28例路易体痴呆患者的视频-多导睡眠图分析

目的研究路易体痴呆（DLB）患者的视频～多导睡眠图,探讨路易体痴呆患者的睡眠结构。方法对临床诊断DLB28例及正常对照28人进行研究。所有入组者均进行简易精神状态检查量表（MMSE）和视频～多导睡眠图（Video-PSG）监测。结果（1）睡眠结构分析：与对照组相比,DLB组总睡眠间期时间（SPT）减少,差异具有统计学意义（P〈0．05）;总睡眠时间（TST）减少、睡眠效率（SE）下降、总醒觉时间（TWT）、入睡后清醒时间（WASO）增多、1期睡眠时间（TS1）、2期睡眠时间（TS2）、NREM睡眠时间（TNREMS）和REM睡眠时间（TREMS）均明显减少,差异具有统计学意义（P〈0．01）;（2）睡眠呼吸事件分析：DLB组与对照组相比,各项指标差异均无统计学意义（P〉0．05）;（3）其他睡眠事件分析：与对照组相比,DLB组睡眠期周期性肢体运动次数（PLMS）、快动眼睡眠行为异常（RBD）明显增多,差异具有统计学意义（P〈0．01）。结论DLB患者存在睡眠结构紊乱,睡眠异常行为亦很常见。视频-多导睡眠图对于研究DLB患者的睡眠障碍很有帮助。     

阻塞型睡眠呼吸暂停综合征患者情绪障碍的研究进展

在临床中睡眠呼吸暂停综合征患者患抑郁、焦虑的概率较高,而且同时患有抑郁、焦虑及OSAS的患者比仅患有OSAS患者病情更重。尽管许多研究评估了OSAS与情绪障碍间的关系,OSAS及情绪障碍之间一些可能的因果机制也已被提出,但是OSAS在情绪障碍的因果关系仍不清楚。对于OSAS伴焦虑抑郁状态的患者,情绪障碍的干预治疗有助于改善OSAS患者的嗜睡、疲劳症状及认知功能,提高患者生活质量。     

Intractable hiccups and sleep apnea syndrome in multiple sclerosis: report of two cases

Two cases of multiple sclerosis associated with intractable hiccups (IH) and sleep apnea syndrome (SAS) are reported. Lesions were detected in the tegmentum of the medulla oblongata by magnetic resonance imaging. In one case, high dose methylprednisolone was remarkably effective for the IH. For the SAS, amitriptyline was effective in one case. The IH and SAS are thought to be important symptoms when a lesion occurs in the tegmentum of the medulla oblongata, including the paramedian and lateral reticular formations. If IH appears in conjunction with a lesion in the tegmentum of the medulla oblongata, one must be vigilant for the development of SAS.     

Effects of Zopiclone on Slow Wave Sleep and Spontaneous K-complexes for Normal Healthy Young Adults

Abstract: Benzodiazepine (BZD) hypnotics have been known to decrease, to some degree, human slow wave sleep (SWS) although they elevate the arousal threshold during sleep. Zopiclone (ZPC), a cyclopyrrolone hypnotic, has attracted the interest of sleep researchers because an increase in human SWS has been reported. Since the increase has not been fully confirmed by all of the studies, the authors investigated the effects of ZPC 10 mg on SWS and the K-complexes for 7 healthy young adults because there is evidence indicating that delta waves consisting of SWS and the spontaneous K-complexes are identical. SWS and st. 4 sleep did not decrease on any of the ZPC nights but st. 3 sleep showed a tendency to reduce on the 1st ZPC night. The frequency of the K-complexes decreased significantly on the 2nd ZPC night and tended to reduce on the 1st ZPC night. Moreover, a significant positive correlation was noted between the decrease rates of SWS and the K-complexes on both the ZPC nights. The authors, therefore, could not obtain any findings suggesting an increase in SWS with ZPC.     

An Autopsy Case of Binswanger's Disease without Hypertension and Associated with Cerebral Infarction in the Terminal Stage

Abstract: We report here an autopsy case of Binswanger's disease (BD) without hypertension and associated with cerebral infarction in the terminal stage. The female patient, who was 74 years old at the time of death, had initially demonstrated manic-depressive disorder-like mental disorder, followed by dementia and neurological deficits. A brain CT scan showed white matter low attenuation bilaterally and symmetrically. BD was clinically diagnosed despite the lack of hypertension. In the terminal stage, she suffered an infarction in the left anterior cerebral artery region, and died of pneumonia. Neuropathologically, we found the infarction of the left anterior cerebral artery region, demyelination, fibrillary gliosis, lacunae and arteriosclerosis of the small arteries and arterioles in the white matter.     

合并OSAHS的老年急性脑梗死患者同型半胱氨酸和胰岛素抵抗临床分析

目的研究合并阻塞性睡眠呼吸暂停综合征(OSAHS)的老年急性脑梗死(ACI)患者血清同型半胱氨酸(Hcy)及稳态模型胰岛素抵抗指数(HOMA-IR)水平,分析老年ACI患者OSAHS、Hcy和HOMA-IR相互关系。方法根据年龄和睡眠呼吸监测数据,将患者分为老年ACI+OSAHS组(n=21)、老年ACI组(n=30)、中年ACI+OSAHS组(n=28)和中年ACI组(n=34),检测并比较各组血清Hcy、胰岛素抵抗指数(HOMA-IR)等各指标。结果老年ACI+OSAHS组较其余3组的Hcy和HOMA-IR均升高,差异有统计学意义(P0.05);中年ACI+OSAHS组较中年ACI组Hcy和HOMA-IR增高,差异有统计学意义(P0.05)。Hcy与年龄、AHI、平均腰围、BMI、HOMAIR均呈正相关;多元线性回归分析显示AHI与年龄、Hcy、HOMA-IR、BMI呈正相关。结论随年龄的增加,合并OSAHS的急性脑梗死患者Hcy和HOMA-IR水平随之升高;OSAHS可能通过升高Hcy及增加胰岛素抵抗导致ACI。     

高血压病患者主观睡眠质量与血压水平的相关性研究

目的研究高血压病患者主观睡眠质量对其血压水平的影响。方法选取重庆市第三军医大学大坪医院住院及门诊高血压病患者为高血压病组,选取体检中心无高血压病健康成人为对照组。分别进行问卷调查、诊室血压及24h动态血压监测。比较高血压病组与对照组的主观睡眠质量,并研究高血压病患者主观睡眠质量与其血压水平的关系。结果高血压病组主观睡眠质量明显差于对照组,高血压病组的主观睡眠质量越差,其收缩压水平越高,高血压病组主观睡眠质量与其收缩压水平呈负相关。结论高血压病患者的主观睡眠质量与其收缩压水平呈负相关,是高血压病患者收缩压增高的危险因素之一。     

Tired and misconnected: A breakdown of brain modularity following sleep deprivation

Sleep deprivation (SD) critically affects a range of cognitive and affective functions, typically assessed during task performance. Whether such impairments stem from changes to the brain's intrinsic functional connectivity remain largely unknown. To examine this hypothesis, we applied graph theoretical analysis on resting‐state fMRI data derived from 18 healthy participants, acquired during both sleep‐rested and sleep‐deprived states. We hypothesized that parameters indicative of graph connectivity, such as modularity, will be impaired by sleep deprivation and that these changes will correlate with behavioral outcomes elicited by sleep loss. As expected, our findings point to a profound reduction in network modularity without sleep, evident in the limbic, default‐mode, salience and executive modules. These changes were further associated with behavioral impairments elicited by SD: a decrease in salience module density was associated with worse task performance, an increase in limbic module density was predictive of stronger amygdala activation in a subsequent emotional‐distraction task and a shift in frontal hub lateralization (from left to right) was associated with increased negative mood. Altogether, these results portray a loss of functional segregation within the brain and a shift towards a more random‐like network without sleep, already detected in the spontaneous activity of the sleep‐deprived brain. Hum Brain Mapp 38:3300–3314, 2017. © 2017 Wiley Periodicals, Inc.     

Outcomes of long-term iron supplementation in pediatric restless legs syndrome/periodic limb movement disorder (RLS/PLMD)

ObjectivesRestless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are thought to center around a genetically mediated sensitivity to iron insufficiency. Previous studies have shown the effectiveness of short-term iron therapy in children with low iron storage. Little is known, however, about long-term iron treatment in children with RLS and PLMD. Therefore, we performed this study to assess the long-term effect of iron therapy in children with RLS and PLMD.MethodsA retrospective chart review was performed for children who met the following criteria: A) diagnosed as having either RLS or PLMD, B) started on iron supplementation, C) followed up for >2 years in a sleep clinic. Baseline values for iron, ferritin, and periodic limb movement of sleep index (PLMS index) were defined in the three months leading up to the initiation of iron therapy. Values were also computed for follow-up periods of 3–6 months, 1–2 years, and >2 years. Serum iron and ferritin levels and PLMS index were compared between baseline and all subsequent follow-ups.ResultsIn total, 105 patients met inclusion criteria, of whom 64 were diagnosed with PLMD alone, seven with RLS alone, and 35 with both RLS and PLMD. The average age was 10.2 ± 5.3 years. Compared to the baseline (27.4 ± 12.1 ng/ml), the average ferritin values at 3–6 months (45.62 ± 21.2 ng/ml, p < 0.001, n = 34), 1–2 years (52.0 ± 48.3 ng/ml, p <0.001, n = 63), and >2 years (54.7 ± 40.5 ng/ml, p <0.001, n = 67) were all significantly increased. Inversely, compared to baseline (21 ± 27.0/h, n = 66), PLMS index values at 3–6 months (7.5 ± 9.5/h p < 0.05, n = 11), 1–2 years (6.9 ± 8.9/h, p <0.001, n = 29), and >2 years (10 ± 14.5/h, p <0.001, n = 31) were all significantly decreased. No significant change in serum iron levels was noted at any time point.ConclusionWhile retrospective in nature, this study demonstrates a sustained improvement in PLMS index and maintenance of adequate ferritin levels >2 years after iron therapy initiation in our RLS/PLMD cohort with a long-term follow-up. Iron therapy appears to lead to long-lasting improvements in children with RLS/PLMD.