慢性失眠患者中脑小血管病临床特征分析  

Clinical features in chronic insomnia comorbidity with silent cerebral small vessel disease

作　　者：王继辉[1] 李冠英[1] 阮恒芳[2] 李莉莉[2] 陈小东 门雪娇[2] 卢婷婷[2] 陆正齐[2] Wang Jihui;Li Guanying;Ruan Hengfang;Li Lili;Chen Xiaodong;Men Xuejiao;Lu Tingting;Lu Zhengqi(Department of Psychiatry,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院精神科,广州510630 [2]中山大学附属第三医院神经内科,广州510630

出　　处：《中国脑血管病杂志》2019年第10期514-519,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析慢性失眠患者中脑小血管病(CSVD)的临床特征。方法行横断面研究,连续纳入2018年1月至2019年4月中山大学附属第三医院精神科和神经内科门诊及住院的符合纳入标准的失眠患者100例,年龄52~75岁,入组2周内完成头部MRI、多导睡眠监测、蒙特利尔认知评估量表(MoCA)测评及视觉模拟评分法评定主观症状。共病CSVD者为研究组(28例),单纯失眠者为对照组(72例),比较两组之间症状、多导睡眠监测参数、认知功能等的差异。结果研究组主观症状中仅头晕评分[7.0(4.5,8.0)分比4.0(2.0,6.0)分]高于对照组;多导睡眠监测入睡后觉醒时间[105.8(66.7,141.3)min比70.1(35.4,116.8)min]、觉醒指数[(29±8)次/h比(21±6)次/h]、非快速眼动睡眠-1比例[(15±4)%比(10±3)%]高于对照组,睡眠效率[(67±18)%比(75±15)%]低于对照组;MoCA总分[19.0(15.0,24.0)分比23.5(17.0,26.5)分]、视空间评分[2.0(1.0,3.0)分比2.5(1.5,3.0)分]、执行功能评分[2.0(1.0,3.0)分比2.5(2.0,3.0)分]、短时记忆评分[2.5(1.0,4.0)分比3.0(2.0,4.0)分]低于对照组;组间差异均有统计学意义(均P<0.05)。结论慢性失眠共病CSVD在中老年人群中占一定比例,主观症状隐蔽,需要从认知评估、睡眠监测等方面进行鉴别。Objective To investigate the clinical features of chronic insomnia patients with cerebral small vessel disease (CSVD).Methods This cross-sectional study consecutively enrolled one hundred out-patient and in-patient patients meeting the diagnostic criteria of chronic insomnia at the department of psychiatry and neurology in the third affiliated hospital,Sun Yet-sen University from January 2018 to April 2019.The patients (52 - 75 years) received magnetic resonance (MR),polysomnography (PSG),Montreal Cognitive Assessment (MoCA) in two weeks after enrollment.The subjective symptoms were evaluated by visual analogue scale (VAS).Patients with comorbid CSVD were in the experimental group (28 cases),while those with simple insomnia were in the control group (72 cases).The differences of symptoms,PSG parameters and cognitive function between the two groups were compared.Results In the experimental group,only dizziness of subjective symptoms was higher than that in the control group (7.0 [4.5,8.0] vs.4.0 [2.0,6.0]).The experimental group also had higher PSG monitored awakening time after sleep (105.8 [66.7,141.3] min to 70.1 [35.4,116.8] min),arousal index ([29±8] times/h vs.[21±6] times/h),ratio of nonrapid eye movement sleep 1 phase ([15±4]% vs.[10±3]%) than the control group,but lower sleep efficiency ([67±18]% vs.[75±15]%).The total MoCA score (19.0 [15.0,24.0] to 23.5 [17.0,26.5]),visuospatial score (2.0 [1.0,3.0] vs.2.5 [1.5,3.0]),executive function score (2.0 [1.0,3.0] vs.2.5 [2.0,3.0]) and short-term memory score (2.5 [1.0,4.0] vs.3.0 [2.0,4.0]) in the study group were significantly lower than that in the control group ( P <0.05).Conclusion Chronic insomnia with CSVD is common with concealing subjective symptoms,and it needs to be identified from the aspects of cognitive assessment and sleep monitoring.

关 键 词：脑小血管病 慢性失眠 小动脉硬化 诊断 认知功能 

分 类 号：R740[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]