失眠症患者睡眠质量及多导睡眠图研究

目的调查分析失眠症患者主、客观睡眠状况及睡眠质量。方法采用睡眠状况自评量表和多导睡眠图监测仪对27例失眠症患者和20例正常对照组分别进行睡眠质量评定和整夜多导睡眠图描记,次日晨完成早晨问卷。结果失眠症组睡眠问题多于对照组(P<0.01)。失眠症组总睡眠时间(TST),睡眠效率、REM睡眠时间、睡眠维持率、N3时间、N3%均低于对照组(P<0.05或0.01),睡后觉醒时间、觉醒次数、N2%、觉睡比、微觉醒总时间均高于对照组(P<0.01)。失眠症组入睡困难因子与睡眠维持率负相关(r=-0.44,P<0.05),与微觉醒总时间正相关(r=0.49,P<0.05);服药情况因子与觉醒次数、睡眠潜伏期、REM潜伏期、N2时间及N2%正相关(r=0.41～0.66,P<0.05或0.01),与REM睡眠时间及比例、N3时间及N3%负相关(r=-0.53～-0.41,P<0.05或0.01)。SRSS总分与N2%正相关(r=0.47,P<0.05),与睡眠维持率负相关(r=-0.41,P<0.05)。失眠症组的主观睡眠潜伏期大于客观睡眠潜伏期(P<0.01),主观总睡眠时间少于客观睡眠时间(P<0.01),而对照组主客观睡眠潜伏期、睡眠时间差异均无统计学意义(P>0.05)。结论失眠症患者的睡眠质量比较差,存在入睡过长、频繁觉醒、深睡眠及REM睡眠减少等睡眠问题。同时对自身睡眠状况的评价存在主、客观的不平衡,失眠症患者有过分估计自己失眠的特点。     

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。     

脑梗死和失眠症患者的多导睡眠图对照研究

为探讨脑梗死和失眠症患睡眠参数改变的生物学特点,对30例脑梗死和30例失眠症患及22名正常人,采用多导睡眠图进行通宵睡眠描记,对照分析相关睡眠参数。结果,脑梗死组和失眠症组均有睡眠潜伏期延长,夜间觉醒次数多,总睡眠时间减少,深睡眠和REM睡眠及REM活动度降低的特点（P＜0．05－0．01）,脑梗死组和失眠症组有关睡眠参数比较也具有差异性（P＜0．05－0．01）。提示,脑梗死组和失眠症组两睡眠参数皆有特征性改变,这些改变特点是脑梗死和失眠症睡眠障碍的病理生理学基础。     

神经衰弱多导睡眠图的研究

本文对22例神经衰弱和29例正常成人多导睡眠图的对照研究表明:神经衰弱患者睡眠潜伏期和记录总时间延长、觉醒时间次数增加、觉睡比值增大、睡眠效率和睡眠维持率下降、REM活动量、强度和密度均增高。这些改变是神经衰弱睡眠障碍的病理生理学基础。     

失眠症患者多导睡眠图的临床研究

目的:失眠症患者多导睡眠图(PSG)的临床分析。方法:应用PSG技术对92例失眠症患者(失眠症组)和83名正常对照者(NC组)进行PSG全夜监测;比较、分析两组睡眠进程指标：总记录时间(TRT)、睡眠潜伏期(SL)、醒起时间(EMAT)、醒觉时间(ATA)、运动觉醒时间(MAT)、醒觉次数(AT)、睡眠总时间(TSA)、觉睡比(A/TSA)、睡眠效率(SE)、睡眠维持率(SMT)、快速动眼睡眠(REM)测量值[REM的潜伏期(RL)、活动度(RA)、强度(RI)、密度(RD)、时间(RT)、周期数(NRP)]及睡眠结构[第1阶段睡眠(S1)、第2阶段睡眠(S2)、第3、4阶段睡眠(S3+S4)。结果:(1)睡眠进程：与NC组相比,失眠症组SL显著延迟,EMAT、ATA、MAT、AT和A/TSA显著增加,TSA、SE和SMT显著减少(P<0.05或P<0.01);(2)REM测量值：与NC组相比,失眠症组RL显著前移,RT显著减少(P均<0.01);(3)睡眠结构：与NC组相比,失眠症组S1显著增多,S2和S3+S4显著减少(P<0.05和P<0.01)。失...     

伴焦虑、抑郁短暂性脑缺血发作患者多导睡眠图分析

目的探讨伴焦虑、抑郁短暂性脑缺血发作(TIA)患者多导睡眠图的特点。方法本研究对56例TIA患者进行临床评估、量表测评和多导睡眠图(PSG)检查,其中伴焦虑和(或)抑郁症状者33例(A组),不伴有焦虑、抑郁症状者(B组)23例。结果匹兹堡睡眠质量指数(PSQI)显示A组PSQI总分高于B组,差异有统计学意义(P0.05)。多导睡眠仪(PSG)显示A组较B组觉醒时间延长,非快速眼动(NREM)期N1、N2期睡眠时间延长,N3期睡眠时间明显缩短,差异有统计学意义(P0.05)。结论伴焦虑、抑郁症状TIA患者觉醒时间延长,NREM期N1、N2期睡眠时间延长,N3期睡眠时间明显缩短。     

23例精神分裂症患者的多导睡眠图比较研究

目的:探讨以阳性症状为主和以阴性症状为主的精神分裂症的多导睡眠图(PSG)模式,并观察利培酮对精神分裂症PSG的影响.方法:对15例以阳性症状为主和8例以阴性症状为主的精神分裂症患者进行2次的PSG检查,给其中10例服用利培酮治疗6周,观察用药后PSG的变化,结果:精神分裂症患者存在睡眠进程紊乱以及睡眠阶段3,4比例下降,以阳性症状为主的精神分裂症患者和以阴性闰状为主的精神分裂症患者相比,前者有更低的睡眠阶段2比例,用利培酮治疗后,睡眠进程指标改善,睡眠阶段2的时间和比例增加,REM睡眠潜伏期增加,REM强度减少.结论:以阳性症状为主的精神分裂症患者有更低的睡眠阶段2比例可能与该组患者的高警觉性有关.睡眠阶段3,4缺陷可能是一个素质标记,而部分患者REM睡眠指标异常可能是一个状态标记.     

佐匹克隆与阿普唑仑治疗伴睡眠障碍老年期痴呆患者的多导睡眠图观察

目的:观察佐匹克隆与阿普唑仑对照治疗伴睡眠障碍的老年期痴呆患者的临床疗效与不良反应。方法:将72例老年期痴呆睡眠障碍的患者以随机数字表法分为2组,研究组39例,每晚睡前15 min口服佐匹克隆片7.5 mg/d;对照组33例,每晚睡前15 min口服阿普唑仑片0.4 mg/d,两组疗程均为3周;采用多导睡眠图评价疗效,不良反应量表(TESS)评价不良反应。结果:研究组与对照组治疗后各睡眠参数较治疗前均有好转(P0.01);两组间比较差异无统计学意义(P0.05)。治疗过程中佐匹克隆组除口腔苦味感外的不良反应发生率(20.51%)低于对照组(60.61%,χ2=11.39,P0.01),佐匹克隆组口腔苦味感发生率(100%)高于阿普唑伦组(3.03%,P0.01)。结论:佐匹克隆与阿普唑仑能够缩短伴睡眠障碍的老年期痴呆患者入睡时间,提高睡眠的质量,疗效相当。但佐匹克隆除口腔苦味感明显外,其他不良反应较少。     

脑卒中后抑郁状态的多导睡眠图研究

目的：探讨脑卒中后抑郁状态患者的睡眠图异常改变及与抑郁症之间的差异。方法：采用多导睡眠图对62例脑卒中和30例抑郁症患者进行整夜睡眠描记，并与对照组比较。结果：卒中后抑郁组与对照组和非抑郁组比较多项睡眠指标均有显著性差异（P＜0．05－01）；卒中后抑郁组的REM睡眠时间和密度明显低于抑郁症组，差异有显著性（P＜0．01），结论：卒中后抑郁状态病人除具有睡眠障碍在多导睡眠图改变外，REM睡眠时间和密度是一个较为特征性的改变。卒中后抑郁状态的发生可能与脑内5－TH递质改变有关。     

慢性疲劳综合征的睡眠脑电图研究

目的 探讨慢性疲劳综合征患者在睡眠状态下脑电生理活动的变化.方法 应用日本Nihon Kohden公司的Neurofax-1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图技术,对25例慢性疲劳综合征患者和33名正常对照者进行多导睡眠图(PSG)整夜监测.结果 与正常对照组比较,慢性疲劳综合征组总记录时间延长[(488.7±21.7)分对(515.9±31.7)分,P＜0.05],睡眠潜伏期延长[(19.9±9.8)分对(40.1±11.7)分,P＜0.01],第1阶段睡眠增加[(9.1±1.9)%对(14.9±7.9)%,P＜0.01],第2阶段睡眠减少[(56.2±4.7)%对(48.8±18.7)%,P＜0.05],以及与神经症相似的REM结果(REM潜伏期前移,REM活动量、强度和密度)均增加.结论 慢性疲劳综合征组的睡眠结构紊乱类似于神经症.     

失眠症的整夜多导睡眠图监测

目的探索建立失眠症的多导睡眠图(PSG)模式.方法应用日本Nihon Kohden公司的Neurofax-1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图技术,对39例失眠症患者和33名正常对照者进行PSG全夜监测.结果与正常组相比,失眠症组的PSG表现为睡眠总时间减少(正常组464.1±22.9分,失眠症组359.7±31.5分,P＜0.01),睡眠潜伏期延迟(正常组19.9±9.8分,失眠症组31.5±18.4分,P＜0.01),醒觉次数多(正常组1.4±0.7次,失眠症组4.9±2.1次,P＜0.01),睡眠效率低(正常组94.6±5.1%,失眠症组84.7±8.3%,P＜0.01),第一阶段睡眠增加(正常组9.1±1.9%,失眠症组27.9±17.9%,P＜0.01),第二阶段睡眠下降(正常组56.2±4.7%,失眠症组45.9±17.7%,P＜0.01),第3,4阶段睡眠降低(正常组16.7±4.9%,失眠症组9.1±5.1%,P＜0.01),REM睡眠潜伏期缩短(正常组87.8±11.7分,失眠症组53.8±19.7分,P＜0.01).此外,失眠症组有8例(N=8/39,20.5%)的睡眠潜伏期和睡眠效率综合分析正常,但患者主诉"无睡眠感",有"主观性失眠"存在.结论失眠症患者PSG存在睡眠进程、睡眠结构和REM值的变化.睡眠潜伏期延迟和慢波睡眠S1增加具有更高的临床价值.本组研究还发现失眠症患者中有一部分对象可能属于"主观性失眠".     

焦虑症患者的全夜Quisi实验研究

目的 探讨建立焦虑症(AN)的Quisi模式.方法 应用德国Quisi仪对24例AN患者的Quisi进行全夜监测,并与33名正常受试者(NC)对照.结果 与正常对照组比较,AN组Quisi主要有REM睡眠潜伏期前移(P＜0.01),醒觉时间增加(P＜0.01),睡眠潜伏期延迟(P＜0.01),睡眠效率下降(P＜0.05),第1阶段睡眠百分比增高(P＜0.01),第2阶段睡眠百分比降低(P＜0.05).结论 在缺乏相关设备的基层医院,Quisi技术可用于对焦虑症的检测.焦虑症患者Quisi的睡眠脑电特点有待进一步随访.     

Polysomnography in patients with intracranial tumors before and after operation

OBJECTIVE : To evaluate the breathing and sleep patterns in patients with brain tumors before and after operation, and assess their relation to the location and size of the tumor, as well as to the post-operative outcome. METHODS : Polysomnographic studies were performed in 11 patients with intracranial tumors (nine supra- and two infratentorial) before and after surgery. RESULTS : Pre-operatively, the mean apnea-hypopnea index (AHI) was 23.3. Six patients demonstrated signs of obstructive sleep apnea (SA) and one had mixed obstructive and central type SA. After operation, the mean AHI decreased to 8.1(P < 0.05). The duration of random eye movement sleep stage increased after tumor removal (P < 0.04). No relation was found between the characteristics of the tumor, nor the post-operative outcome and SA. CONCLUSIONS : Patients with brain tumors often suffer from SA and this can further worsen their symptoms related to increased intracranial pressure. Removal of the tumor results in a substantial decrease in sleep-related disturbances and may thus play a role in clinical recovery.     

Sleep Perception in Obstructive Sleep Apnea: A Study Using Polysomnography and the Multiple Sleep Latency Test

MethodsWe recruited patients who visited our sleep clinic for the evaluation of their snoring and/or observed OSA. Participants completed a structured questionnaire and underwent overnight polysomnography. On the following day, five sessions of the multiple sleep latency test (MSLT) were applied. We divided the patients into two groups: normal sleep perception and abnormal perception. The abnormal-perception group included patients whose perceived total sleep time was less than 80% of that measured in polysomnography.ResultsFifty OSA patients were enrolled from a university hospital sleep clinic. Excessive daytime sleepiness, periodic limb movement index (PLMI), and the presence of dreaming were positively associated with poor sleep perception. REM sleep near the sleep termination exerted important effects. Respiratory disturbance parameters were not related to sleep perception. There was a prolongation in the sleep latency in the first session of the MSLT and we suspected that a delayed sleep phase occurred in poor-sleep perceivers.ConclusionsAs an objectively good sleep does not match the subjective good-sleep perception in OSA, physicians should keep in mind that OSA patients who perceive that they have slept well does not mean that their OSA is less severe.     

Polysomnography in patients with post‐traumatic stress disorder

Aims: The purpose of the present study was to investigate sleep structure in post‐traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. Methods: Sleep patterns of 24 non‐medicated male PTSD patients and 16 age‐ and sex‐matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD‐only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. Results: Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. Conclusions: PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD.     

Serial macro-architectural alterations with levodopa in Parkinson's disease: Polysomnography (PSG)-based analysis

Purpose:

We studied the sleep macroarchitecture with polysomnography (PSG) in drug naïve patients with Parkinson''s disease (PD) and reassessed them following treatment with levodopa.

Materials and Methods:

This prospective hospital-based study included 15 patients with PD (age: 59 ± 11.2 years, duration of PD: 11.8 ± 12.3 months; and male: female (M:F) = 11:4). They were assessed for demography, phenotype, modified Hoehn and Yahr staging (H & Y); Schwab and England and Activities of Daily Living (S and E ADL) Scale; and Unified PDRating Scale (UPDRS). Sleep was assessed using Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and National Institute of Mental Health and Neurosciences (NIMHANS) comprehensive sleep disorder questionnaire. They underwent overnight PSG at baseline and after13.3 ± 5.7 months of levodopa (440 mg/day).

Results:

Patients with PD had responded to levodopa as indicated by the significant improvement in UPDRS motor score in ON state compared to OFF state. Nocturnal sleep quality indices did not vary significantly, but the excessive daytime somnolence improved (P = 0.04) with levodopa. Sleep efficiency (P = 0.65), latency to sleep onset (P = 0.19), latency to stage 1 (P = 0.12), and duration of stage 1 (P = 0.55) had increased. Duration of ‘awake in bed’ (P = 0.24), slow wave sleep (P = 0.29), and rapid eye movement (REM) sleep (P = 0.24) decreased with treatment. Periodic leg movements (PLMs) had reduced (P = 0.68) and mean oxygen saturation during sleep improved (P = 0.002). Surprisingly, snore index (P < 0.03) during sleep had increased with levodopa.

Conclusions:

Sleep alterations in PD occur even in early stages due to the disease process. There was improvement in most of the parameters of sleep macroarchitecture with levodopa.     

Assessment of State and Trait Anxiety in Subjects with Anxiety and Depressive Disorders

The State-Trait Anxiety Inventory (STAI) is one of the most widely used scales for the evaluation of anxiety in medical and, to a lesser extent, psychiatric patients. Although there is a relatively large amount of STAI data about anxiety for individuals with a variety of psychiatric disorders, the results of many anxiety studies include only state or trait and many studies have been influenced by comorbidity and by variations in diagnostic criteria used. We studied state and trait anxiety and compared the revised form of the STAI (Form Y) with the original (Form X) to evaluate the anticipated improvement in the measure. In addition, we compared the STAI results with those of another self-report measure (the Symptom Checklist–90 anxiety and depression scales) and also with interviewer-rated measures of anxiety (Hamilton Rating Scale for Anxiety) and depression (Hamilton Rating Scale for Depression). Results indicate that the STAI does not clearly differentiate anxiety disorders from depressive disorders and support the use of multiple tests and of both self-report and interviewer ratings in the evaluation of anxiety and depression in psychiatric patients.     

Polysomnography and body temperature changes by phototherapy in a delayed sleep phase syndrome case

Abstract We examined polysomnography (PSG) and body temperature in a patient with delayed sleep phase syndrome who responded to phototherapy. The patient was a 31-year-old woman whose condition had slightly improved by a vitamin B₁₂ administration. Phototherapy was administered to her in combination with the vitamin B₁₂ medication, and this combined treatment successfully advanced her delayed sleep phase. On PSG, the regimen showed shortened sleep latency, decreased total sleep time and stages 1 and 2 sleep, and increased slow wave sleep. Phototherapy also improved temporal distribution of delta half-waves (0.5-2.0 Hz, 31 µV) as well as phase relationship between sleep and body temperature.