右佐匹克隆治疗适应性失眠患者的有效性及对睡眠结构的影响

目的 使用临床评估量表和多导睡眠检测技术研究镇静催眠药物右佐匹克隆治疗适应性失眠患者的有效性及其对睡眠结构的影响.方法 采用治疗前后自身对照设计,比较适应性失眠患者使用右佐匹克隆治疗前后的睡眠结构变化及评估其药物疗效.纳入对象为上海长征医院神经内科睡眠障碍门诊中符合诊断标准的患者共32例,其中女性20例,男性12例,平均年龄36.2岁.患者接受连续3d药物治疗(每次3 mg右佐匹克隆),观察指标为服药前及服药第3天睡眠相关的主观与客观检查(量表评估和多导睡眠图检查),记录并分析患者的总卧床时间、总睡眠时间、觉醒时间、入睡潜伏期、睡眠效率、非快速眼动(NREM)睡眠各期时间百分比、快速眼动(REM)睡眠时间百分比等,并使用失眠严重程度指数量表( ISI)和MMSE评价患者的失眠严重程度和药物对于患者日间认知功能的影响.结果 右佐匹克隆能够缩短入睡潜伏期治疗前( 52.92±11.71) min,治疗后(28.2±10.11)min；t=-4.376,P＜0.01]、延长总睡眠时间治疗前(365.22±30.13) min,治疗后(429.18±26.93)min;t=4.102,P＜0.01]、减少觉醒次数治疗前(5.00±1.92)次,治疗后(2.73±0.91)次；t=-4.592,P＜0.01]、提高睡眠效率(治疗前72.69％±6.32％,治疗后82.67％±4.16％；t=3.371,P＜0.01)、缩短觉醒时间治疗前(88.51±17.48) min,治疗后(65.93±21.10) min；t=-5.863,P＜0.01]、降低NREM 1期时间百分比(治疗前12.54％±2.10％,治疗后7.30％±2.90％；t=-3.155,P＜0.01)、增加慢波睡眠时间百分比(治疗前8.03％±5.37％,治疗后9.31％±5.29％；t=4.228,P＜0.01),而对NREM 2期睡眠时间百分比、REM睡眠时间百分比无明显影响.右佐匹克隆能够提高患者对睡眠质量的主观评价(ISI评分降低,t=-2.551,P＜0.05),且服药后对患者次日清晨的认知功能无明显影响(MMSE评分未见降低).结论 右佐匹克隆能够正性调节急性失眠患者的睡眠结构,提高患者的主观睡眠质量,对日间认知功能无明显影响,安全性好.

Efficacy and impact of premedication with eszopiclone on sleep structure of patients with acute insomnia

Objective To evaluate the efficacy of eszopiclone for patients with acute insomnia and the impact of premedication with eszopiclone on sleep structure of patients with acute insomnia.Methods In an open-label,self-control trial was conducted at Changzheng Hospital Sleep Centers,and patients (n =32) with acute insomnia (12 men,20 women; mean age,36.2 years) were administered eszopiclone 3 mg for three consecutive nights.Sleep was monitored via polysomnography.The insomnia severity index (ISI),and mini-mental state examination (MMSE) were used to assess the degree of insomnia and impact of drugs on cognitive function during the day.Results Eszopiclone can shorten sleep latency ( before treatment:(52.92 ± 11.71 ) min,after treatment:(28.2 ± 10.11 ) min; t =-4.376,P ＜0.01 ),prolong total sleep time(before treatment:(365.22 ±30.13) min,after treatment:(429.18 ±26.93 ) min; t =4.102,P ＜ 0.01 ),decrease wake up times( before treatment:( 5.00 ± 1.92 ) times,after treatment:( 2.73 ± 0.91 )times; t =- 4.592,P ＜ 0.01 ),improve sleep efficiency ( before treatment:72.69％ ± 6.32％,after treatment:82.67％ ± 4.16％ ; t =3.371,P ＜ 0.01 ),reduce awake time ( before treatment:( 88.51 ±17.48) min,after treatment:(65.93 ±21.l0)min; t =-4.592,P ＜0.01 ),decrease light sleep ( NREM1 period) the percentage of time ( before treatment:12.54％ ± 2.10％,after treatment:7.30％ ± 2.90％ ;t=-3.155,P ＜ 0.01 ),and increase the percentage of slow wave sleep (before treatment:8.03％ ±5.37％,after treatment:9.31％ ±5.29％; t =4.228,P ＜0.01).No effect was observed on the percentage of NERM2 period (t =0.731,P ＞0.05) and REM period (t =-0.813,P ＞0.05).Eszopiclone can improve the quality of subjective assessment of sleep ( ISI score decreased,t =- 2.551,P ＜ 0.05) and has no significant effect on cognitive function on first the morning after patients taking the medication.Conclusion Eszopiclone can positively regulate the sleep structure in patients with acute insomnia and improve subjective assessment of sleep quality.It is safe and has no significant effect on cognitive function.