发作性睡病快眼动睡眠期肌张力失弛缓特征与临床表征  

Relationship between the characteristics of dystonia and clinical manifestations in narcolepsy during rapid eye movement sleep

作　　者：翟怡[1] 詹淑琴[1] 王玉平[1] 张益萌 丁岩[1] 赵昕[1] 刘江红[1] 李宁[1] Zhai Yi;Zhan Shuqin;Wang Yuping;Zhang Yimeng;Ding Yan;Zhao Xin;Liu Jianghong;Li Ning(Department of Neurology,the Capital Medical University Xuanwu Hospital,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,脑功能疾病调控治疗北京市重点实验室,北京100053

出　　处：《脑与神经疾病杂志》2021年第9期529-533,共5页Journal of Brain and Nervous Diseases

基　　金：国家自然科学基金项目(81571294,81771398,82001388,81301138);科技部重点研发计划(2019YFC0121202);中国睡眠研究会项目:阿戈美拉丁治疗快速眼动期行为障碍的临床研究。

摘　　要：目的通过分析发作性睡病(NT)患者多导睡眠监测(polysomnography,PSG)中快眼动睡眠期(REM)肌张力失弛缓(RWA)现象,研究其与NT临床表现的关系。方法纳入自2018年3月至2021年3月于首都医科大学宣武医院神经内科睡眠门诊就诊并确诊为NT的患者82例。对其进行睡眠问卷调查、多导睡眠监测(PSG)及多次小睡潜伏期实验(MSLT)检查,并计算REM期肌张力失弛缓(RWA)指数。结果发作性睡病1型(NT1):41例50%;发作性睡病2型(NT2):41例50%。病程:≤1年者NT1(25/41)60.98%,NT2(16/41)39.02%。全部患者中RWA指数增高者[RWA(+)](37/82)45.12%,其中NT1 RWA(+)(25/41)60.98%,NT2 RWA(+)(12/41)29.27%。全部患者中伴有快眼动睡眠期行为异常(RBD)者[RBD(+)]为(37/82)45.12%,其中NT1 RBD(+)(24/41)58.53%,NT2 RBD(+)(13/41)31.71%。全部患者中睡眠中生动梦境或噩梦者(+)(51/82)62.20%,其中NT1(36/41)87.80%,NT2(15/41)36.59%。结论NT中NT1患者就诊时病程更短,伴有RWA指数增高的比例、伴有RBD的比例均高于NT2,更易伴有生动梦境或噩梦。RWA指数增高者更易伴猝倒及生动梦境或噩梦,提示产生RWA的病理生理机制与NT猝倒及生动梦境或噩梦的产生具有相关性,RWA可作为NT患者病情监测及评估的一个客观有效指标。RWA可作为NT临床分型的参考,对发NT电生理诊断具有较高临床价值。Objective To study the correlation between rapid eye movement(REM)sleep without atonia(RWA)and the clinical manifestations of narcolepsy(NT)by analyzing RWA in the polysomnography(PSG)of patients with NT.Methods From March 2018 to March 2021,82 patients who visited the sleep clinic of the department of NT of Xuanwu hospital and were diagnosed with NT were counted.All patients accepted sleep scale evaluation,PSG and multiple sleep latency test(MSLT)examination,and the RWA index was counted.Results NT type 1(NT1):50%(41 patients);NT type 2(NT2):50%(41 patients).Clinical course:less than 1 year:NT1:60.98%(25/41),NT2:39.02%(16/41).Among all patients,the percentage of those whose RWA index increased[RWA(+)]was 45.12%(37/82).In detail,the proportion of RWA(+)in NT1 was 60.98%(25/41)and in NT2 was 29.27%(12/41).RBD was present in 45.12%(37/82)of total patients,the percentage of RBD(+)was 58.53%(24/41)in NT1 patients and 31.71(13/41)%in NT2 patients.62.20%(51/82)of all patients had vivid dreams or nightmares during sleep.Specifically,87.80%(36/41)of patients with NT1 and 36.59%(15/41)of patients with NT2 suffered such dreams.Conclusions Compared with patients who have NT2,patients have NT1 suffer shorter clinical course,have higher proportion of patients with RWA(+)and RBD(+),and are more likely to suffer vivid dreams or nightmares.Those who have an increased RWA index are more likely to suffer cataplexy and vivid dreams or nightmares,suggesting that the pathophysiological mechanism of RWA is related to cataplexy in NT and vivid dreams or nightmares.RWA can be used as an objective and effective indicator for monitoring and evaluating patients with NT.RWA can be used as a reference for clinical classification of NT and has high clinical value for electrophysiological diagnosis of NT.

关 键 词：发作性睡病 REM期肌张力失弛缓 多导睡眠监测 多次小睡潜伏期试验 

分 类 号：R746.9[医药卫生—神经病学与精神病学]