老年慢性失眠症患者的多导睡眠图特征及其中医证型分析

目的 探讨老年慢性失眠症（chronic insomnia disorder，CID）患者的多导睡眠监测（polysomnography，PSG）特点及中医证候类型，为老年CID的预防及诊疗提供参考。方法 选取2022年5月至2023年5月就诊于浙江省立同德医院神经内科门诊诊断为CID，并行PSG的患者为研究对象，共205例，基于年龄差异分为老年组（≥60岁）与非老年组（<60岁），统计两组患者的中医证型分布情况，采用PSG记录和比较两组患者的睡眠结构和进程参数，并做相关性分析。结果 老年患者的总睡眠时间(total sleep time，TST)、睡眠效率[TST/总卧床时间(time in bed，TIB)]、快速动眼睡眠（rapid eyes movement，REM）期总持续时间、N2期总持续时间、N3期总持续时间，REM%均低于非老年组，差异有统计学意义（P<0.05）。而入睡后清醒时间、N1期潜伏期、N2期潜伏期、N1%均高于非老年组，差异有统计学意义（P<0.05）。老年CID患者的中医辨证以心肾不交证较为多见。结论 老年与非老年组CID的患者多导睡眠检测存在差异。较非老年组而言，老年组的睡眠时间缩短、睡眠效率降低、睡眠潜伏期延长、REM总持续时间减少，临床中医辨证分型中以心肾不交证常见。

Polysomnographic characteristics of elderly patients with chronic insomnia and analysis of Chinese medicine evidence patterns

Objective To explore the characteristics of polysomnography (PSG) and the types of Chinese medicine symptoms in elderly patients with chronic insomnia disorder (CID), and to provide reference for the prevention and diagnosis of CID in the elderly. Methods A total of 205 patients diagnosed as CID with parallel PSG in the outpatient clinic of the Department of Neurology of Zhejiang Provincial Tongde Hospital from May 2022 to May 2023 were selected for the study, and were divided into the geriatric group (≥60 years old) and the non-geriatric group (<60 years old) based on the difference in age, and statistics were collected on the distribution of Chinese medicine syndromes in the patients of the two groups, and the PSG was used to record and compare the structure and process of sleep in the patients of the two groups. parameters, and do correlation analysis. Results Total sleep time (TST), sleep efficiency TST time in bed (TIB), total duration of rapid eyes movement (REM) period, total duration of N2 period, total duration of N3 period, and REM% were lower in elderly patients than in the non-elderly group (P<0.05). And the time to wakefulness after sleep, N1 latency, N2 latency, and N1% were statistically higher than those of the non-elderly group(P<0.05). The TCM diagnosis of elderly patients with CID is more commonly characterized by cardiac and renal disorders. Conclusion There were differences in polysomnographic sleep testing between the elderly and non-elderly groups of patients with CID. Compared with the non-elderly group, the elderly group had shorter sleep duration, lower sleep efficiency, longer sleep latency, reduced total REM duration, and the most common clinical Chinese medicine diagnostic typology of cardiac and renal disorders.