多项睡眠图联合长程视频脑电图观察82例癫痫患者睡眠结构的变化

目的：探讨癫痫患者睡眠痢性放电对睡眠结构的影响。方法：对确诊为癫痫的成人患者82例进行多项睡眠图（PSG）检查,同步行长程视频脑电图（V－EEG）监测,分析患者的睡眠结构、EEG痫性波情况。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,其中8例患者无REM睡眠,所有患者夜间觉醒次数均增多。睡眠中痫性放电对NREMI期、Ⅲ－Ⅳ期睡眠的影响显著,在有痫性放电者的NREMI期睡眠明显增多,NREMⅢ－Ⅳ期睡眠明显减少。结论：癫痫患者存在睡眠结构紊乱,睡眠中出现痫性放电的患者睡眠结构的紊乱更严重。采用PSG联合长程V－EEG同步监测有利于更全面分析睡眠结构与痫性放电之间的关系。     

儿童癫痫发作与睡眠觉醒周期的关系

目的：研究儿童癫痫发作与睡眠觉醒周期的关系。方法：经同步录像脑电图（V—EEG）监测,对142例儿童癫痫发作期的临床表现与V-EEG进行同步分析。结果：142例患儿中94例（66．2％）患儿的发作与睡眠觉醒周期相关。此94例患儿的154次发作中,思睡期36次（23．4％）,睡眠I-Ⅱ期64次（41．6％）,睡眠Ⅲ-Ⅳ期10次（6．5％）,REM期1次（0．6％）,觉醒后43次（27．9％）;发作类型中,部分性发作或伴泛化全面性发作81次（52．6％）,痉挛发作27次（17．5％）,肌阵挛25次（16．2％）,强直发作11次（7．1％）,失神发作7次（4．6％）,强直阵挛发作3次（2．0％）。结论：儿童癫痫发作与睡眠觉醒周期密切相关,了解发作与睡眠觉醒周期的关系,既有助于更好地管理和治疗癫痫患儿,又有助于合理安排EEG检查的方式和时机,提高检查阳性率,确定发作类型。     

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。     

卒中后抑郁患者的多项睡眠图研究

目的：探讨多项睡眠图（PSG）各项指标对卒中后抑郁（PSD）患者的诊断价值。方法：卒中后抑郁组（PSD组）和卒中后无抑郁组（对照组）以年龄1：1配对,用PSG仪对两组各59例患者进行整夜睡眠描记并对结果进行分析。结果：睡眠进程：PSD组睡眠潜伏期延长,觉醒时间增多,睡眠总时间减少,睡眠效率下降,睡眠维持率下降,两组比较差异有统计学意义;非快速眼动睡眠（NREM）：PSI）组S1增多,S2减少,但S3＋S4两组比较差异无显著意义;快速眼动睡眠（REM）：PSD组REM潜伏期缩短,REM时间减少,REM周期数减少。结论：PSI）患者存在PSG指标变化,PSG对PSD的诊断和鉴别诊断有临床价值。     

中风后抑郁患者的多道睡眠图研究

目的：探讨多道睡眠图（PSG）指标对中风后抑郁（PSD）的诊断价值。方法：30例研究对象分为3组进行多道睡眠图（PSG）检查并分析其结果：病例组为10例PSD患者，根据DSM-IV诊断标准确诊；对照组为10例中风后抑郁的患者；正常组为年龄、性别匹配的健康者。结果：与对照组、正常组比较，病例组睡眠结构发生明显变化，表现为睡眠潜伏期缩短，RSM-NREM周期次数增加；RER潜伏期缩短；REM活动度、强度、密度增加；S1阶段睡眠增加，S2和S3 4阶段睡眠减少。总睡眠时间、慢波睡眠时间比正常组少，但与对照组之间无差异。三组之间觉醒时间及睡眠效率无明显差异。结论：PSD患者存在PSG指标变化，这些改变可能有助于PSD的诊断参考。     

血浆儿茶酚胺水平联合脑电图在儿童睡眠障碍评估中的应用价值分析

目的 探讨血浆儿茶酚胺（CA）水平联合脑电图在儿童睡眠障碍评估中的应用价值。方法 选择2017年8月至2021年12月南方医科大学附属小榄医院儿科收治的80例睡眠障碍患儿为研究对象,另选取80例健康儿童作为对照。收集纳入对象临床资料,观察并对比两组血浆CA水平及脑电图参数差异,利用受试者操作特征（ROC）曲线分析CA及脑电图参数对儿童睡眠障碍的诊断价值。采用LASSO及Logistic回归探讨影响儿童睡眠的相关因素,并采用R语言构建列线图预测模型。结果 与无睡眠障碍组儿童比较,睡眠障碍组患儿肾上腺素（E）、多巴胺（DA）、去甲肾上腺素水平（NE）均显著增加（P<0.05）;睡眠总时间、S1期、S2期、S3期、S4期、REM及睡眠效率显著降低（P<0.05）,而睡眠潜伏期、觉醒时间、觉醒次数则显著增加（P<0.05）。CA、脑电图均对儿童睡眠障碍具有一定的诊断价值（AUC>0.7）,且二者联合诊断价值更高。NE、E、DA、睡眠潜伏期、觉醒时间、觉醒次数为儿童发生睡眠障碍的独立危险因素,S3期为保护因素,基于以上因素构建的列线图预测模型具有良好的准确性和临床有效性。...     

注意缺陷多动障碍综合征患儿睡眠结构的初探

目的 探讨注意缺陷多动障碍（ADHD）综合征患儿的睡眠结构，睡眠中痢性放电及睡眠周期性肢体运动（PLMS）的情况；比较ADHD各亚型问睡眠结构的差异。方法 利用多导睡眠监护仪对2005年6月至2006年11月在首都儿科研究所神经科门诊就诊的符合DSM-Ⅳ诊断标准的58例ADHD患儿及30名正常儿童进行整夜睡眠结构监测。结果 ADHD组58例，其中4例睡眠监测未完成，实际完成54例。ADHD组中混合型（ADHD—C）31例（57．4％，31／54），注意缺陷型（ADHD-I）15例（27．8％，15／54），多动／冲动型（ADHD．H）8例（14．8％，8／54）。①与对照组比较，ADHD组快速动眼期（REM）潜伏期短、睡眠潜伏期延长和睡眠效率降低，差异有统计学意义（P〈0．05）；②ADHD-C患儿睡眠Ⅱ期百分比较ADHD-I增加，差异有统计学意义（P〈0．05）；③ADHD组PLMS发生率为37．0％（20／54），对照组PLMS发生率为13．3％（4／30），差异有统计学意义（P〈0．05）；④ADHD组和对照组EEG未见痢性放电。结论 ①ADHD患儿存在REM睡眠结构的改变、入睡困难及睡眠效率降低；②睡眠Ⅱ期百分比的增多可使ADHD-C较ADHD-I有更多和更重的症状；③ADHD患儿睡眠过程中PLMS发生率较对照组显著升高，PLMS也是导致ADHD患儿睡眠质量下降的原因之一。     

468例癫Xian患者睡眠期Xian样放电与睡眠结构变化分析

目的：观察癫Xian患者的睡眠时相与Xian样放电的关系，并初步探讨癫Xian异常脑波活动对睡眠的影响。方法：对468例癫Xian患者进行24小时动态脑电图(AEEG）监测，观察发作间期清醒与睡眠脑电图Xian样放电的发作频率，分析58例癫Xian患者及对照组睡眠脑电图中睡眠时程、觉醒次数、睡眠纺缍波的变化。结果：468例患者中出现Xian样放电362例，睡眠期Xian样放电检出率88％，觉醒期检出率58％。Xian样放电主要出现于NREM睡眠Ⅰ-Ⅱ期。与对照组比较，癫Xian组NREMⅠ-Ⅱ睡眠期延长，NREMⅢ-Ⅳ期缩短；觉醒次数增加，觉醒次数与Xian样放电频率呈正相关；并有睡眠纺锤波减少及不对称。结论：癫Xian患者的Xian样放电主要出现于NREM睡眠Ⅰ-Ⅱ期，癫Xian活动对睡眠有一定影响，癫Xian患者睡眠质量下降。     

阿尔茨海默病患者的多导睡眠图研究

目的：探讨阿尔茨海默病患者（Alzheimer diseased．AD）睡眠参数改变的生物学特点。方法：应用多道睡眠图对35例阿尔茨海默病患者进行睡眠描记，分析相关睡眠参数，并与30例正常人比较。结果：阿尔茨海默病患者潜伏期延长（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％）、快眼动（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：阿尔茨海默病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。     

78例睡眠呼吸暂停综合征患者的睡眠特征及其与夜间低氧血症的关系

目的 :了解SAS患者的睡眠特征及其与夜间低氧血症的关系。方法 :采用PSG对 78例SAS患者和 30例正常对照者进行整夜睡眠监测 ,比较两组间的睡眠特征。并对不同严重程度的夜间低氧血症SAS患者进行睡眠变量比较 ,分析二者的关系。结果 :与正常对照者相比 ,SAS患者夜间睡眠结构紊乱 ,主要为深睡眠减少、浅睡眠相对增加、REM睡眠减少、觉醒增加、睡眠潜伏期缩短、呼吸暂停或低通气次数增加、动脉血氧饱和显著下降 (P <0 .0 5 )。SAS患者夜间最低血氧饱和度与夜间总睡眠时间、睡眠效率、NREM睡眠时间及呼吸紊乱指数呈显著负相关 (r>0 .3,P <0 .0 5 ) ,与觉醒比例呈显著正相关 (r >0 .5 ,P <0 .0 1)。结论 :SAS患者睡眠结构紊乱突出 ,夜间反复发作的低氧血症对睡眠质量产生较大影响。     

成人原发性癫痫患者63例睡眠结构分析

目的：了解癫痫患者睡眠结构及夜间激醒、腿动、呼吸事件特点。方法：对63例成人原发性癫痫患者（病例组）及40名正常人（对照组）的夜间多项睡眠图（PSG）结果进行分析。结果：两组入睡潜伏期、REM潜伏期、睡眠维持率、睡眠效率、浅睡期比例、深睡期比例、REM期比例和清醒期比例、分别为（87．64±27．94）minVS（150．33±82．26）min（P〈0．05）、（13．11±5．23）minVS（17．34±19．26）min（P〉0．05）、（0．58±0．09）VS（0．70±0．50）（P〈0．05）、（0．22±0．07）VS（0．16±0．35）（P〈0．05）、（0．20±0．05）VS（0．14±0．38）（P〈0．05）、（0．08±0．07）VS（0．17±0．90）（P〈0．05）、（0．91±0．07）VS（0．89±0．07）（P〈0．05）和（0．96±0．03）VS（0．81±0．16）（P〈0．05）。两组夜间激醒指数、在NREM期激醒指数、孤立性腿动指数、在REM期及NREM期孤立性腿动指数、呼吸暂停指数、低通气指数、呼吸暂停低通气指数比较P值均〈0．05,差异有统计学意义。结论：成人原发性癫痫患者存在夜间睡眠结构紊乱、睡眠质量较差和睡眠呼吸障碍。     

睡眠剥夺对健康成人睡眠脑电图的变化观察

目的：探索睡眠剥夺对健康成人睡眠脑电图（PSG）的影响.方法：选择34名健康成人志愿者行睡眠剥夺36h,作睡眠剥夺前后的PSG整夜监测.结果：与睡眠剥夺前相比,健康成人PSG表现为睡眠潜伏期缩短（P＜0.05）,NREM中的第1阶段睡眠减少（P＜0.05）,第4阶段（S4）睡眠增多（P＜0.01）.结论：睡眠剥夺后再睡眠,健康成人通过其NREM睡眠阶段中S4的比例作为“补偿”.睡眠剥夺可影响健康成人的脑电生理活动.     

Relationship of epileptic seizures to sleep stage and sleep depth

STUDY OBJECTIVES: Interictal epileptiform discharges (IEDs) are facilitated by NREM stages 3 and 4 sleep and as sleep is deepening. To determine whether sleep influences seizures in a similar way to IEDs, we examined seizure rates in various stages of sleep in epilepsy patients undergoing overnight video-EEG-polysomnography (VPSG). DESIGN: Cross-sectional study. SETTING: Neurology Department. PATIENTS, MEASUREMENTS, AND INTERVENTIONS: We reviewed VPSGs from our Sleep and Epilepsy Laboratories to identify patients with recorded seizures during sleep. A total of 55 patients having 117 seizures were identified. RESULTS: Ninety-five percent of seizures occurred in NREM sleep (61% in stage 2, 20% in stage 1, 14% in stages 3 and 4 combined), and 5% in REM sleep. Adjusting for time spent in each stage of sleep, patients had 0.34 seizures per hour in stage 1, 0.38 seizures per hour in stage 2, 0.29 seizures/hr in stage 3 and 4 combined, and 0.09 seizures per hour in REM sleep. Seizures/hour was higher in NREM sleep (0.35 for NREM and 0.09 for REM; p=0.0001). For single seizures occurring in 1 night, seizure rate was significantly higher in NREM stages 1 and 2 as compared to NREM stages 3 and 4 sleep. A significant increase in log delta power, an automated measure of sleep depth, was observed in the 10 minutes prior to seizures. CONCLUSIONS: Both seizures and IEDs are facilitated by NREM sleep. While deeper stages of NREM sleep activate IEDs, lighter stages of NREM sleep promote seizures, at least for single seizures occurring in 1 night.     

Respiratory and body movements as indicators of sleep stage and wakefulness in infants and young children

Conventional polysomnographic (PSG) sleep staging to sleep staging based on a static-charge-sensitive bed (SCSB) recording in infants and young children was compared. The study consisted of whole-night clinical sleep studies in 22 children at 24 weeks (SD 24, range 1–79 weeks) of age. Most of the children presented with respiratory disturbances during sleep. From the SCSB record, sleep stages were differentiated according to regularity of breathing, presence of body movements, and most important, presence of high-frequency components of breathing (SCSB spikes). With both methods, three sleep/wake stages were distinguished: rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep and wakefulness. The average inter-scorer reliability of the PSG sleep staging controlled in nine subjects was 88%. The average concordance between the two methods ranged from 82 to 85%, depending on the criteria used for scoring the SCSB. The mean sensitivity of the SCSB to detect NREM sleep ranged from 77 to 90% and the mean sensitivity to detect REM sleep ranged from 61 to 86%. The mean positive predictive value was 89–96% for NREM sleep and 54–67% for REM sleep. In conclusion, REM sleep is characterized by irregular breathing with superimposed fast respiratory movements. These changes are specific enough to allow distinction between episodes of NREM sleep, REM sleep and wakefulness with the non-invasive SCSB method in infants and young children. Incomplete concordance between PSG and SCSB score was most frequently observed during sleep stage transition periods, where the behavioural state and electrophysiological criteria disagreed. When combined with the PSG, the SCSB provides complementary information about the behavioural state of child.     

Word recall correlates with sleep cycles in elderly subjects

Morning recall of words presented before sleep was studied in relation to intervening night sleep measures in elderly subjects. Night sleep of 30 elderly subjects aged 61-75 years was recorded. Before sleep, subjects were presented with a list of paired non-related words and cued recall was asked immediately after the morning awakening. Recall positively correlated with average duration of NREM/REM cycles, and with the proportion of time spent in cycles (TCT) over total sleep time (TST). No significant correlations were found with other sleep or wake measures. These results suggest the importance of sleep structure for sleep-related memory processes in elderly adults.     

The effects of sleep stages and time of night on NREM sleep ERPs.

Event-related potential (ERP) is one of the best techniques for studying information processing during sleep because it does not require behavioral responses or consciousness awareness. Several ERP components have been identified during non-rapid eye movement (NREM) sleep, but the associated underlying processes of these waveforms remain unclear. The present study examines the effect of sleep stage and time of night on the NREM ERPs to further understand these processes. An oddball paradigm was conducted in 11 healthy subjects to elicit ERPs throughout the night. Polysomnographic recordings were also applied to identify sleep stages. The results showed that P220, N350, and P900 decreased during the second half of the night, when the NREM sleep drive is partially satiated. This finding is consistent with the notion that the NREM ERPs reflect an inhibitory process associated with sleep drive. P220 and P900 were also found to increase as subjects entering deep sleep. However, the N350 was not affected by the deepening of sleep and peaked earlier during stage 1 sleep. Although these components are all related to the process for sleep preservation, the N350 may be more associated with sleep-wake transition and the P220 and P900 with the process of deepening of sleep.     

Thinking and hallucinating: reciprocal changes in sleep

Internal deliberations (focused thoughts) and endogenous percepts (hallucinations) vary in a reciprocal manner across the states of waking and sleep, paralleling changes in regional brain activation. As subjects go from waking through sleep onset to NREM sleep and then to REM sleep, they report progressively more hallucinoid imagery and progressively less thinking. We have investigated whether this reciprocity in cognition between NREM and REM is maintained throughout the night. To do so, we analyzed 229 REM and 165 NREM reports collected with the Nightcap sleep monitoring system from 16 participants in their homes over 14 nights. The reports were scored for the presence of hallucinations and directed thinking by external judges. As predicted, hallucinations were more frequent in REM than in NREM for each segment of the night, and directed thinking was more frequent in NREM in the first 5 h of the night. Late in the night, directed thinking was equally infrequent in NREM and REM. At the same time, hallucinations increased within both NREM and REM as the night progressed, whereas directed thinking decreased in NREM and remained at a stable, low level in REM. These findings suggest that a reciprocal shift in focused thinking and hallucinating is a general property of cognitive activity across the wake-sleep cycle. Biological evidence supports the hypothesis that these cognitive changes are governed by specific state regulatory and neurocognitive processes at several levels of the brain.