内侧视前区微量注射NMDA对异丙酚睡眠作用的影响

目的 通过在内侧视前区(mPOA)微量注射NMDA,观察其对异丙酚睡眠作用的影响,探讨异丙酚睡眠作用机制。方法 SD大鼠42只,随机分为6组:NS组、2%二甲基亚砜(DMS0)组、异丙酚组、NMDA 10pmol组、NMDA 20pmol组、异丙酚+NMDA 20pmol组,记录并分析睡眠EEG变化。结果 微量注射异丙酚80 ng显著增加2 h内总睡眠时间,主要为延长非快动跟睡眠时期,缩短睡眠潜伏期。给予不同剂量NMDA时,2 h内总睡眠时间显著缩短,睡眠潜伏期延长。NMDA20pmol可拮抗异丙酚诱发的睡眠,主要缩短非快动眼睡眠时期,对快动眼睡眠无明显影响。结论 在mPOA微量注射NMDA可拮抗异丙酚的睡眠作用。     

Sleep quality of mechanically ventilated patients sedated with dexmedetomidine

Purpose

Dexmedetomidine is thought to activate an endogenous pathway that naturally promotes non-rapid eye movement (NREM) sleep. Dexmedetomidine may induce restorative sleep, that is, NREM stage 3 and 4 (slow wave sleep; SWS) or sleep continuity in mechanically ventilated patients. Few data have been published, however, on the sleep characteristics of mechanically ventilated patients during dexmedetomidine infusion.

Methods

We recorded polysomnography (PSG) for 24?h in mechanically ventilated patients sedated with dexmedetomidine. Dexmedetomidine (0.2–0.7 μg/kg/h) was administered intravenously to maintain the Richmond Agitation–Sedation Scale between ?1 and ?4 only during the nighttime (9:00 p.m. to 6:00 a.m.). During the daytime, we interrupted the sedatives and analgesics unless the patient complained of discomfort. When this occurred midazolam or opioids were administered intermittently. Sleep stages and the frequency of arousal/awakening during the nighttime were analyzed using Rechtschaffen and Kales criteria.

Results

For the ten mechanically ventilated adult patients recruited into the study, the median total sleep time (TST) during the night was 4.7?h (IQR, 4.2–8.1?h), and 78?% of sleep occurred during the night (median 78?%, IQR: 69–88?%). Sleep architecture was exclusively NREM sleep stage 1 (median 28.9?% of TST) and stage 2 (median 71.2?% of TST). Neither SWS (median 0?% of TST) nor rapid eye movement (REM) sleep (median 0?% of TST) was observed. Median frequency of arousals/awakenings was 9.3/h (IQR, 3–19.5/h).

Conclusions

In mechanically ventilated patients, nighttime infusion of dexmedetomidine preserved the day-night cycle of sleep but induced severely disturbed sleep architecture without evidence of SWS or REM sleep.     

腺样体肥大儿童睡眠特征分析及护理

目的研究腺样体肥大对儿童睡眠结构的影响,以便有针对性地指导护理。方法通过多导睡眠图分析47例腺样体肥大儿童睡眠结构,并与同龄组儿童睡眠结构正常值进行比较。结果腺样体肥大组的睡眠结构存在如下异常:与同龄组正常儿童相比,S1期、Delta期、NREM期所占比例增加,S2期、REM期所占比例减少;总醒觉时间,NREM醒觉次数明显高于REM醒觉次数;REM潜伏期比正常值延长约2倍,睡眠效率低于正常值。结论腺样体肥大主要引起睡眠结构紊乱、醒觉次数增加、REM睡眠剥夺睡眠片段、睡眠效率低,但Delta期睡眠时间增加。针对睡眠和围手术期的护理干预有助于该病患儿的康复。     

Episodic Cluster Headache: NREM Prevalence of Nocturnal Attacks. Time to Look Beyond Macrostructural Analysis?

(Headache 2010;50:1050‐1054) Background.— A high prevalence of nocturnal sleep‐related attacks is reported in patients with cluster headache (CH). Episodic CH is considered closely related to rapid eye movement (REM) sleep. Objective.— The aim of this study was to analyze the relationships between episodic CH attacks and sleep macrostructure. Methods.— Data were obtained by means of 24‐hour continuous ambulatory polysomnography (PSG) capturing CH attacks in 4 out of 7 episodic CH patients (all males; mean age 38.4 ± 9.2 years) studied. Results.— Eight CH attacks were captured during the PSG monitoring; 5 arose from sleep: 4 from non‐rapid eye movement (NREM) sleep (stage 2 NREM), and 1 from REM sleep. One patient experienced CH attacks during both NREM and REM sleep in the same night. Conclusions.— In the light of previous literature findings, the prevalence of NREM‐related episodic CH attacks observed, and the finding of attacks arising during both REM and NREM sleep in the same subject, suggest that the relationship between CH and sleep stages is heterogeneous, and the existence of a specific macrostructural pattern associated with episodic CH attacks appears to be uncertain. A more comprehensive approach taking into account the microstructure of NREM and REM sleep is expected to provide more in depth information about the pathophysiology of CH, whose complexity might overcome the simplistic dichotomy of REM/NREM staging.     

利用多导睡眠仪评估持续低流量吸氧对轻度阻塞性睡眠呼吸暂停低通气综合征的治疗

目的探讨持续低流量吸氧在治疗轻度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者时价值。方法60例轻度(AHI≤20)OSAHS患者接受持续低流量吸氧治疗,观察治疗前和治疗时多导睡眠仪(PSG)参数变化。治疗效果主要表现睡眠效率(SE),觉醒次数(WASO),I期+II期,III期+IV期及REM期睡眠各占总睡眠时间(TST)的比例,呼吸暂停低通气指数(AHI),夜间平均血氧饱和度(MSaO2),夜间最低血氧饱和度(LSaO2)。结果轻度阻塞性睡眠呼吸暂停低通气综合征患者治疗前AHI(17±2.8)次/h,MSaO2(91.1±2.1)%,LSaO2(86.2±1.2)%,经持续低流量吸氧治疗后AHI(3.0±1.2)次/h,MSaO2(97±1.5)%,LSaO2(94±1.6)%,均有显著差异(P<0.05)。结论轻度OSAHS患者经持续低流量吸氧治疗后睡眠结构明显改善,可选择持续低流量吸氧治疗。     

松郁安神方对PCPA致失眠大鼠睡眠时相的影响

目的:观察松郁安神方对失眠大鼠睡眠时相的影响.方法:采用腹腔注射对氯苯丙氨酸(Para-chlorophenylalanine,PCPA)建立失眠大鼠模型,用松郁安神方进行干预,通过动物睡眠生物解析系统,记录脑电(Electroencephalogram,EEG)和肌电(Electromyogram,EMG),分析睡眠...     

Dysfunction of arousal systems in sleep-related migraine without aura

Primary headaches are closely related to sleep. Modifications in the patterns of arousal during sleep have been reported in migraine, especially in the nights preceding a headache attack. We aimed at evaluating the pattern of arousal from sleep in a group of patients affected by sleep-related migraine. We enrolled 10 consecutive patients, three males and seven females, aged between 20 and 62 years, who presented frequent attacks of migraine without aura (more than five per month), closely related to sleep (more than one-half of the attacks occurred during sleep, causing an awakening). A control group was studied, matched for age and sex. Patients and controls underwent a full-night polysomnographic study, following adaptation; arousal pattern was studied by the scoring of the high-frequency EEG arousal and by the cyclic alternating pattern (CAP). Migraineurs showed a lower CAP rate in non-rapid eye movement (NREM) sleep and, in particular, a lower number of A1 phases (low-frequency, high-amplitude EEG bursts) compared with the controls. Migraineurs also showed a lower index of high-frequency EEG arousals during rapid eye movement (REM) sleep. The reduction in the CAP rate indicates a lower level of arousal fluctuation in NREM sleep. The reduced arousal index in REM suggests a dysfunction in neural structures involved in both the control of REM sleep and the pathophysiology of migraine, such as the hypothalamus and the brainstem.     

Differentiating between light and deep sleep stages using an ambulatory device based on peripheral arterial tonometry

The objective of this study is to develop and assess an automatic algorithm based on the peripheral arterial tone (PAT) signal to differentiate between light and deep sleep stages. The PAT signal is a measure of the pulsatile arterial volume changes at the finger tip reflecting sympathetic tone variations and is recorded by an ambulatory unattended device, the Watch-PAT100, which has been shown to be capable of detecting wake, NREM and REM sleep. An algorithm to differentiate light from deep sleep was developed using a training set of 49 patients and was validated using a separate set of 44 patients. In both patient sets, Watch-PAT100 data were recorded simultaneously with polysomnography during a full night sleep study. The algorithm is based on 14 features extracted from two time series of PAT amplitudes and inter-pulse periods (IPP). Those features were then further processed to yield a prediction function that determines the likelihood of detecting a deep sleep stage epoch during NREM sleep periods. Overall sensitivity, specificity and agreement of the automatic algorithm to identify standard 30 s epochs of light and deep sleep stages were 66%, 89%, 82% and 65%, 87%, 80% for the training and validation sets, respectively. Together with the already existing algorithms for REM and wake detection we propose a close to full stage detection method based solely on the PAT and actigraphy signals. The automatic sleep stages detection algorithm could be very useful for unattended ambulatory sleep monitoring assessing sleep stages when EEG recordings are not available.     

Effectiveness of intermediate-term use of secobarbital.

Secobarbital, 100 mg, was evaluated in two separate sleep laboratory drug evaluation studies, each with 4 insomniac patients. In both studies, the effect of secobarbital in inducing and maintaining sleep was evaluated, as well as the effects of the drug on sleep stages. Statistical analysis demonstrated that the results of the two studies could be combined. With short-term drug administration of secobarbital (up to 3 nights), there was an improvement in both sleep induction and sleep maintenance. Total wake time was decreased 43% below baseline and was consistently decreased in each third of the night. With intermediate-term drug administration (2 wk), total wake time was decreased only 14% (not statistically significant). Following drug withdrawal, the degree of sleep difficulty returned to baseline levels. The results indicate that secobarbital 100 mg is effective for short-term use but loses much of its effectiveness with intermediate use and suggest that the drug is of limited value for insomniac patients who require nightly medication beyond a period of 1 wk. With short-term administration, secobarbital induced a slight decrease in rapid eye movement (REM) and slow-wave sleep and a significant increase in stage 2 sleep. With intermediate administration, sleep stage values were similar to baseline levels. Following withdrawal, there was only a minimal increase in REM sleep above baseline levels, a significant increase in stage 3 sleep, and a significant decrease in stage 2 sleep. The rebound increase in stage 3 sleep is similar to that reported following withdrawal of pentobarbital.     

EEG microstates of wakefulness and NREM sleep

EEG-microstates exploit spatio-temporal EEG features to characterize the spontaneous EEG as a sequence of a finite number of quasi-stable scalp potential field maps. So far, EEG-microstates have been studied mainly in wakeful rest and are thought to correspond to functionally relevant brain-states. Four typical microstate maps have been identified and labeled arbitrarily with the letters A, B, C and D. We addressed the question whether EEG-microstate features are altered in different stages of NREM sleep compared to wakefulness. 32-channel EEG of 32 subjects in relaxed wakefulness and NREM sleep was analyzed using a clustering algorithm, identifying the most dominant amplitude topography maps typical of each vigilance state. Fitting back these maps into the sleep-scored EEG resulted in a temporal sequence of maps for each sleep stage. All 32 subjects reached sleep stage N2, 19 also N3, for at least 1 min and 45 s. As in wakeful rest we found four microstate maps to be optimal in all NREM sleep stages. The wake maps were highly similar to those described in the literature for wakefulness. The sleep stage specific map topographies of N1 and N3 sleep showed a variable but overall relatively high degree of spatial correlation to the wake maps (Mean: N1 92%; N3 87%). The N2 maps were the least similar to wake (mean: 83%). Mean duration, total time covered, global explained variance and transition probabilities per subject, map and sleep stage were very similar in wake and N1. In wake, N1 and N3, microstate map C was most dominant w.r.t. global explained variance and temporal presence (ratio total time), whereas in N2 microstate map B was most prominent. In N3, the mean duration of all microstate maps increased significantly, expressed also as an increase in transition probabilities of all maps to themselves in N3. This duration increase was partly--but not entirely--explained by the occurrence of slow waves in the EEG. The persistence of exactly four main microstate classes in all NREM sleep stages might speak in favor of an in principle maintained large scale spatial brain organization from wakeful rest to NREM sleep. In N1 and N3 sleep, despite spectral EEG differences, the microstate maps and characteristics were surprisingly close to wakefulness. This supports the notion that EEG microstates might reflect a large scale resting state network architecture similar to preserved fMRI resting state connectivity. We speculate that the incisive functional alterations which can be observed during the transition to deep sleep might be driven by changes in the level and timing of activity within this architecture.     

多导睡眠监测评估两种模式正压通气呼吸机对重度阻塞性睡眠呼吸暂停综合征的疗效

目的探讨自动调节持续气道正压通气呼吸机(Auto-CPAP)与双水平正压通气呼吸机(Bi-PAP)在治疗重度阻塞性睡眠呼吸暂停综合征(OSAHS)患者时的疗效。方法 120例重度(AHI>40)OSAHS患者根据AHI是否大于60,并且夜间平均血氧饱和度(MSaO2)是否低于80%分为A组和B组,先后接受Auto-CPAP和Bi-PAP治疗,观察治疗前和治疗时PSG参数变化。结果 A组患者应用Auto-CPAP较Bi-PAP治疗效果无明显差异,B组患者应用Bi-PAP较Auto-CPAP治疗效果明显改善。治疗效果主要表现在睡眠效率(SE),觉醒次数(WASO),Ⅰ期+Ⅱ期,Ⅲ期+IV期及REM期睡眠各占总睡眠时间(TST)的比例,而呼吸暂停低通气指数(AHI),夜间平均血氧饱和度(MSaO2),夜间最低血氧饱和度(LSaO2)无明显差异。结论对于重度OSAHS患者,AHI≤60,MSaO2≥80%的患者建议选择Auto-CPAP进行治疗,AHI大于60,MSaO2低于80%建议选择Bi-PAP进行治疗。     

Effect of acute gouty arthritis on sleep patterns: A preclinical study

Background: It has been demonstrated that the interrelation between pain and sleep produces changes in sleep patterns and pain perception. Although some evidences suggest that sleep and pain may interact in a complex way, polysomnographic studies in animals with acute nociception are limited in number. Aims: This study was carried out in order to evaluate the effect of intra‐articular knee injection of uric acid on sleep‐wake patterns. Methods: Surgical electrode implantation was performed in seven anesthetized Wistar rats to carry out 10h polysomnographic recordings. Acute nociception was induced by the intra‐articular administration of 30% uric acid crystals into the knee joint of the right hind limb. Two recordings before and after intra‐articular drug administration were obtained. Sleep‐wake parameters were classified as (i) wakefulness (W), (ii) slow wave sleep (SWS), and (iii) rapid eye movement (REM) sleep. Frequency and duration from each parameter were evaluated under the two above‐mentioned conditions. Results: Intra‐articular administration of uric acid induced: (i) an increased duration of wakefulness (p=0.014), (ii) a decrement in the duration (p=0.001) and number of events (p=0.027) in REM sleep, and (iii) a decrement in the total sleep time (p=0.001). SWS did not present statistical differences between groups. Conclusions: These data suggest that a nociceptive stimulus, induced by the intra‐articular administration of uric acid, alters the sleep‐wake equilibrium with REM sleep being particularly altered. However, further research concerning pain–sleep interaction is needed.     

软腭等离子射频消融对阻塞性睡眠呼吸暂停低通气综合征的疗效

目的　探讨采用等离子低温射频术对轻症阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者行软腭部消融的临床疗效。方法　选择 18例轻度OSAHS患者 ,分别于术前和术后 8周行多导睡眠图等检查 ,比较软腭长度、悬雍垂长度、鼾声评级及Epworth嗜睡程度评分 ,观察术中、后的主要反应。结果　患者射频治疗前和治疗 8周后多导睡眠参数比较显示 :治疗后Ⅰ +Ⅱ期睡眠 /总睡眠时间 (TST) (% )明显缩短 ,Ⅲ +Ⅳ期睡眠 /TST (% )明显延长、睡眠效率 (TST/总记录时间 % )及最低脉氧饱和度 (LSpO2 )均显著提高 (P <0 .0 5 ) ;此外 ,呼吸暂停低通气指数的减低以及打鼾时间 /TST的缩短均较治疗前相差非常显著 (P <0 .0 1)。患者射频治疗 8周后软腭长度及悬雍垂长度的缩短及鼾声评级的降低均较治疗前相差非常显著 (P <0 .0 1)。Epworth嗜睡程度评分亦较治疗前明显降低 (P <0 .0 1)。软腭射频术后对疼痛、讲话及吞咽的影响的评分标准 ,18例患者术后 1～ 3天对以上三项的影响基本在轻度以内 ,术后 7天时影响又较 1～ 3天时进一步改善。结论　等离子低温射频消融对于轻度OSAHS患者具有较明显的近期疗效 ,且安全无明显不良反应。其远期疗效尚有待观察。     

The metabotropic glutamate (mGLU)2/3 receptor antagonist LY341495 [2S-2-amino-2-(1S,2S-2-carboxycyclopropyl-1-yl)-3-(xanth-9-yl)propanoic acid] stimulates waking and fast electroencephalogram power and blocks the effects of the mGLU2/3 receptor agonist ly379268 [(-)-2-oxa-4-aminobicyclo[3.1.0]hexane-4,6-dicarboxylate] in rats

The highly selective metabotropic glutamate (mGlu)2/3 receptor agonist LY379268 [(-)-2-oxa-4-aminobicyclo[3.1.0]hexane-4,6-dicarboxylate] completely suppresses rapid eye movement (REM) sleep and strongly depresses theta (6-10 Hz) and high-frequency (10-60 Hz) power in the waking and nonrapid eye movement (NREM) EEG, effects consistent with depressed brain excitation (arousal). We hypothesized the selective mGlu2/3 receptor antagonist LY341495 [2S-2-amino-2-(1S,2S-2-carboxycyclopropyl-1-yl)-3-(xanth-9-yl)propanoic acid] given alone would 1) increase arousal, producing sleep-wake EEG effects opposite those of LY379268, and 2) block/reverse the effects of LY379268 when the drugs are coadministered. Rats with implanted electrodes were injected with 1, 5, or 10 mg/kg LY341495 at hour 5.5 of the dark period. In the coadministration study the rats received the same dose of LY341495 followed 30 min later by 1 mg/kg LY379268. LY341495 alone increased waking by reducing NREM and REM sleep. LY341495 also depressed low-frequency and stimulated high-frequency EEG power. It produced a sharp spike in theta power in waking but not NREM sleep, a striking state-dependent difference in pharmacological response. These changes indicate that blocking mGlu2/3 receptors increases brain arousal. Moreover, they show that mGlu2/3 receptors actively support arousal even in the absence of heightened glutamate excitation. The coadministration experiment demonstrates that LY341495 is selective in vivo since it dose-dependently attenuates or reverses the sleep-wake EEG effects of the highly selective mGlu2/3 receptor agonist LY379268. The capacity of mGlu2/3 receptor agonists and antagonists to alter the sleep wake balance suggests they could be developed to enhance sleep or sustain arousal. Their opposing actions on theta EEG could test the putative role of these oscillations in memory consolidation.     

Effects of 50mg amisulpride on EEG, psychomotor and cognitive functions in healthy sleep-deprived subjects

Amisulpride, a substituted benzamide, binds selectively to the dopamine D2- and D3-receptors. It has higher affinity for limbic compared to striatal dopamine receptors in vivo. At low doses, amisulpride facilitates dopamine transmission via a selective blockade of presynaptic D2- and D3-receptors. Amisulpride is an active antipsychotic compound effective at low doses for negative symptoms and at high doses for positive symptoms of schizophrenia. The CNS profile of multiple doses of a low dosage regimen of amisulpride (50 mg once daily for 4 days) was assessed in a randomised, double-blind, 3-way crossover, placebo-controlled study carried out in 12 young sleep-deprived (for 36 h) subjects, using EEG and various measures of psychomotor and cognitive functions. Caffeine slow release (600 mg) was used as a positive reference. Multiple doses of 50 mg amisulpride once daily were devoid of any detrimental effects on EEG and psychomotor performance and cognitive function after total sleep deprivation. In addition, 50mg amisulpride partially antagonized the deleterious effects of sleep deprivation on EEG and subjective sedation as shown by trends, and a significant increase in EEG relative beta power and a decrease in subjective sedation. These effects were more pronounced at the end of sleep deprivation, suggesting possible alerting effects of amisulpride at this dose level. Caffeine significantly antagonized the detrimental effects of sleep deprivation on vigilance (increase in EEG beta waves, speed of reaction, sustained attention and reduction in subjective sedation). In conclusion, the present results demonstrate that 50 mg amisulpride is devoid of detrimental effects on EEG, psychomotor and cognitive performance after sleep deprivation, a situation well-known to amplify such effects if they exist. Moreover, some data suggest possible alerting effects of this low dosage regimen of amisulpride.     

成人部分性癫痫患者的睡眠结构与听觉事件相关电位的特征及相关性研究

目的探讨成人部分性癫痫患者的睡眠结构与听觉事件相关电位(AERPS)的特征及相关性。方法选取2012年5月至2014年8月本院收治的54例成人部分性癫痫患者作为研究组,另选取54例同期健康体检者作为对照组,均行AERPS和睡眠脑电图监测,分析两组对象睡眠参数和AERPS参数,并探讨其相关性。结果研究组总睡眠时间、睡眠效率和非快速眼动睡眠(NREM3)+4期占总睡眠时间百分比较对照组低,而NREM1期、NREM2期和清醒期占总睡眠时间百分比较对照组高,差异均有统计学意义(P0.05)。研究组潜伏期P300高于对照组,差异有统计学意义(P0.05)。研究组患者P300潜伏期与NREM3+4期占总睡眠时间百分比(r=-0.452,P0.05)、睡眠效率(r=-0.413,P0.05)呈负相关,与其余睡眠参数间无明显相关性。结论成人部分性癫痫患者睡眠结构和AERPS均发生异常,其中睡眠参数的变化与P300潜伏期有负相关性。     

Chronic use of triazolam: the effects on the sleep patterns of insomniacs

The present study was designed to evaluate the effects of triazolam 0.5 mg on the sleep of insomniac patients when given for 3 weeks. The results showed that both acute and chronic triazolam administration are effective in decreasing sleep latency, increasing sleep duration, increasing sleep efficiency and decreasing total wake time without producing major effects on sleep staging. Sleep Stages 1 and 2 were significantly altered by drug treatment but in a positive direction. This change is primarily attributable to the significant decrease in sleep onset. Deep sleep and REM were not significantly changed during triazolam treatment nor was there any evidence of REM rebound after discontinuation of the medication. It was noted that some of the sleep parameters measured shifted toward baseline measures in the first night after triazolam treatment was terminated. However, the total recovery period recorded (7 days) showed the quality and quantity of sleep obtained to be improved over baseline measures. The recovery data compared favourably with those improvements noted during chronic administration of triazolam. It was also found that 3 weeks of triazolam 0.5 mg usage did not result in tolerance to its hypnotic properties. Thus, triazolam maintains its hypnotic effectiveness throughout 3 weeks of administration.     

AASM standards of practice compliant validation of actigraphic sleep analysis from SOMNOwatch™ versus polysomnographic sleep diagnostics shows high conformity also among subjects with sleep disordered breathing

In recent AASM practice, parameter actimetry is cited to measure total sleep time in obstructive sleep apnoea patients, when polysomnography is not available. An actigraph was therefore compared to polysomnographic data in 28 subjects with known sleep disordered breathing. Total sleep time (TST), sleep period time (SPT), sleep efficiency (SE), sustained sleep efficiency (SSE), sleep onset latency (SL) and sleep/wake pattern were compared to gold standard polysomnography. The results of an epoch-by-epoch comparison of sleep/wake from actigraphy to sleep stages from polysomnography gave a sensitivity of 90.2%, a specificity of 95.2% and an overall accuracy of 85.9%. Correlations were moderately strong for SE (0.71, p < 0.001) and SSE (0.65, p < 0.001) and high for TST (0.89, p < 0.001), SPT (0.91, p < 0.001) and SL (0.89, p < 0.001). It was concluded that actigraphy is not identical with PSG recording but gives good results in sleep/wake patterns and predicting TST, SPT, SSE, SE and SL also in sleep apnoea patients not suffering from other sleep disorders. The difficult detection of correct sleep onset causes SSE and SL to be less predictable. Therefore a 15-epoch criterion was introduced and resulted in high correlation of 0.89 for sleep latency, but has to be tested on a bigger population.     

多虑平治疗原发性失眠有效性及安全性的系统评价

目的系统评价多虑平治疗原发性失眠的有效性及安全性。方法计算机检索Cochrane图书馆（2009年第4期）、PubMed（1966～2009.12）、EMbase（1974～2009.12）、ISI（1961～2009.12）、CBM（1978～2009.12）、CNKI（1979～2009.12）、VIP（1989～2009.12）和万方（1998～2009.12）数据库,并补充查找相关会议文献及在研文献,由2名评价者独立选择研究、评价质量、提取资料并交叉核对,而后采用RevMan 5.0软件对数据进行统计分析。结果共纳入4篇文献,共171例患者。Meta分析结果表明：与安慰剂相比,中低剂量多虑平（1～25 mg）对原发性失眠患者的总睡眠时间、睡眠后觉醒时间、睡眠期间觉醒时间、睡眠有效率等睡眠质量指标的改善作用明显,其差异有统计学意义。相反,高剂量多虑平（50 mg）对绝大多数睡眠质量指标的改善与安慰剂相比并无统计学意义。而中高剂量多虑平（25～50 mg）对原发性患者的快速眼动睡眠、二期睡眠、快速眼动睡眠潜伏时间等睡眠结构指标的改善与安慰剂相比,其差异有统计学意义。结论中低剂量多虑平（1～25 mg）可有效改善原发性失眠患者的睡眠质量,但使用中等剂量多虑平治疗原发性失眠时需关注副作用及对睡眠结构的影响;尚不推荐使用高剂量多虑平（50 mg）治疗原发性失眠。由于纳入研究质量与例数有限,上述结论尚需开展更多高质量大样本的研究加以验证。     

奥氮平对精神分裂症患者睡眠脑电活动的影响

目的：应用多导睡眠图探讨奥氮平对精神分裂症患睡眠脑电活动的影响。方法：对13例精神分裂症患连续进行3个晚上多导睡眠图检查，其中第2、3晚上睡前予10mg奥氮平，观察用药后多导睡眠图的变化。正常对照组14名，作2夜基础多导睡眠图监测。结果：精神分裂症患服用奥氮平后睡眠进程和睡眠总时间有所改善，觉醒时间减少和S1缩短，S2和慢波睡眠(S3、S4）显增加，而快速眼动(REM)时间和潜伏期未见明显变化。结论：奥氮平能增加睡眠总时间，改善睡眠质量，这可能与奥氮平拮抗5-羟色胺能神经元作用相关。