening ( n = 11). Bed-wetting was observed in 22 children.     

Untersuchungen zur circadianen Periodik bei der genuinen Epilepsie vom Aufwachtyp

Zusammenfassung Untersucht wurden an 3 Kontrollpersonen und an 6 Patienten mit genuiner Epilepsie vom Aufwachtyp über einen Zeitraum von 72 h die Herzfrequenz, die Körpertemperatur sowie die Ausscheidung der Elektrolyte Calcium, Kalium und Natrium im Urin. Für alle Patienten, Aufwachepileptiker und Kontrollpersonen, bestanden auf der Station konstante Bedingungen, sie erhielten eine Standarddiät mit konstanten Werten für Calcium, Kalium und Natrium, mit der 2 Tage vor Beginn der eigentlichen Meßreihe begonnen wurde. Während der Untersuchungszeit wurden keinerlei Medikamente eingenommen.Bestimmt wurden anhand der Originaldaten die Zeiten der Kurvenwendepunkte und durch die Power-Spektralanalyse die Periodendauern der einzelnen gemessenen Parameter.Bei den Aufwachepileptikern ergaben sich inkonstantere Befunde hinsichtlich der Lage der Maxima und Minima und auch der 24 h-Periodik, ohne daß jedoch eine konstante Abweichung in eine Richtung, d. h. entweder eine Vorverschiebung oder eine Verspätung in der Phasenlage, vorlag und auch ohne konstante Veränderung in den Periodendauern aller gemessenen Größen bei ein und demselben Aufwachepileptiker.Zumindest hinsichtlich der hier unter den genannten Bedingungen gemessenen Parameter fand sich kein sicherer Unterschied zwischen den Aufwachepileptikern und den Kontrollpersonen, der als spezifisches, allen Aufwachepileptikern gemeinsames Merkmal einer gestörten circadianen Rhythmik gelten könnte.

---

Studies on the circadian periodicity in patients with the awakening type of idiopathic epilepsy

Summary In 6 patients with idiopathic epilepsy of the awakening type and 3 control subjects, the heart rate, body temperature and urinary excretion of sodium, potassium and calcium were measured over 72 h. The patients and the control subjects stayed in the hospital under constant environmental conditions including a standard diet with a constant content of sodium, potassium and calcium. The diet began 2 days before the onset of data collection. No drugs were given during the whole period.The data obtained during the 72-hour period were scored visually concerning the position of the maxima and minima, whereas the period duration was calculated by means of power spectral analysis.The epileptic patients showed more inconstant results concerning the time of maxima and minima as well as the 24-hour periodicity.However, a constant deviation i.e. a constant phase shift or a constant change in period duration into the same direction could not be observed. The different parameters showed different behavior even in the same patient. Thus a constant difference in the circadian periodicity between normal subjects and patients with epilepsy of the awakening type could not be found in the data recorded in the present study.

     

Psychological coping styles and cortisol over the day in healthy older adults

Patterns of psychological coping are associated with a variety of health outcomes but the underlying pathways are not yet established. The purpose of this study was to assess the relationship between salivary cortisol output over the course of a day and coping style. Data were available from 350 men and 192 women with an average age of 60.9 years. Participants were drawn from the Whitehall II cohort, and had no history of cardiovascular disease. Individuals who were taking medication that might affect cortisol levels were also excluded. Saliva samples were provided on waking, then 0.5, 2.5, 8 and 12 h after waking, and just before the participant went to sleep. Coping style was measured with a standard instrument, the COPE, and data were factor analysed to generate three factors: seeking social support, problem engagement and problem avoidance. The relationships between these factors and the cortisol awakening response (CAR), the slope of cortisol change over the day and total cortisol output over the day (excluding the waking period) were assessed using multiple linear regression. Cortisol output over the day was inversely associated with coping with stress by seeking social support (p=0.034) and by problem engagement (p=0.003), independently of age, gender, body mass index, smoking, depression, self-rated health, time of waking and income. Individuals who coped by problem engagement and seeking support had lower cortisol levels. Additionally, gender, BMI, smoking, self-rated health and time of waking were independently related to cortisol output over the day. There were no significant associations between coping and the CAR or cortisol slope over the day. The results indicate that adaptive coping styles are related to low levels of cortisol over the day, suggesting that neuroendocrine pathways may partly mediate relationships between psychological coping and health.     

Genetic polymorphisms in the aryl hydrocarbon receptor-signaling pathway and sleep disturbances in middle-aged women

ObjectiveWe aimed to determine if selected genetic polymorphisms in the aryl hydrocarbon receptor (AHR)-signaling pathway and circadian locomotor output cycles kaput (CLOCK) are associated with insomnia and early awakening in middle-aged women.MethodsWomen aged 45 to 54 years (n = 639) were recruited into a middle-aged health study and agreed to complete questionnaires and donate blood samples. Questionnaires were used to assess sleep outcomes. Blood samples were processed for genotyping for the selected polymorphisms: AHR (rs2066853), AHR repressor (AHRR) (rs2292596), aryl hydrocarbon nuclear translocator (ARNT) (rs2228099), and CLOCK (rs1801260). Data were analyzed using multivariable logistic regression.ResultsWomen heterozygous for the AHRR alleles (GC) had decreased odds of insomnia compared to women homozygous for the AHRR_C allele (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.49–0.96). Women with at least one of the AHRR_G or CLOCK_C alleles had significantly decreased odds of insomnia compared to women homozygous for the AHRR_C and CLOCK_T alleles (aOR, 0.64; 95% CI, 0.43–0.96). Additionally, women homozygous for the AHRR_G and CLOCK_C alleles had significantly decreased odds of insomnia compared to women homozygous for the AHRR_C and CLOCK_T alleles (aOR, 0.56; 95% CI, 0.35–0.89). None of the selected single nucleotide polymorphisms (SNPs) or combinations of SNPs were significantly associated with early awakening.ConclusionsSelected genetic polymorphisms in the AHR-signaling pathway (i.e., AHRR) and CLOCK may play a role in decreasing the risk for experiencing insomnia during the menopausal transition.     

The cortisol awakening response in relation to objective and subjective measures of waking in the morning

Studies of the salivary cortisol awakening response (CAR) may be confounded by delays between waking in the morning and obtaining the 'waking' salivary sample. We used wrist actigraphy to provide objective information about waking time, and studied the influence of delays in taking the waking sample on the CAR. Eighty-three men and women (mean age 61.30 years) who were referred to hospital with suspected coronary artery disease were studied. Saliva samples were obtained on waking and 15 and 30 min later. The mean interval between waking defined by actigraphy and reported waking time was 6.12+/-(S.D.) 14.8 min, with 55.4% having no delay. The waking saliva sample was obtained an average 5.78+/-15.0 min after self-reported waking, and 12.24+/-20.3 min after objective waking. The waking cortisol value was significantly higher in participants who had a delay between waking and sampling >15 min (mean 14.46+/-6.34 nmol/l) than in those with zero (mean 10.45+/-6.41 nmol/l) or 1-15 min delays (mean 11.51+/-5.99 nmol/l, p=0.043). Cortisol did not increase between 15 and 30 min after waking in those who delayed >15 min. There were no differences in CAR between participants with zero and 1-15 min delays from objectively defined waking to reported sample times. A small proportion (14.7%) of participants who did not delay saliva sampling showed no increase in cortisol over the 30 min after waking. These CAR nonresponders did not differ from the remainder on sleep patterns, waking time, clinical or medication characteristics, but were more likely to be of higher socioeconomic status (p=0.009). We conclude that long delays between waking and obtaining 'waking' cortisol samples will lead to misleading CAR results, but that delays up to 15 min may not be problematic. A small minority of individuals do not show a positive CAR despite not delaying saliva sampling after waking.     

Chronotype and diurnal cortisol profile in working women: differences between work and leisure days

The influence of chronotype on the diurnal profile of salivary cortisol was examined in a sample of 187 healthy women: 21 evening chronotype, 24 morning chronotype and 142 intermediate chronotype. Saliva samples were collected at waking, 30 min post-awakening, at 1000 h, 1200 h, 1500 h, 1700 h and at bedtime on one work and one leisure day. Several components of the diurnal profile were examined including the cortisol awakening response, the total cortisol output and the diurnal profile on both the work and the leisure day, a significant main effect of time emerged (both p<0.01). After adjustment for age, smoking status, self-rated health, time of waking, and sleep problems, no effect of chronotype was evident for cortisol in the evening, the cortisol awakening response, or total cortisol output over the working day. However, on the leisure day, total cortisol output was greater in evening-types than intermediate or morning-types, after adjustment for covariates (p=0.029). The present data indicate that chronotype has a limited impact on the diurnal cortisol profile of healthy women, and may be somewhat impervious to individual preferences for morning or evening activity.     

Cortisol awakening response in abstinent alcohol-dependent patients as a marker of HPA-axis dysfunction

Hypothalamo-pituitary-adrenocorticoid (HPA)-axis reactivity to psychosocial or pharmacological stimulants is diminished in alcohol-dependent patients during early abstinence but recovers after several months of abstention. In order to assess the physiological reactivity in the morning we used the cortisol awakening response (CAR) in saliva to compare 24 early abstainers (mean 21.9+/-7.6, range 10-36 days) with 12 alcohol-dependent patients with longer abstention periods (mean 116.8+/-45.7, range 59-230 days) and looked for an association with sleep, especially rapid eye movement (REM) sleep of the preceding night. Both groups did not differ with respect to age, duration of alcohol dependence, daily drinking dosage before detoxification, body mass index, depressivity, level of anxiety, daily cigarette consumption or sleep quality during the preceding 14 days. Sleep in the night before cortisol assessment did not differ with respect to total sleep time (412.4+/-35.9 vs. 407.0+/-38.7 min). Immediately upon awakening and 15, 30, 45 and 60 min later, specimens of salivary cortisol were collected. While starting from equal levels upon awakening longer abstaining patients with alcohol dependence showed a stronger CAR (ANOVA with repeated measurement, time x group effect: F=4.33, p<0.01) with distinctly higher cortisol levels 45 and 60 min after awakening (T=3.79, p<0.001 and T=3.06, p<0.005, respectively). Across both groups the time spent in REM-sleep only correlated with cortisol levels upon awakening (r=0.33, p<0.05). Our data indicate that CAR is a useful tool for investigating alterations in the HPA-axis regulation in abstaining alcohol-dependent patients.