矛盾性失眠患者日间觉醒程度及与相关睡眠指标的关系

The daytime alertness and its correlation with sleep parameters in patients with paradoxical insomnia

目的探讨矛盾性失眠患者的日间觉醒程度及与相关睡眠指标的关系。方法对符合DSM-Ⅳ原发性失眠诊断标准的129例患者进行整夜多导睡眠监测（polysomnography，PSG）及日间多次睡眠潜伏期测试，并在次日晨起询问其主观睡眠情况。根据PSG及主观睡眠情况，将受试者分为矛盾性失眠组（55例）和非矛盾性失眠组（74例），运用t检验比较2组患者主客观睡眠质量及日间觉醒程度的差异。结果与非矛盾性失眠组比较，矛盾性失眠组患者睡眠知觉更低[（49.37±22.55）%比（60.86±37.13）%；t=3.91,P〈0.01]，客观睡眠时间更长（t=-8.25, P〈0.01）、快眼动睡眠潜伏期更短（t=3.19, P〈0.01）、入睡后觉醒时间更短（t=8.90, P〈0.01）、平均睡眠潜伏期更短[（10.97±5.22）min比（12.72±4.52） min；t=2.04, P=0.04]；矛盾性失眠组患者平均睡眠潜伏期与快眼动睡眠潜伏期呈正相关，与睡眠知觉呈负相关（r=0.36, P〈0.01；r=-0.30, P〈0.05）。结论与非矛盾性失眠患者相比，矛盾性失眠患者客观睡眠质量更好，不存在明显的日间高觉醒，其觉醒水平与睡眠知觉呈负相关。

Objective To explore the daytime alertness and its correlation with sleep parameters in patients with paradoxical insomnias（PI）. Method A total of 129 patients meeting DSM-Ⅳ primary insomnia criteria were divided into paradoxical insomnia group （PI, n=55） and non-paradoxical insomnia group （NPI, n=74）. The one night polysomnography （PSG）, daytime multiple sleep latency test （MSLT）,and the subjective sleep perception measured by a morning self-rated questionnaire were reviewed and compared between two groups. Result Compared to NPI group, PI group had lower sleep perception（（49.37±22.55） % vs.（60.86±37.13）%; t=3.91, P〈0.01） , longer total sleep time （t=-8.25, P〈0.01） , shorter rapid eye movement sleep latency（t=3.19, P〈0.01） and shorter daytime mean sleep latency （（10.97±5.22） min vs. （12.72±4.52） min; t=2.04, P=0.04）. In the PI group, daytime mean sleep latency negatively correlated with sleep perception （r=-0.30, P〈0.05） and positively correlated with rapid eye movement sleep latency （r=0.36, P〈0.01） . Conclusion PI patients may have better objective sleep quality than NPI patients. Daytime hyperarrousal is absent in PI patients. The alertness level of PI patients negatively correlates with sleep perception.