酒依赖患者的睡眠生理及睡眠行为特征客观生理学测试的准确性

Characteristics of sleep physiology and sleep behavior in patients with alcohol dependence:Accuracy of objective physiological test

目的:酒依赖患者可引起睡眠行为及睡眠生理变化,应用主观问卷和客观睡眠生理学测试可评估其特征。方法:选择1999-07/2003-12在常州市解放军第102医院精神医学中心住院的酒依赖患者26例作为酒依赖组,均为男性,年龄33～58岁;选择22例男性健康志愿者为对照组,年龄29～55岁。两组观察对象均知情同意。采用自行设计的睡眠行为调查表调查两组睡眠行为指标,包括入睡困难、早醒、睡眠维持困难和睡眠过多。应用全夜多导睡眠图检测两组睡眠进程及结构的参数。全部受试者于21:30进入实验室,第1晚预睡,第2晚放置电极进行多导睡眠图检查。结果:酒依赖组有3例患者在停药后精神症状仍重而剔除,进入结果分析酒依赖组和正常对照组分别为23和22例。①入睡困难、早醒、睡眠维持障碍发生率:酒依赖组较对照组显著增高犤(83%,61%,91%);(14%,9%,18%,),(χ2=10.99～21.48,P<0.01)犦。②多导睡眠图检测结果:酒依赖组睡眠潜伏期较对照组延长犤(44.9±6.0)min,(24.7±4.7)min,(t=12.5,P<0.01)犦,醒觉次数、醒觉时间及Ⅰ期睡眠占总睡眠时间比例犤(5.2±1.5)次,(54.3±11.6)min,(15.9±1.9)%犦较对照组增多犤(2.4±0.4)次,(20.4±4.1)min,(7.2±0.6)%,(t=13.6～15.1,P<0.01)犦。酒依赖组睡眠效率、睡眠维持率及Ⅲ,Ⅳ期深睡眠占总睡眠时间比例犤(71.5±4.9)%,(80.3±3.9)%,(8.9±2.1)%犦较对照组减少犤(90.0±2.3)%,(90.8±3.3)%,(17.7±7.5)%,(t=5.62～15.8,P<0.01)犦。结论:酒依赖患者在睡眠行为及睡眠生理上存在着显著的异常变化,说明长期滥用酒精可能会引起睡眠行为及睡眠生理障碍,而睡眠障碍会加重酒依赖者中枢神经系统的改变,支持长期过量饮酒会造成中枢神经系统损害的论点。

AIM： Alcohol dependence can cause the changes of sleep behavior and sleep physiology. This study was aimed to evaluate the characteristics by means of subjective questionnaire and objective sleep physiological tests.METHODS： Twenty-six male patients with alcohol dependence（alcohol dependence group） at 33 to 58 years of age, who were hospitalized in the Mental Health Center of the 102 Hospital of Chinese PLA between July 1999 and December 2003, and 22 healthy male volunteers （control group） at 29 to 55 years of age agreed to participate in the study. The self-designed sleep behavior inventory was used in both groups to investigate the indexes of sleep behavior,including difficulty in falling asleep, early wake-up, difficulty in sleep maintenance and excessive sleep. The indexes of sleep process and structure in both groups were detected with overnight polysomnogram.All the testees entered the laboratory at 21：30, they slept in the first night, and electrode was placed to perform exam of polysomnogram in the second night.RESULTS： Three cases in the alcohol dependence group were deleted for they still had severe mental symptoms after drug withdrawal; so 23 cases in the alcohol dependence group and 22 cases in the control group were involved in the analysis of results. ① The occurrence rates of difficulty in falling asleep, early wake-up and difficulty in sleep maintenance were significantly higher in the alcohol dependence group than in the control group [（83%, 61%, 91%）; （14%, 9%, 18%）; x^2=10.99 to 21.48, P 〈 0.01]. ② The results of polysomnogram detection： The sleep latency was prolonged in the alcohol dependence group as compared with the control group [（44.9±6.0）, （24.7±4.7） minutes, t=12.3,P 〈 0.01]; The number of wake-up times, time of wake up and proportion of stage1 Ⅰ sleep time to total sleep time were in the alcohol dependence group were increased as compared with those in the control group [（5.2±1.5） times, （54.3±11.6） minutes, （15.9±1.9）%;（2.4±0.4） times, （20.4±4.1） minutes, （7.2±0.6）%, t=13.6 to 15.1, P 〈 0.01].The sleep effectiveness, rate of sleep maintenance and the proportion of stage Ⅳ deep sleep time to total sleep time were decreased in the alcohol dependence group as compared with the control group[（71.5±4.9）%, （80.3±3.9）%, （8.9±2.1）%： （90.0±2.3）%, （90.8±3.3）%,（17.7±7.5） %, t=5.62 to 15.8, P〈 0.01].CONCLUSION： Patients with alcohol dependence have significant abnormal c, hanges in sleep behavior and sleep physiology, it is indicated that long-term alcohol abuse may cause disorders of sleep behavior and sleep physiology, and sleep disorder will aggravate the changes of central nerve system in patients with alcohol dependence.The view that long-term excessive alcohol-drinking can lead to damage of central nerve system is supported in the study.