失眠症者睡眠的主观评估和多导睡眠图对比分析

目的：探讨失眠症患者对睡眠评估的心理特征。方法：应用多导睡眠图对５０例失眠症患者进行整夜睡眠描记,次日早晨起床后询问夜间睡眠情况,并与２２名正常人进行对比分析。结果：与对照组比较、失眠症组睡眠潜伏期长,睡眠时间减少,睡眠效率低（Ｐ〈０．０１）;失眠症主观评估的睡眠潜伏期,总睡眠时间和睡眠效率与多导睡眠图结果比较具有显著不一致（Ｐ〈０．０５￣０．０１）。结论：失眠症组不但睡眠质量低于正常人,而且有着     

应用多导睡眠图评价针灸治疗失眠症的效果

目的:观察通过针灸治疗对失眠症患者的多导睡眠图影响。方法:采用8通道多导睡眠图进行规范检测,比较50例失眠患者针灸治疗前后多导睡眠图的差异。结果:经针灸治疗后,失眠患者总睡眠时间增加,睡眠结构中深睡眠所占比例增加,觉醒次数减少,患者自我感觉睡眠质量提高。结论:针灸治疗能改善睡眠,多导睡眠图能一定程度的地评价睡眠质量。     

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…     

失眠症患者状态-特质焦虑与睡眠结构的关系

目的:探讨失眠症患者睡眠结构改变与状态焦虑和特质焦虑的关系.方法:对31例失眠症患者和20例正常对照者进行状态-特质焦虑问卷调查和整夜多导睡眠图描记,失眠症组于症状缓解出院后3~4月回访时重复检查.结果:(1)在睡眠结构上,与对照组相比,失眠症组呈现睡眠时间减少[(333.71±84.33)min vs.(403.65±19.29)min]、睡眠效率下降[(70.41±17.35) % vs.(83.45±4.42) %]、睡眠潜伏期[(39.48±24.24) min vs.(19.65±8.57) min]和快速眼动睡眠潜伏期延长[(106.60±42.89) min vs.(86.80±12.25) min],S_1睡眠时间比例增加[( 25.36±14.22) %vs.(8.86±1.77) %]、觉醒次数增多[(4.45±2.51) vs.(1.75±1.07)].S_(3+4)睡眠[(7.38±9.70)% vs.(13.78±4.24)%]和快速眼动睡眠时间比例[( 14.54±5.61) %vs.(19.18±2.14) %]减少 (Ps<0.05).(2)在状态-特质焦虑问卷评分上,失眠症组状态焦虑[(47.94 ±8.96) vs.(39.15±4.51)]和特质焦虑[(49.94 ±8.90) vs.(42.05±7.13)]得分均高于对照组(Ps<0.05).状态焦虑与睡眠潜伏期、快眼动睡眠潜伏期、觉醒次数和S_1睡眠时间比例均呈正相关(r=0.25~0.44,Ps<0.05),而与快眼动睡眠时间比例呈负相关(r=-0.41,P<0.01);特质焦虑与睡眠潜伏期和觉醒次数正相关(r=0.37,0.29;均Ps<0.05).(3)回访时患者睡眠结构改善,状态焦虑得分下降,特质焦虑无明显变化.结论:失眠症患者有明显的睡眠结构改变和较高的状态焦虑和特质焦虑,其睡眠结构改变与状态焦虑和特质焦虑相关.     

阻塞性睡眠呼吸暂停综合征的情绪状况

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者情绪状况的改变. 方法对63例疑诊OSAS的患者行全夜多导睡眠图(PSG)检查,根据呼吸暂停低通气指数(AHI)分为OSAS组和对照组,对其进行抑郁和焦虑症状评定,比较两组中各指标的差异性. 结果 OSAS患者SAS、SDS得分均升高.OSAS患者抑郁和焦虑的发生率分别为44.2%和32.6%,明显高于对照组,以抑郁尤为明显. 结论 OSAS患者存在明显情绪障碍.     

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。     

睡眠呼吸暂停低通气综合征患者的抑郁焦虑症状研究

目的:探讨睡眠呼吸暂停低通气综合征(SAHS)患者并发抑郁焦虑情况.方法:对50例SAHS患者和30例正常对照者进行整夜多导睡眠图(PSG)检查,分别对其进行抑郁、焦虑症状评定.结果:SAHS组SAS量表、SDS量表标准分均高于正常对照组(P<0.05).SAHS组抑郁和焦虑发生率分别为42.0%和32.0%.SAHS组抑郁焦虑情绪与夜间总睡眠时间、NREM和REM睡眠时间呈显著负相关(r>0.6),与觉醒次数及睡眠潜伏期呈正相关(r>0.3).结论:SAHS患者存在显著的抑郁焦虑症状.     

多项睡眠图联合长程视频脑电图观察未治疗的28例癫癎患者睡眠结构和呼吸事件的变化

目的:探讨成人癫癎患者药物治疗前睡眠结构和睡眠呼吸事件的变化。方法:对确诊为癫癎的成人患者28例进行多项睡眠图(PSG)检查,同步行长程视频脑电图(LTV EEG)检查,分析患者的睡眠结构、睡眠呼吸事件情况。结果:本组病人PSG睡眠结构特点表现为各睡眠参数均有不同程度的改变,以REM潜伏期增加、REM睡眠减少为著,浅睡眠明显增多,而深睡眠则无明显差异。其中2例患者无REM睡眠。所有患者夜间觉醒次数均增多,睡眠效率明显下降。但在觉醒时间、周期性腿动和呼吸暂停指数上,并无明显变化。结论:癫癎患者在药物治疗前存在睡眠结构紊乱。     

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。     

儿童阻塞性睡眠呼吸暂停低通气综合征的性别对比研究

目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的多导睡眠图(PSG)特点及性别.方法对比分析了277例不同性别儿童的OSAHS的性别年龄比较研究、身高体重及多导睡眠图.结果 OSAHS患者,其年龄比例;睡眠时间男(6.80±1.33)h,女(7.08±1.12)h;非快速眼动睡眠潜伏期男(19.87±19.15)min,女(16.62±13.73)min;快速眼动睡眠潜伏期男(1.73±1.10)h,女(1.50±0.78)h;睡眠觉醒次数男(25.68±14.54)次/h,女(23.18±13.44)次/h;最长呼吸暂停时间男(74±77)秒,女(67±43)秒;呼吸暂停及低通气次数男(80.1±112.7)次/h,女(77.9±101.6)次/h;最低血氧男(72.63±16.66)%,女(73.62±11.98)%;平均血氧男(94.42±2.75)%,女(94.02±2.39)%;以及OSAHS程度等均差异无显著性(p>0.05).结论 OSAHS儿童患者性别、各年龄段、体重指数以及PSG检查结果具有一致性,临床上不需区别对待.     

The exploratory power of sleep effort,dysfunctional beliefs and arousal for insomnia severity and polysomnography‐determined sleep

Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent, particularly in patients with primary insomnia, indicating that the two measures are partially independent. To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG‐determined sleep. The aim of this study was to investigate to what extent three major components of insomnia models, i.e. sleep effort, dysfunctional beliefs and attitudes about sleep, and presleep arousal, are associated with subjective insomnia severity and PSG‐ determined sleep. A sample of 47 patients with primary insomnia according to DSM‐IV criteria and 52 good sleeper controls underwent 2 nights of PSG and completed the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre‐Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG‐ determined total sleep time. All analyses were adjusted for age, gender, depressive symptoms and group status. The results showed that subjective insomnia severity was associated positively with sleep effort. PSG‐determined total sleep time was associated negatively with somatic presleep arousal and dysfunctional beliefs and attitudes about sleep. This pattern of results provides testable hypotheses for prospective studies on the impact of distinct cognitive and somatic variables on subjective insomnia severity and PSG‐determined total sleep time.     

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.     

Sleep education for paradoxical insomnia

This case study series investigated a new treatment for paradoxical insomnia patients as there is no standard treatment for this patient group at this time. Four paradoxical insomnia patients had a polysomnography (PSG) sleep study, an unsuccessful brief course of behavioral treatment for insomnia, and then a novel sleep education treatment comprising review of their PSG with video and exploration of the discrepancy between their reported and observed sleep experience. Two patients responded well to sleep education, mainly with improved self-reported sleep onset latency, total sleep time, and Insomnia Severity Index scores; and the other two, who exhibited sleep architecture anomalies, were unresponsive. These findings suggest that sleep education holds promise for some paradoxical insomnia patients. Suggestions for future studies are given.     

Psychophysiological insomnia: the behavioural model and a neurocognitive perspective

A number of paradoxes are apparent in the assessment and treatment of psychophysiological insomnia and sleep state misperception. Three of these paradoxes exist as discrepancies between polysomnographic (PSG) measures and the subjective impressions regarding sleep quality and quantity. The remaining incongruity exists largely within the objective domain. In the case of subjective–objective discrepancies, patients with insomnia: (1) frequently identify themselves as having been awake when awakened from PSG defined sleep; (2) tend to overestimate sleep latency and underestimate total sleep time as compared with PSG measures; (3) appear to derive more benefit from pharmacotherapy that can be explained by objective gains. The remaining paradox pertains to the observation that hypnotic medications, by and large, do not normalize sleep architecture or produce a more ‘sleep-like’ EEG. In this paper, we review possible explanations for these various paradoxes, introduce a new perspective and suggest possible research avenues. The model introduced is based on the observation that beta and/or gamma activity (which have been found to be associated with cognitive processes) is enhanced in insomnia at or around sleep onset. We propose that this kind of high frequency EEG activity may interfere with the normal establishment of sleep onset-related mesograde amnesia. As a result, the patient with insomnia maintains a level of information and/or memory processing that blurs the phenomenological distinction between sleep and wakefulness and influences retrospective judgments about sleep initiation and duration.     

Subjective versus objective evaluation of hypnotic efficacy: experience with zolpidem.

There is little published literature on the correlation between subjective and objective efficacy of hypnotics. We wanted to determine whether there was a correlation between the patient's subjective evaluation of the efficacy of the hypnotic with the polysomnographic (PSG) findings. We studied 16 patients with chronic insomnia (sleep latency, greater than or equal to 30 minutes; total sleep time, greater than 240 but less than 420 minutes) for 11 nights who took placebos on nights 1 and 2, zolpidem (imidazopyridine) on nights 3-9 and placebo on nights 10 and 11. Patients completed a questionnaire each morning following PSG, which evaluated subjective sleep quality, sleep latency and total sleep time. These data were compared to PSG findings to answer specific questions about sleep latency reduction, efficacy of the hypnotic after a week's use, sleep quality after discontinuing the drug, and any correlation between subjective and objective measures. PSG findings indicated a shortened sleep latency, increased total sleep time, decreased total wake time and increased sleep efficiency when patients ingested zolpidem 30 minutes before bedtime. We found that after 7 nights (nights 3-9) the drug was still effective in reducing sleep latency and increasing total sleep time. Upon withdrawal (nights 10 and 11) sleep returned to baseline (nights 1 and 2). Subjectively, the patients confirmed those findings on the questionnaire, as well as a subjective reduction in the number of awakenings and, interestingly, a subjective increase in the time spent awake after sleep. Many of the objective variables we examined correlated highly with the subjective variables. While on zolpidem, subjects believed and were objectively shown to have a decreased sleep latency, increased total sleep time and decreased time awake before persistent sleep, although they tended to overestimate sleep latency and time spent awake before persistent sleep and underestimated total sleep time. Although the correlation between objective and subjective measures was high for the group, in individual patients there was an impressive difference between the two, and the highest coefficient of variation between a subjective and objective measures was 0.453. No correlations were found with subjective measures of refreshing quality of sleep, decrease in number of awakenings, how sleepy patients felt in the morning or their ability to concentrate in the morning. Thus, we believe the PSG remains the keystone in the evaluation of hypnotic efficacy.     

Comparison of actigraphy with polysomnography and sleep logs in depressed insomniacs

Actigraphy is increasingly used in the assessment and treatment of various clinical conditions, being a convenient and cost‐effective method of capturing bodily movements over long periods of time. This study examined the use of actigraphy in the measurement of sleep of patients with depression and insomnia. Fifty‐four patients diagnosed with a current major depressive episode and chronic insomnia underwent a baseline overnight study with concurrent actigraphic and polysomnography (PSG) monitoring, as well as subjective sleep diaries. Agreement between PSG, actigraphy and sleep diary measurements was evaluated using two‐tailed t‐tests, Pearson’s correlations and the Bland–Altman concordance technique. The only significant difference found between actigraphy and PSG was in latency to persistent sleep, in which actigraphy underestimated sleep latency relative to PSG (P < 0.05). There were moderate positive correlations between actigraphy and PSG for all variables. In contrast, significant differences were observed between sleep diaries and PSG for all sleep variables. Bland–Altman concordance diagrams also demonstrated that, while bias was limited between PSG and the other two measurement types, there were somewhat broad 95% limits of agreement for all sleep variables with both sleep diaries and actigraphy. In summary, actigraphic measurements of sleep more closely approximated those of PSG than did sleep diaries in this sample of depressed insomniacs.     

Sleep perception and the multiple sleep latency test in patients with primary insomnia

The purpose of this study was to examine the relationship between overnight sleep perception and the daytime multiple sleep latency test (MSLT) among individuals who were primary insomnia patients (PIPs) or good sleeper controls (GSCs). We collected overnight sleep data via polysomnography (PSG), subjective sleep data via a morning questionnaire (self‐evaluated) and MSLT data via four 20‐min naps over 8 h. Subjects included 122 PIPs and 48 GSCs. Sleep perception was calculated as subjective sleep time/objective sleep time × 100%. PIPs showed a significant difference (P < 0.001) between sleep time, as determined by PSG (387.8 ± 100 min) and self‐report (226.3 ± 160 min), but no difference was obtained for GSCs (440.6 ± 53 versus 435.4 ± 65 min). The means for sleep perception were 56.4 ± 38.8% for the PIPs and 99.3 ± 13.6% for the GSCs (P < 0.001). In the PIPs group, weak but statistically significant negative correlations (r: ?0.20 to ?0.25) were found for MSLT versus sleep perception and versus self‐ and PSG‐evaluated sleep time. Compared to PIPs with low scores on the MSLT, those with high scores had less sleep perception (%), less self‐ and PSG‐evaluated sleep time and greater sleep misperception time. GSCs did not show significant correlations between MSLT and sleep measures or differences in comparisons between individuals with high and low scores on the MSLT. These results add novel data to the literature by suggesting that 24‐h hyperarousal potentially plays a key role in the pathophysiological issues of insomnia.     

Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients

Primary insomnia (PI) is characterized by low subjective sleep quality which cannot always be verified using polysomnography (PSG). To shed light on this discrepancy, subjective estimates of sleep and PSG variables were compared in patients with PI and good sleeper controls (GSC). 100 patients with PI (age: 42.57 +/- 12.50 years, medication free for at least 14 days) and 100 GSC (41.12 +/- 13.99 years) with a sex distribution of 46 men and 54 women in each group were included. Both PSG and questionnaire variables showed clear impairments of sleep quality in PI compared with GSC. The arousal index within total sleep time was increased, which was mainly because of a strong increase within rapid eye movement (REM) sleep. Subjectively, more PI than GSC subjects estimated wake times longer than obtained from PSG. Linear modeling analysis of subjective wake time in terms of PSG parameters revealed that in addition to PSG defined wake time, REM sleep time contributed significantly to subjective wake time. This REM sleep contribution was larger for PI than for GSC subjects. The findings suggest that REM sleep-related processes might contribute to subjectively disturbed sleep and the perception of waking time in patients with PI.     

Wrist actigraphy in insomnia.

To assess the use of actigraphy in evaluating insomnia, 36 patients with a serious complaint of insomnia slept 3 nights each in the laboratory, where the usual polysomnograms (PSGs) were obtained as well as actigraphic assessments of their sleep. Patients also wore actigraphs for 7 days at home, were extensively interviewed and filled out psychometric tests. Based on all this information, the patients were then diagnosed according to the International Classification of Sleep Disorders. Averaged over the 3 nights for each insomniac, the mean discrepancy between actigram and PSG was 49 minutes per night. In three-fourths of the cases, actigram and PSG agreed to within 1 hour on the total amount of sleep per night. Discrepancies, however, were not random: In patients with psychophysiologic insomnia and in insomnia associated with psychiatric disease, the actigram typically overestimated sleep when compared with the PSG. In patients with sleep-state misperception, the actigram was either quite accurate or it underestimated sleep when compared with the PSG. Comparing laboratory with home sleep, one-third of all insomniacs slept better in the laboratory and two-thirds slept better at home. In addition, night-by-night variability was higher at home than in the laboratory. Based on our study, we now recommend actigraphy as an additional tool in the clinical evaluation of insomnia, but we believe that in complex cases it should be combined with 1 PSG night in the sleep disorders center.     

Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value

This investigation examined the diagnostic value of polysomnography (PSG) for evaluating disorders of initiating and maintaining sleep (DIMS). The sample consisted of 100 outpatients who presented to the Duke Sleep Disorders Center with a complaint of chronic insomnia. All patients were given comprehensive medical, psychiatric, behavioral, and ambulatory PSG evaluations. Sleep disorder diagnoses were assigned using the criteria of the Association of Sleep Disorders Centers. Overall, PSG yielded important diagnostic information in 65% of the sample: 34% were given a primary sleep disorder diagnosis that was heavily dependent on PSG data [periodic movements of sleep (PMS) = 25%, apnea = 3%, and subjective insomnia = 6%]; 15% were given a secondary diagnosis of one of these three disorders; and PSG ruled out suspected PMS in 9% and sleep apnea in 7% of the sample. Patients greater than 40 years of age had a significantly higher rate of positive PSG findings than younger patients. Using only the clinical exam, two experienced sleep clinicians were able to predict only 14 of 25 PMS cases and one of three cases of sleep apnea. Based on these data, we suggest using PSG routinely with older insomniacs and with younger patients who fail initial treatment.