阻塞性睡眠呼吸暂停致日间过度嗜睡患者多导睡眠监测特点分析

目的：探索阻塞性睡眠呼吸暂停(OSA)引起日间过度嗜睡(EDS)患者的多导睡眠监测(PSG)特点。方法：选取2021年8月至2022年8月甘肃省人民医院睡眠医学中心门诊或住院的OSA引起日间过度嗜睡患者(ESS量表≥12分)42例,年龄、性别匹配的OSA不伴有嗜睡(ESS量表<12分)患者46例,探索OSA引起EDS患者的夜间睡眠特点。结果：OSA伴EDS组和OSA不伴EDS组比较,AHI、夜间ASpO₂、总睡眠时间、睡眠效率、N1期睡眠占比、N2期睡眠占比差异均无统计学意义(均P>0.05)。夜间LSpO₂、睡眠潜伏时间、觉醒指数、N3期睡眠比、R期睡眠比占比差异均有统计学意义(均P<0.05)。结论：OSA伴EDS患者表现出不同于OSA不伴EDS患者的PSG特点,其夜间缺氧更严重、觉醒次数更多、深睡眠比例更低。     

阿尔茨海默病患者睡眠障碍的临床研究

目的:评价阿尔茨海默病(AD)患者睡眠质量,研究AD患者睡眠障碍的临床特征.方法:采用匹兹堡睡眠质量指数量表(PQSI)、爱泼沃斯思睡量表(ESS)和睡眠日志对138例AD患者和138例正常老人的睡眠状况及临床特征进行评估.结果:AD组PQSI各因子评分和ESS评分高于对照组,两组比较差异有统计学意义(P<0.01).AD组睡眠障碍患病率(73.91%)显著高于对照组(28.26%),两组比较差异有统计学意义(P<0.01).AD患者睡眠障碍的主要临床特征有日落激越(28.26%)、睡眠-觉醒节律紊乱(42.03%)、日间过度思睡(EDS)(55.07%)、夜间躁动或游荡(45.65%)以及入睡困难(51.45%)、早醒(71.74%)、片断睡眠(73.19%)、不宁腿综合征(RLS)(15.22%)、睡眠周期性肢体运动障碍(PLMS)(11.59%)以及阻塞性睡眠呼吸暂停综合征(0sAs)(10.87%)等;而对照组的主要表现为入睡困难(30.43%)、早醒(44.42%)、片断睡眠(49.28%)和EDS(21.0l%).结论:AD患者总体睡眠质量差,其睡眠障碍的主要临床特征是日落激越、睡眠-觉醒节律紊乱、日间过度思睡和夜间躁动.提示掌握AD患者睡眠障碍有利于开展针对性防治.     

观察睡眠护理对呼吸内科患者睡眠及生命质量的影响

目的:观察睡眠护理对呼吸内科患者睡眠及生命质量的影响.方法:选取2019年6月至2020年12月牡丹江医学院附属红旗医院收治的呼吸内科患者90例作为研究对象,按照随机数字表法分为观察组和对照组,每组45例.对照组患者给予常规护理,观察组患者给予睡眠护理,采用匹兹堡睡眠质量指数(PSQI)评分比较2组患者干预前后睡眠质量...     

睡眠与初发性脑出血发病关系的临床研究

目的:探讨睡眠状况与初发性脑出血的关系,同时探讨不同脑出血部位与睡眠的关系及影响因素。方法:选取2018年6月至2021年6月汕头市澄海区人民医院外一科收治的初发性脑出血患者60例作为观察组,选取同时期在汕头市澄海区人民医院体检中心体检的健康体检者60例作为对照组。采用匹兹堡睡眠质量指数(PSQI)评估2组研究对象近期的睡眠时间和睡眠质量,并利用无序多分类Logistic回归模型对不同部位脑出血、睡眠质量、睡眠时间以及其他影响因素之间的关系进行分析。结果:1)对照组睡眠质量明显优于观察组,差异有统计学意义(P <0.05); 2) 2组睡眠时间不足发生率比较,差异无统计学意义(P> 0.05),但观察组睡眠时间过长发生率明显多于对照组,差异有统计学意义(P <0.05); 3)不同部位脑出血患者睡眠时间比较,差异无统计学意义(P> 0.05),不同部位脑出血患者睡眠质量比较,差异有统计学意义(P <0.05); 4)睡眠质量差(PSQI> 5分)是丘脑出血的危险因素;高血压是小脑出血的危险因素,高脂血症是脑干出血的危险因素。结论:睡眠时间过长和睡眠质...     

以睡眠障碍为主要发作形式的癫痫15例

目的:探讨癫痫发作与睡眠障碍之间的关系。方法:对1999年6月至2005年6月间于我院门诊就诊的睡眠障碍患儿的脑电图、24h脑电地形图及头颅CT检查结果进行回顾性分析。结果:其中15例经脑电图或24h脑电地形图确诊为癫痫(局限性精神症状性发作或复杂部分性发作),经按癫痫治疗后睡眠障碍消失。结论:局限性(部分性发作)癫痫可阻止睡眠,而减少发作性放电则可恢复正常睡眠结构,并可以此防止对以睡眠障碍为主要或唯一表现的癫痫的漏诊,提高癫痫的诊断率。     

保护性睡眠护理对新生儿睡眠质量及疼痛程度的影响

目的:探讨保护性睡眠护理对新生儿睡眠质量及疼痛程度的影响。方法:选取2019年1月1日～2020年6月30日经阴道分娩的77例新生儿154例,采用分段随机法分为对照组和观察组各77例,两组均接受常规护理,观察组同时给予保护性睡眠护理。比较两组出生后3 d、30 d的身长、体重、神经行为[采用新生儿神经行为量表(NBNA)]、疼痛程度[采用新生儿疼痛评估量表(NIPS)]、睡眠时间及睡眠质量。结果:出生后30 d,观察组身长、体重优于对照组(P0.01);出生后30 d,观察组NBNA中行为能力、被动肌张力、原始反射、主动肌张力评分及总分均高于对照组(P0.01);出生后30 d,观察组NIPS评分、睡眠时间及睡眠质量优良率均优于对照组(P0.01,P0.05)。结论:保护性睡眠护理可有效延长新生儿的睡眠时间,改善其睡眠质量,并可减轻操作引起的疼痛,有利于新生儿神经行为的发育。     

米氮平对抑郁症伴睡眠障碍患者抑郁症状、PSQI评分及睡眠结构的影响

目的:探讨米氮平治疗抑郁症伴睡眠障碍的临床效果。方法:选取2018年1月至2019年6月阜宁县第三人民医院收治的抑郁症伴睡眠障碍患者80例作为研究对象,按照随机双盲法分为对照组和观察组,每组40例。对照组以艾司西酞普兰治疗,观察组以米氮平治疗,比较2组患者抑郁症状、睡眠质量及睡眠结构。结果:观察组治疗后汉密顿抑郁量表(HAMD)评分(6. 84±1. 21)分低于对照组的(8. 36±1. 75)分,兹堡睡眠质量指数量表(PSQI)评分(5. 21±0. 72)分低于对照组的(8. 46±1. 26)分,差异有统计学意义(P 0. 05)。观察组治疗后实际睡眠时间、睡眠效率高于对照组,睡眠潜伏期短于对照组,差异有统计学意义(P 0. 05)。结论:米氮平治疗抑郁症伴睡眠障碍具有明显效果,能够减轻患者抑郁症状,改善睡眠质量及睡眠结构,临床价值高,值得推广。     

心血管内科老年患者实施睡眠护理干预的效果

目的:对心血管内科老年患者实施睡眠护理干预的效果进行探讨。方法:选取2018年6月至2019年6月蚌埠市第一人民医院收治的心血管内科患者80例作为研究对象,采取随机数字表法随机分为对照组和观察组,每组40例,对照组采用常规护理,观察组采用睡眠护理干预。结果:2组患者在护理前其匹斯堡睡眠质量评分和生命质量评分差异均无统计学意义(P>0.05),护理后观察组评分情况均优于对照组(P<0.05)。结论:对于心血管内科老年患者实施睡眠护理干预有利于提高护理的质量,提高患者的睡眠质量以及生命质量,因此该方法值得积极推个和运用。     

个性化睡眠护理干预对重度失眠症患者的临床疗效

目的:观察个性化睡眠护理干预在重度失眠症患者中的应用效果。方法:选取2018年6月至2019年6月九峰中心卫生院收治的重度失眠症患者58例作为研究对象,按照随机数字表法随机会分为对照组与观察组,每组29例。对照组采用常规护理,观察组采用个性化睡眠护理,评估2组患者护理前后睡眠质量(PSQI)、生命质量(GQOL-74)。结果:在PSQI评分、GQOL评分方面护理前2组差异无统计学意义(P 0. 05),护理后观察组均较对照组好,差异有统计学意义(P 0. 05); 2组生命质量评分护理前无统计学意义(P 0. 05),护理后均有改善,但观察组更好,优于对照组(P 0. 05)。结论:个性化睡眠护理干预能够有效改善重度失眠症患者睡眠质量及生命质量,值得临床借鉴。     

睡眠质量与胸外微创手术患者术后康复效果的相关性研究

目的:探讨睡眠质量与胸外微创手术患者术后康复效果的相关性.方法:选取2019年6月至2020年6月谷城县人民医院收治的微创手术患者128例作为研究对象,采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表分别进行术前、术中、术后睡眠质量评分调查.结果:回收有效调查表122...     

发作性睡病5例临床特征分析

[目的]探讨发作性睡病的临床特征.[方法]对本院5例发作性睡病患者的临床资料进行回顾性分析.[结果]5例患者均无明显诱因及阳性家族史,均有白天过度嗜睡,其中3例伴猝倒,2例有入睡前幻觉.首发症状为白天过度嗜睡2例,猝倒伴白天过度嗜睡3例.实验室及影像学检查均无特殊改变.5例患者均进行整夜多导睡眠图（PSG）检查及多次小睡潜伏期试验（MSLT）检查.PSG结果显示睡眠潜伏期〈10 min,快速眼动睡眠（REM）潜伏期〈20 min.MSLT结果显示所有患者平均睡眠潜伏期〈5 min,其中3例出现2次或2次以上睡眠始发REM睡眠（SOREMPs）,2例未见SOREMPs,但平均REM潜伏期〈10 min.[结论]发作性睡病是慢性神经系统疾病,PSG及MSLT检查可以明确诊断,对患者应给予长期的药物治疗,心理治疗和健康教育,以提高患者的生活质量     

发作性睡病患者猝倒持续状态的临床特征与多导睡眠图表现

  目的  探讨发作性睡病患者猝倒持续状态的临床特征和多导睡眠图表现。  方法  2002年1月至2011年12月间在北京协和医院神经科就诊的115例发作性睡病患者中, 收集5例伴猝倒持续状态患者的病例资料。该5例患者年龄46~53岁, 平均49.1岁, 病程3~9个月, 均完成神经系统查体、头部磁共振检查、多次小睡潜伏期试验, 其中3例完成多导睡眠图检查。  结果  5例患者中, 首发症状为白天嗜睡4例, 猝倒1例。所有患者均因频繁猝倒就诊。其他症状包括:睡眠幻觉2例, 睡眠麻痹3例。多次小睡潜伏期试验平均睡眠潜伏期0.5~2.5 min。4例可见2次以上睡眠始发快速动眼睡眠, 1例可见1次。多导睡眠图可见猝倒发作时, 肌电活动明显抑制, 脑电图显示为清醒状态。5例患者均给予氯米帕明治疗, 猝倒症状消失。  结论  发作性睡病患者猝倒频繁发作, 可诊断猝倒持续状态, 其多导睡眠图表现支持猝倒发作是快速动眼睡眠的分离现象, 即肌电图显示肌张力明显降低, 而脑电图仍显示为清醒状态。     

A Retrospective Review of the Sleep Characteristics in Patients with Chronic Fatigue Syndrome and Fibromyalgia

This study characterizes findings on sleep testing and Human Leukocyte Antigen (HLA) markers in a group of patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS). One hundred eighteen patients seen in a general neurology practice over 5 years meeting standard clinical criteria for FM or CFS were analyzed retrospectively. Cases of untreated sleep apnea or restless legs syndrome were excluded prior to inclusion in this study. Ninety‐two patients had multiple sleep latency testing (MSLT). Seventy‐three (80%) were abnormal by standard criteria. Of 57 females having positive MSLTs, 22 (39%) had one or more periods of sleep onset rapid eye movement (SOREM), and 5 of 16 (31%) males with positive MSLTs had one or more SOREM. Highly fragmented sleep, as previously described in FM, was seen but not analyzed quantitatively. HLA DQB1*0602 was obtained in 74 patients, and positive in 32 (43%), P < 0.0001 compared with published values in 228 populations. In our patients, who presented with neuromuscular fatigue or generalized pain, we found a sleep disorder characterized by objective hypersomnia. Some patients had characteristics of narcolepsy. Objective assessment by sleep studies can assist the diagnostic process, aid future research, and provide rationale for treatment.     

Excessive Daytime Sleepiness: A Clinical Review

Excessive daytime sleepiness (EDS) is a highly prevalent condition that is associated with significant morbidity. The causes of EDS are varied, and include inadequate sleep, sleep disordered breathing, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome). Additionally, EDS could represent a symptom of an underlying medical or psychiatric disorder. Assessment of EDS includes a thorough sleep, medical, and psychiatric history, targeted clinical examination, and appropriate use of actigraphy to measure sleep duration and sleep-wake patterns, polysomnography to assess for associated conditions such as sleep-related breathing disorders or other factors that might disrupt nighttime sleep, multiple sleep latency testing to ascertain objective sleepiness and diagnose central disorders of hypersomnolence, and measurement of cerebrospinal fluid hypocretin-1 concentration. Treatment of EDS secondary to central disorders of hypersomnolence is primarily pharmacologic with wakefulness-promoting agents such as modafinil, stimulants such as methylphenidate and amphetamines, and newer agents specifically designed to improve wakefulness; behavioral interventions can provide a useful adjunct to pharmacologic treatment. When excessive sleepiness is secondary to other conditions, the treatment should focus on targeting the primary disorder. This review discusses current epidemiology, provides guidance on clinical assessments and testing, and discusses the latest treatment options. For this review, we collated the latest evidence using the search terms excessive sleepiness, hypersomnia, hypersomnolence, treatment from PubMed and MEDLINE and the latest practice parameters from the American Academy of Sleep Medicine.     

Cerebral perfusion abnormality in narcolepsy with cataplexy

To investigate abnormal cerebral perfusion in narcoleptics with cataplexy, 25 narcoleptics with cataplexy and 25 normal controls were enrolled in this study. Cerebral perfusion was measured by brain single photon emission computed tomography (SPECT) using 99mTc-ethylcysteinate dimer. Patients and normal controls had not received any medication prior to the SPECT scan. Differences in cerebral perfusion between narcoleptics and normal controls were subjected to statistical parametric mapping (SPM) analysis. Overnight polysomnography and multiple sleep latency test (MSLT) were performed in all patients. Brain SPECT was carried out on all patients and normal controls during the waking state. Clinical symptoms and MSLT results of all patients are in accord with the International Classification of Sleep Disorders criteria for narcolepsy. MSLT showed a short mean sleep latency (1.69 +/- 1.0 min) and 2-5 sleep onset REM periods in individual patient. SPM analysis of brain SPECT showed hypoperfusion of the bilateral anterior hypothalami, caudate nuclei, and pulvinar nuclei of thalami, parts of the dorsolateral/ventromedial prefrontal cortices, parahippocampal gyri, and cingulate gyri in narcoleptics [P < 0.05 by Student's t test with false discovery rate (FDR) correction]. Significant hypoperfusion in the white matter of frontal and parietal lobes was also noted in narcoleptics. This study shows reduced cerebral perfusion in subcortical structures and cortical areas in narcoleptics. The distribution of abnormal cerebral perfusion is concordant with the pathway of the cerebral hypocretin system and may explain the characteristic features of narcolepsy, i.e., cataplexy, emotional lability, and attention deficit.     

Sleep disorders associated with traumatic brain injury

OBJECTIVES: To investigate the frequency of sleep disorders in traumatic brain injury (TBI) patients with hypersomnia and to discern the relationship between posttraumatic sleep disorders and pretraumatic sleep symptoms. DESIGN: Prospective cohort study using the criterion standard to diagnose sleep disorders in a consecutive sample of TBI patients. SETTING: Academic medical center with level I trauma center, rehabilitative medicine services, and accredited sleep disorders center. PATIENTS: Ten TBI patients with subjective excessive sleepiness. INTERVENTION: Nocturnal polysomnography followed by Multiple Sleep Latency Test. Subjects who had overt sleep apnea on the first nocturnal polysomnography had a second nocturnal polysomnography with titration of nasal continuous positive airway pressure. MAIN OUTCOME MEASURES: Diagnosis of sleep-disordered breathing, narcolepsy, and posttraumatic hypersomnia. RESULTS: A diagnosis of treatable sleep disorder was made in all 10 subjects. Sleep-disordered breathing was found in 7 subjects: overt obstructive sleep apnea (OSA) was diagnosed in 5 subjects, rapid eye movement-related OSA in 1, and upper airway resistance syndrome (UARS) in 1. Narcolepsy was diagnosed in 2 subjects, and the diagnosis of posttraumatic hypersomnia was made in 1 subject. Three subjects had symptoms of hypersomnia before their injury (1 each with narcolepsy, OSA, UARS), and 2 of these were driving a car at the time of injury. CONCLUSION: Treatable sleep disorders appear to be common in the sleepy TBI population, but may be largely undiagnosed and untreated.     

抑郁症与不伴抑郁失眠症患者睡眠模式比较

目的 验证抑郁症和失眠症同源性假说。方法 采用多导睡眠图记录仪,记录并分析30例抑郁症患者和30例失眠症患者整夜的脑电图、眼电图、肌电图等。结果 抑郁症患者快动眼(REM)睡眠明显活跃,各项 REM指标均与失眠症患者有非常显著性差异( P <0.01);失眠症患者以睡眠持续性差、浅睡和觉醒增多以及深睡和REM睡眠明显受抑制为特征,不少患者的整个慢波睡眠(S3+S4)缺失。结论 抑郁症与不伴抑郁情绪的失眠症睡眠模式不同,抑郁症以 REM睡眠过度活跃为特征,而失眠症以非REM睡眠明显紊乱为主要特征。     

快眼动睡眠指标对抑郁障碍临床诊断的意义

目的探索快眼动(rapid eye movements,REM)睡眠的一些指标改变在抑郁障碍诊断中的意义.方法采用ICD-10作为临床诊断标准,以REM睡眠9项指标的改变作为判定抑郁障碍的电生理标准,分别对120例门诊和住院的精神疾病患者进行筛查,并通过计算Kappa值对两种诊断方式的一致性进行评估.结果120例患者中,通过临床诊断确诊抑郁障碍患者52例,以REM睡眠潜伏期缩短、REM活动度、REM强度、REM密度以及REM睡眠次数增加等改变甄别出的抑郁障碍患者59例,两种诊断方式具有较好的一致性(Kappa值为0.73,P＜0.05).结论REM睡眠上述指标的联合改变,对抑郁障碍的诊断有一定的意义,值得关注和进一步研究.     

The role of emotional brain processing during sleep in depression

ACCESSIBLE SUMMARY: ? Explores current research illuminating the physiological mechanisms contributing the relationship of sleep dysfunction and depression. ? Investigates the crucial role of sleep in the affective modulation of brain functioning. ? Describes the relationship between emotional brain processing during rapid eye movement and depression. ? Points to the use of multi-therapeutic approaches for treatment with emphasis on positive behavioural imagery therapies. ABSTRACT: This review synthesizes some of the most current investigative research to illuminate the physiological mechanisms contributing to the relationship between sleep dysfunction and depression. Major depression has consistently been linked to sleep abnormalities and insomnia is a robust risk factor in the initiating and development of depression. Recent neurobiological findings indicate the crucial role of sleep in the affective modulation of brain functioning. Studies have demonstrated that sleep in major depression is characterized by a reduction in slow wave sleep, interruptions in sleep continuity, longer periods of rapid eye movement (REM) sleep including a shortening of REM latency (i.e. the time between sleep onset and the occurrence of the first REM period), as well as an increase in REM density. The failure of sleep dependant emotional brain processing in REM sleep that seems to occur in depression, support the development and fostering of clinical depression. How depression likely interplays with these sleep processes points to the use of multi-therapeutic approaches for treatment with emphasis on positive behavioural imagery therapies.     

脑梗死恢复期患者的多道睡眠图评价

目的 探讨脑梗死恢复期患者睡眠参数改变的生物学特点。方法 应用多道睡眠图对36例脑梗死恢复期患者进行睡眠描记，分析相关睡眠参数，并与20例正常人比较。结果 脑梗死恢复期患者睡眠伏期延长（38.44min）、总睡眠时间减少（259.71min）、中途醒转次数增多(7.55次）、睡眠效率低（58.06%)、眼动（REM）睡眠潜伏期缩短（62.36min）、REM睡眠时间（32.42min）和REM活动度（67.91单位）减少（P＜0.05-0.01)。结论 脑梗死恢复期患者不但有睡眠量的减少，而且伴有睡眠质的改变，其中REM睡眠潜伏期、REM睡眠时间和REM活动度是评价脑功能恢复的客观指标。