静息-活动、睡眠-觉醒昼夜节律在人体和疾病中的变化及Actigaphy监测仪在临床的应用
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摘要
背景：许多生命现象都具有一定的节律性，称为生物节律。生物节律包括年节律、月节律和昼夜节律等。其中昼夜节律是生物体最基础的内源性生物节律，是机体适应环境的主要特征之一。在人类，昼夜节律对于心理和生理状态的维持具有重要作用。年节律或月节律的研究较少，月经周期是月节律的一个特征性代表。月经周期与昼夜节律的相互影响是极受关注的领域之一。但有关月经周期对昼夜节律的影响研究结果并不一致。
目的：研究自然生活环境下正常育龄期女性月经周期中睡眠-觉醒及静息-活动昼夜节律的变化。
方法：使用静息-活动监测仪(Actigraphy)和睡眠日志，调查12例自然生活状态下健康育龄期妇女在月经周期不同阶段中睡眠与活动节律的变化。所有受试者在一个月经周期中四次进入试验，每次均使用同一监测仪，连续佩带5-7天：①月经周期的第1-5天(行经期，Phase Ⅰ)，②月经周期的第11-15天(排卵期，PhaseⅡ)，③月经周期的第18-23天(黄体早期，Phase Ⅲ)，④月经周期的第25-28天(黄体晚期，PhaseⅣ)。基础体温测量及卵巢B超检查优势卵泡来确定排卵期。卵巢B超检查同时显示受试者生殖系统结构正常。
结果：排卵期睡眠潜伏期(SL)较黄体早期有延长趋势(19±18vs．9±6，p＜0.10)，但总体睡眠－觉醒节律参数在四期之间无统计学显著差异；而静息－活动节律方面，行经期日间稳定系数(IS)比黄体早期显著增加(p＜0.05)，排卵期与黄体晚期比较昼夜变异性(IV)有增加趋势(p＝0.10)。黄体早期日间活动开始时间明显较黄体晚期提前(p＜0.05)；黄体早期的活动峰值时相比围排卵期显著提前(p＜0.05)。
结论：1)自然生活状态下的青年妇女在月经周期的各阶段中睡眠总量及质量并无显著性差别，睡眠－觉醒的节律性亦无明显变异。2)月经周期可以影响静息－
安徽医科大学硕士学位论文
活动昼夜节律的时相，而总体静息一活动数量与质量未发生显著变化。
Background: The results of different studies of the menstrual-related sleep changes were inconsistent. The menstrual-related circadian sleep-wake and rest-activity rhythms changes are still uncertain. In present study, using actigraphic monitoring of wrist activity, we investigated the sleep-wake and rest-activity patterns of the normally menstrual cycle healthy women during reproductive life.
Objective: To investigate the circadian sleep-wake and rest-activity rhythms during the menstrual cycle of healthy reproductive women in nature life environment.
Method: Using actigraphic monitoring of wrist activity and sleep diary, we investigated the sleep-wake and rest-activity patterns of 12 normally cyclic healthy women during reproductive life. All subjects worn the actigraphy in wrist for 4 periods (5-7 days) during a menstrual cycle.(1)phase I : menstrual phase, 1-5 days of menstrual cycle; (2)phase II: peri-ovulation phase, 11-15 days; (3)phase III: early to mid-luteal phase, 18-23 days; (4)phase IV: late luteal phase, 25-28 days. In phase II the ovulation was determined by changes in body basal temperature and every subject was monitored with ultrasonography to help to ensure the phase according to the dimension of dominant follicle and to ensure the presence of a normal genital system.
Result: The variables of circadian sleep-wake pattern were similar in the four phases, except an increased tendency of the sleep latency in peri-ovulation phase compared with the early to mid-luteal phase (19 18 vs. 9 6, p<0.10). Concerning the
circadian patterning of rest-activity, the interdaily stability (IS) in menstrual phase was significantly higher compared with the early to mid luteal phase (p<0.05), and the intradaily variability (IV) in peri-ovulation phase has an increased tendency compared with the late luteal phase (p=0.01). In early to mid luteal phase, the M10 onset time was significantly earlier compared with the late follicular/peri-ovulation phase (p<0.05), and the cosinor peak time was significantly earlier compared with the late luteal phase (p<0.05).
Conclusion: The results suggest that the phase of circadian rest-activity rhythm is modulated by the menstrual cycle, while the quantity and quality of the rest-activity rhythm have no essential difference. The menstrual cycle have no effects on the circadian sleep-wake rhythm in normally cyclic healthy women.
目的：研究自然生活环境下正常育龄期女性月经周期中睡眠-觉醒及静息-活动昼夜节律的变化。
方法：使用静息-活动监测仪(Actigraphy)和睡眠日志，调查12例自然生活状态下健康育龄期妇女在月经周期不同阶段中睡眠与活动节律的变化。所有受试者在一个月经周期中四次进入试验，每次均使用同一监测仪，连续佩带5-7天：①月经周期的第1-5天(行经期，Phase Ⅰ)，②月经周期的第11-15天(排卵期，PhaseⅡ)，③月经周期的第18-23天(黄体早期，Phase Ⅲ)，④月经周期的第25-28天(黄体晚期，PhaseⅣ)。基础体温测量及卵巢B超检查优势卵泡来确定排卵期。卵巢B超检查同时显示受试者生殖系统结构正常。
结果：排卵期睡眠潜伏期(SL)较黄体早期有延长趋势(19±18vs．9±6，p＜0.10)，但总体睡眠－觉醒节律参数在四期之间无统计学显著差异；而静息－活动节律方面，行经期日间稳定系数(IS)比黄体早期显著增加(p＜0.05)，排卵期与黄体晚期比较昼夜变异性(IV)有增加趋势(p＝0.10)。黄体早期日间活动开始时间明显较黄体晚期提前(p＜0.05)；黄体早期的活动峰值时相比围排卵期显著提前(p＜0.05)。
结论：1)自然生活状态下的青年妇女在月经周期的各阶段中睡眠总量及质量并无显著性差别，睡眠－觉醒的节律性亦无明显变异。2)月经周期可以影响静息－
安徽医科大学硕士学位论文
活动昼夜节律的时相，而总体静息一活动数量与质量未发生显著变化。
Background: The results of different studies of the menstrual-related sleep changes were inconsistent. The menstrual-related circadian sleep-wake and rest-activity rhythms changes are still uncertain. In present study, using actigraphic monitoring of wrist activity, we investigated the sleep-wake and rest-activity patterns of the normally menstrual cycle healthy women during reproductive life.
Objective: To investigate the circadian sleep-wake and rest-activity rhythms during the menstrual cycle of healthy reproductive women in nature life environment.
Method: Using actigraphic monitoring of wrist activity and sleep diary, we investigated the sleep-wake and rest-activity patterns of 12 normally cyclic healthy women during reproductive life. All subjects worn the actigraphy in wrist for 4 periods (5-7 days) during a menstrual cycle.(1)phase I : menstrual phase, 1-5 days of menstrual cycle; (2)phase II: peri-ovulation phase, 11-15 days; (3)phase III: early to mid-luteal phase, 18-23 days; (4)phase IV: late luteal phase, 25-28 days. In phase II the ovulation was determined by changes in body basal temperature and every subject was monitored with ultrasonography to help to ensure the phase according to the dimension of dominant follicle and to ensure the presence of a normal genital system.
Result: The variables of circadian sleep-wake pattern were similar in the four phases, except an increased tendency of the sleep latency in peri-ovulation phase compared with the early to mid-luteal phase (19 18 vs. 9 6, p<0.10). Concerning the
circadian patterning of rest-activity, the interdaily stability (IS) in menstrual phase was significantly higher compared with the early to mid luteal phase (p<0.05), and the intradaily variability (IV) in peri-ovulation phase has an increased tendency compared with the late luteal phase (p=0.01). In early to mid luteal phase, the M10 onset time was significantly earlier compared with the late follicular/peri-ovulation phase (p<0.05), and the cosinor peak time was significantly earlier compared with the late luteal phase (p<0.05).
Conclusion: The results suggest that the phase of circadian rest-activity rhythm is modulated by the menstrual cycle, while the quantity and quality of the rest-activity rhythm have no essential difference. The menstrual cycle have no effects on the circadian sleep-wake rhythm in normally cyclic healthy women.
引文
1. Barton J, Folkard S, Smith L, Poole CJ. Effects on health of a change from a delaying to an advancing shift system. Occup Environ Med, 1994; 51 (11): 749～755
2. Shibui K, Uchiyama M, Okawa M, Kudo Y, Kim K, Liu X, Kamei Y, Hayakawa T, Akamatsu T, Ohta K, Ishibashi K. Diurnal fluctuation of sleep propensity and hormonal secretion across the menstrual cycle. Biol Psychiatry, 2000; 48(11):1062～1068
3. Bao AM, Liu RY, van Someren E J, Hofman MA, Cao YX, Zhou JN. Diurnal rhythms of free estradiol during the menstrual cycle. European Journal of Endocrinology, 2003; 148(2):227～232
4. Parry BL, Mendelson WB, Duncan WC, Sack DA, Wehr TA. Longitudinal sleep EEG, temperature, and activity measurements across the menstrual cycle in patients with premenstrual depression and in age-matched controls. Psychiatry Res, 1989; 30(3): 285～303
5. Tryon WW. Activity Measurement in Psychology and Meddicine, Plenum Press, New York. 1991
6. Binkley S. Wrist activity in a woman: daily, weekly, menstrual, lunar, annual cycles? Physiol Behav, 1992; 52(3): 411～421
7. van Someren E J, Swaab DF, Colenda CC, Cohen W, McCall WV, Rosenquist PB. Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patiensts by application of nonparametric methods. Chronobiol Int, 1999; 16(4): 505～518
8. Sokolove PG, Bushell WN. The chi square periodogram: its utility for analysis of circadian rhythms. J Theor Biol, 1978; 72(1): 131～160
9. Chang A, Kushida C, Palombini L, Carrillo O, Hindman J, Hong S, Hyde P, Guilleminault C. Comparison study of actigraphic, polysomnographic, and
subjective perception of sleep parameters. Sleep, 1999; 22:S43
10. Batschelet E. Circular statistics in biology. New York, NY: Academic Press Inc,1981, 169-177
11. Manber R, Bootzin RR. Sleep and the menstrual cycle. Health Psychol, 1997 May; 16(3):209～214
2. Shibui K, Uchiyama M, Okawa M, Kudo Y, Kim K, Liu X, Kamei Y, Hayakawa T, Akamatsu T, Ohta K, Ishibashi K. Diurnal fluctuation of sleep propensity and hormonal secretion across the menstrual cycle. Biol Psychiatry, 2000; 48(11):1062～1068
3. Bao AM, Liu RY, van Someren E J, Hofman MA, Cao YX, Zhou JN. Diurnal rhythms of free estradiol during the menstrual cycle. European Journal of Endocrinology, 2003; 148(2):227～232
4. Parry BL, Mendelson WB, Duncan WC, Sack DA, Wehr TA. Longitudinal sleep EEG, temperature, and activity measurements across the menstrual cycle in patients with premenstrual depression and in age-matched controls. Psychiatry Res, 1989; 30(3): 285～303
5. Tryon WW. Activity Measurement in Psychology and Meddicine, Plenum Press, New York. 1991
6. Binkley S. Wrist activity in a woman: daily, weekly, menstrual, lunar, annual cycles? Physiol Behav, 1992; 52(3): 411～421
7. van Someren E J, Swaab DF, Colenda CC, Cohen W, McCall WV, Rosenquist PB. Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patiensts by application of nonparametric methods. Chronobiol Int, 1999; 16(4): 505～518
8. Sokolove PG, Bushell WN. The chi square periodogram: its utility for analysis of circadian rhythms. J Theor Biol, 1978; 72(1): 131～160
9. Chang A, Kushida C, Palombini L, Carrillo O, Hindman J, Hong S, Hyde P, Guilleminault C. Comparison study of actigraphic, polysomnographic, and
subjective perception of sleep parameters. Sleep, 1999; 22:S43
10. Batschelet E. Circular statistics in biology. New York, NY: Academic Press Inc,1981, 169-177
11. Manber R, Bootzin RR. Sleep and the menstrual cycle. Health Psychol, 1997 May; 16(3):209～214