发作性睡病患者的夜间睡眠结构变化

目的分析发作性睡病患者的睡眠结构,了解其夜间睡眠紊乱的情况。方法对比分析38例发作性睡病患者与44例年龄及体重指数（BMI）匹配、无睡眠障碍主诉的正常对照者的睡眠结构。蹰组均经国际标准问卷调查及夜间多导生理记录仪睡眠呼吸监测（PSC）、多次小睡睡眠潜伏时间试验（MSLT）检查,按国际标准方法分析睡眠结构。结果38例患者均诉入睡快,无入睡困难,夜间平均睡眠潜伏期为5．6min。但其中30例（79％）诉夜间易醒或醒后长时间不易再入睡。PSG监测显示,发作性睡病患者的睡眠效率明显低于正常对照者（分别为81．7％±12．5％、87．1％±7．9％,P=0．029）,NREMI期睡眠明显长于正常对照组（分别为21．5±12．2、10．3±6．3,P=0．000）,REM睡眠潜伏期缩短（分别为55．4min±60．2min、120．1min±66．6min,P=0．000）、次数增多（分别为7．8±4．8次、4．0±1．5次,P=0．000）,但REM占总睡眠时间的百分比并不高（分别为17．7％±6．9％、18．9％±5．5％,P=0．23）,与频繁从REM睡眠中觉醒致REM睡眠中断有关。入睡后长觉醒时间占总睡眠时间的百分比显著延长（分别为18．2％±15．5％、9．3％±9．2％,P=0．004）。尽管短觉醒占总睡眠时间的比例只有2．2％±4．7％,但其次数显著增加,平均达（15±10）次,且大多发生于REM睡眠中,较对照组的（4．5±2．0）次增多（P=0．001）。两组的PSG检查已排除严重睡眠呼吸暂停低通气综合征,未发现合并周期性腿动等其他睡眠障碍性疾患。结论夜间睡眠紊乱也是发作性睡病的重要症状之一,可能与该疾病本身维持睡眠的机制异常有关。

Changes of sleep architecture in patients with narcolepsy

OBJECTIVE: To investigate the sleep architectures of patients with narcolepsy. METHODS: 38 drug-naive narcoleptic patients, 25 males and 13 females, aged 21 +/- 6.5, and 44 age-, sex ratio-, and BMI-matched normal persons underwent polysomnography (PSG) and multiple sleep latency test (MSLT) during one night sleep. Conventional visual scoring of the polysomnograms was performed according to the international. RESULTS: The sleep latency of the patients was 5.6 min, however, 30 patients (79%) complained of fragmented nocturnal sleep and difficulty to fall asleep again. The sleep efficiency of the narcoleptics was 81.7% +/- 12.5%, significantly lower than that of the normal persons (87.1% +/- 7.9%, P = 0.029). The non-rapid eye movement (NREM) I sleep accounted for (21.5 +/- 12.2)% in the patients, a proportion significantly higher than that of the normal persons (10.3 +/- 6.3)%, P = 0.000]). The AHI of the patients was 0.6 +/- 1.3 times/h, not significantly different from that of the normal persons (0.5 +/- 1.1 times/h). Although the rapid eye movement (REM) period and eye movement density of the narcoleptics were significantly increased, their REM period duration was not significantly different from that of the normal subjects (17.7% +/- 6.9% vs 18.9% +/- 5.5%, P = 0.23), probably due to the interruption of REM sleep by more frequent arousals in narcoleptics. PSG did not show significant periodic leg movements in these 2 groups. CONCLUSION: One of the important symptoms of narcolepsy, night sleep disturbance may contribute to the pathological sleepiness of narcolepsy during daytime.