发作性睡病患者自发性体动及体温昼夜特征分析

Circadian characteristics of spontaneous physical activity and body temperature in narcoleptic patients

目的探讨发作性睡病患者自发性体动及深部体温昼夜节律特点。方法共14例发作性睡病患者和14例性别、年龄相匹配的正常对照者，行夜间多导睡眠图监测和次日多次睡眠潜伏期试验（MSLT），体动记录仪连续监测自发性体动1～2周并每日记录睡眠日记，于昼夜20个时间点测量深部体温。结果与对照组相比，发作性睡病组患者夜间卧床时间增加（P=0．008），睡眠效率降低（P=0．001），入睡后觉醒次数增加（P=0．000）、觉醒时间延长（P=0．000），易出现睡眠始发的快速眼动睡眠（SOREMP，P=0．002）；MSLT试验中平均睡眠潜伏期缩短（P=0．000），SOREMPs次数增加（P=0．000）；夜间总活动量和活动度增加（均P=0．000），白天总活动量和活动度减少（均P=0．000），夜间与白天总活动量和活动度比值升高（均P=0．000）。两组受试者深部体温呈现明显昼夜节律变化，其中值、振幅和峰值相位差异均无统计学意义（P=0．177，0．730，0．488）。结论尽管发作性睡病患者存在明显的睡眠．觉醒节律和自发性体动的昼夜节律紊乱，但其对深部体温的影响并不显著，提示发作性睡病患者体温中枢的调节能力相对保留。

Objective To assess circadian characteristics of spontaneous physical activity and deep body temperature in narcoleptic patients. Methods Fourteen narcoleptic patients and 14 healthy age- and sex-matched control subjects were enrolled. Nocturnal polysomnography （PSG） was recorded, followed by standard multiple sleep latency test （MSLT）. Then all subjects were required to wear the actigraphy （actiwateh） at home with continuous monitoring of spontaneous physical activity for 1-2 weeks and complete the daily sleep record. All subjects＇ deep body temperatures were measured at 20 time points. Results In comparison with control subjects, PSG data suggested narcoleptic patients had significantly longer time in bed at night （P = 0.008）, decreased sleep efficiency （P = 0.001）, increased awakenings （P = 0.000）, extended wake time after sleep onset （P = 0.000） and sleep onset rapid eye movement period （SOREMP, P = 0.002）. MSLT data suggested decreased average sleep latency （P = 0.000） and increased SOREMPs （P = 0.000）. Actigraphy data suggested increased nocturnal activity and nocturnal activity per hour （P = 0.000, for all）, decreased daytime activity and daytime activity per hour （P = 0.000, for all） and increased nocturnal activity per hour/daytime activity per hour （P = 0.000, for all）. The deep body temperature in both groups showed significant circadian rhythms. The differences in mesor, amplitude and peak phase of deep body temperature between 2 groups had no statistical significance （P = 0.177, 0.730, 0.488）. Conclusions Narcoleptic patients are characterized by impaired circadian rhythm of sleep-wake and spontaneous physical activity. The limited effects on deep body temperature suggest the relative conservation of thermoregulation in narcolepsy.