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  

Clinical and polysomnogram analysis of 24 adult patients with narcolepsy and rapid eye movement sleep behavioral abnormalities

作　　者：张晓 刘畅[1] 孙海燕 赵丹阳 潘雪 王赞[1] 吕玉丹[1] ZHANG Xiao;LIU Chang;SUN Haiyan(Department of Neurology and Neuroscience,The First Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学白求恩第一医院神经内科和神经科学中心,吉林长春130021 [2]一汽总医院神经内科,吉林长春130021

出　　处：《中风与神经疾病杂志》2018年第6期541-544,共4页Journal of Apoplexy and Nervous Diseases

基　　金：吉林省科技厅优秀青年人才基金项目(No.20170520021JH)

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.

关 键 词：发作性睡病 快速眼动睡眠期 行为异常 多导睡眠监测 

分 类 号：R741[医药卫生—神经病学与精神病学]