24例成人发作性睡病伴快速眼动睡眠期行为异常患者临床及多导睡眠图分析
|
摘要
目的探讨发作性睡病(Narcolepsy)合并快速眼动睡眠期行为异常(REM sleep behavior disorder,RBD)患者的临床及多导睡眠图特征,为临床诊断提供客观依据。方法收集本院24例临床诊断为发作性睡病同时合并RBD患者,行多导睡眠监测(polysomnography,PSG)及多次睡眠潜伏期试验(multiple sleep latency test,MSLT),对其临床症状及电生理检查结果进行统计分析。结果临床症状:本组24例均存在白天不能控制的过度嗜睡(100%);临床症状表现形式有睡眠相关性幻觉、睡眠瘫痪、猝倒发作、夜间睡眠中打鼾、憋醒、夜间睡眠中拍打同床人、梦境扮演经历。PSG分析:24例患者中24例N1期睡眠时间增加(100%);18例N2期睡眠时间减少(75%);18例N3期睡眠时间减少或消失(75%);12例REM睡眠时间延长(50%);9例(37.5%)存在呼吸暂停-低通气情况(AHI>5次/时);15例(62.5%)存在周期性肢体运动(PMLS指数>15次/时);24例伴随下颌肌电持续或间断增高(100%);12例伴随出现肢体或颜面部异常活动(50%)。MSLT分析:24例平均睡眠潜伏时间均小于8 min同时大于或等于两次REM起始睡眠(100%)。结论成人发作性睡病患者常合并睡眠呼吸暂停-低通气综合征,继发性嗜睡症状需与发作性睡病相鉴别;发作性睡病者常合并RBD,异常动作并非每夜都发生,但PSG可发现微小的异常动作或肌电活动,帮助疾病诊断;发作性睡病常合并周期性肢体运动,且分布在REM睡眠期较多时,需注意是否同时存在RBD可能。
Objective To investigate the characteristics of clinical and polysomnography in patients with narcolepsy and REM sleep behavior disorder( RBD),providing an objective basis for clinical diagnosis. Method Twenty-four patients with narcolepsy complicated with RBD were collected in our hospital. Polysomnography( PSG) and multiple sleep latency test( MSLT) were performed. Clinical symptoms and electrophysiological examinations were performed. The results were statistically analyzed. Result Clinical symptoms: There were 24 cases of excessive drowsiness( 100%) that could not be controlled during the day in 24 cases in this group; Symptoms include sleep-related hallucinations,sleep paralysis,cataplexy,snoring during nighttime sleep,wake-up,night-time sleep,sleep on the same bed,dream experience. PSG analysis: 24 cases of 24 patients with increased N1 sleep time( 100%); 18 cases of reduced N2 sleep time( 75%); 18 cases of N3 sleep decreased or disappeared( 75%); 12 cases of REM sleep time prolonged( 50%); 9 cases( 37. 5%) with apnea-hypopnea( AHI > 5/h); 15 cases( 62. 5%) with periodic limb movements( PMLS index > 15/h); 24 cases were accompanied by continuous or intermittent elevation of the mandibular muscle( 100%); 12 cases were associated with abnormal limb or facial activity( 50%). MSLT analysis: The average sleep latency in 24 cases was less than 8 minutes and greater than or equal to 2 REM sleep initiations( 100%). Conclusion Patients with adult narcolepsy are often associated with sleep apnea-hypopnea syndrome. The symptoms of secondary drowsiness need to be differentiated from narcolepsy. People with narcolepsy often have RBD,and abnormal actions do not occur every night,but PSG Can find small abnormal movements or EMG activity,to help diagnose the disease; narcolepsy often combined with periodic limb movements,and in the REM sleep period is more,pay attention to whether there is the possibility of RBD.
Objective To investigate the characteristics of clinical and polysomnography in patients with narcolepsy and REM sleep behavior disorder( RBD),providing an objective basis for clinical diagnosis. Method Twenty-four patients with narcolepsy complicated with RBD were collected in our hospital. Polysomnography( PSG) and multiple sleep latency test( MSLT) were performed. Clinical symptoms and electrophysiological examinations were performed. The results were statistically analyzed. Result Clinical symptoms: There were 24 cases of excessive drowsiness( 100%) that could not be controlled during the day in 24 cases in this group; Symptoms include sleep-related hallucinations,sleep paralysis,cataplexy,snoring during nighttime sleep,wake-up,night-time sleep,sleep on the same bed,dream experience. PSG analysis: 24 cases of 24 patients with increased N1 sleep time( 100%); 18 cases of reduced N2 sleep time( 75%); 18 cases of N3 sleep decreased or disappeared( 75%); 12 cases of REM sleep time prolonged( 50%); 9 cases( 37. 5%) with apnea-hypopnea( AHI > 5/h); 15 cases( 62. 5%) with periodic limb movements( PMLS index > 15/h); 24 cases were accompanied by continuous or intermittent elevation of the mandibular muscle( 100%); 12 cases were associated with abnormal limb or facial activity( 50%). MSLT analysis: The average sleep latency in 24 cases was less than 8 minutes and greater than or equal to 2 REM sleep initiations( 100%). Conclusion Patients with adult narcolepsy are often associated with sleep apnea-hypopnea syndrome. The symptoms of secondary drowsiness need to be differentiated from narcolepsy. People with narcolepsy often have RBD,and abnormal actions do not occur every night,but PSG Can find small abnormal movements or EMG activity,to help diagnose the disease; narcolepsy often combined with periodic limb movements,and in the REM sleep period is more,pay attention to whether there is the possibility of RBD.
引文
[1]Dauvilliers Y,Arnulf I,Mignot E.Narcolepsy with cataplexy[J].Lancet,2007,369:499-511.
[2]Colombo PP,Zaccagni M,Ubertini C,et al.Narcolepsy[J].Riv Psichiatr,2009,44(1):15-27.
[3]Wierzbicka A,Wichniak A,Waliniowska E,et al.REM sleepbehaviour disorder in narcolepsy[J].Neurol Neurochir Pol,2009,43(5):421-427.
[4]Miyamoto T,Miyamoto M,Iwanami M,et al.Idiopathic REM sleep behavior disorder:implications for the pathogenesis of Lewy body diseases[J].Parkinsons Dis,2011,2011:91286.
[5]周明珠,刘振国,吴佳英,等.帕金森病患者快速眼球运动睡眠行为障碍的回顾分析及前瞻性研究[J].中华神经科杂志,2010,43:858-862.
[6]Krahn LE,Pankratz VS,Oliver L,et al.Hypocretin(orexin)levels in cerebrospinal fluid of patients with narcolepsy:relationship tocataplexyand HLADQB 10602 status[J].Sleep,2002,25:733-736.
[7]Hong S,Lin L,Jeong J,et al.A study of the diagnos ticutility of HLA typing,CSF Hypocretin 1 measurements,and MSLT testing for the diagnosis of narcolepsy in 163 Koreanpatients with unexplained excessive day time sleepiness[J].Sleep,2006,29:1429-1438.
[8]Thannickal TC,Moore RY,Nienhuis R,et al.Reduced number of hypocretin neurons in human narcolepsy[J].Neuron,2000,27(3):469-474.
[9]Sutcliffe JG,de Lecea L.The hypocretins:Excitatory neuromodulatory peptides for multiple homeostatic systems,including sleep and feeding[J].J Neurosci Res,2000,62(2):161-168.
[10]Thorpy M.Therapeutic advances innarcolepsy[J].Sleep Med,2007,8:427-440.
[11]Hungs M,Fan J,Lin L,et al.Identification and functionalanalysis of mutations in the hypocretin(orexin)genes of narcoleptic canines[J].Genome Res,2001,11:531-539.
[12]Willie JT,CHemelli RM,Sinton CM,et al.Distinctnarcolepsy syndromes in Orexinnull micemolecu largenetic dissection of NonREM and REM sleepregulatory processes[J].Neuron,2003,38:715-730.
[13]Knudsen S,Gammeltoft S,Jennum PJ.Rapid eye movement sleep behavior disorder in patients with narcolepsy is associated with hypocretin-1 defciency[J].Brain,2010,2(133):568-579.
[14]Kiyashchenko LI,Mileykovskiyc BY,Lai YY,et al.Increased and decreased muscle tone with orexin(hypocretin)microinjections in the locus coeruleus and pontine inhibitory area[J].Neurophysio,2001,85(2):2008-2016.
[2]Colombo PP,Zaccagni M,Ubertini C,et al.Narcolepsy[J].Riv Psichiatr,2009,44(1):15-27.
[3]Wierzbicka A,Wichniak A,Waliniowska E,et al.REM sleepbehaviour disorder in narcolepsy[J].Neurol Neurochir Pol,2009,43(5):421-427.
[4]Miyamoto T,Miyamoto M,Iwanami M,et al.Idiopathic REM sleep behavior disorder:implications for the pathogenesis of Lewy body diseases[J].Parkinsons Dis,2011,2011:91286.
[5]周明珠,刘振国,吴佳英,等.帕金森病患者快速眼球运动睡眠行为障碍的回顾分析及前瞻性研究[J].中华神经科杂志,2010,43:858-862.
[6]Krahn LE,Pankratz VS,Oliver L,et al.Hypocretin(orexin)levels in cerebrospinal fluid of patients with narcolepsy:relationship tocataplexyand HLADQB 10602 status[J].Sleep,2002,25:733-736.
[7]Hong S,Lin L,Jeong J,et al.A study of the diagnos ticutility of HLA typing,CSF Hypocretin 1 measurements,and MSLT testing for the diagnosis of narcolepsy in 163 Koreanpatients with unexplained excessive day time sleepiness[J].Sleep,2006,29:1429-1438.
[8]Thannickal TC,Moore RY,Nienhuis R,et al.Reduced number of hypocretin neurons in human narcolepsy[J].Neuron,2000,27(3):469-474.
[9]Sutcliffe JG,de Lecea L.The hypocretins:Excitatory neuromodulatory peptides for multiple homeostatic systems,including sleep and feeding[J].J Neurosci Res,2000,62(2):161-168.
[10]Thorpy M.Therapeutic advances innarcolepsy[J].Sleep Med,2007,8:427-440.
[11]Hungs M,Fan J,Lin L,et al.Identification and functionalanalysis of mutations in the hypocretin(orexin)genes of narcoleptic canines[J].Genome Res,2001,11:531-539.
[12]Willie JT,CHemelli RM,Sinton CM,et al.Distinctnarcolepsy syndromes in Orexinnull micemolecu largenetic dissection of NonREM and REM sleepregulatory processes[J].Neuron,2003,38:715-730.
[13]Knudsen S,Gammeltoft S,Jennum PJ.Rapid eye movement sleep behavior disorder in patients with narcolepsy is associated with hypocretin-1 defciency[J].Brain,2010,2(133):568-579.
[14]Kiyashchenko LI,Mileykovskiyc BY,Lai YY,et al.Increased and decreased muscle tone with orexin(hypocretin)microinjections in the locus coeruleus and pontine inhibitory area[J].Neurophysio,2001,85(2):2008-2016.