成人癫痫患者睡眠结构的多导睡眠图研究

A Study of Sleep Architecture in Adult Patients with Epilepsy by Polysomnogram (PSG)

目的:使用多导睡眠图来研究癫痫患者的睡眠结构特征;探索癫痫活动与睡眠之间的关系。方法:回顾性分析54例的成人(年龄≥16岁)癫痫患者和58例正常对照的含16导脑电图的视频多导睡眠监测图,分别以性别、发作类型对癫痫组进行分组,进一步分析比较癫痫组和对照组、男女性癫痫组、不同发作类型癫痫组的各项睡眠结构参数。结果:1)与对照组比较,癫痫患者的WASO(16.90±14.32 VS 53.95±60.08,P<0.05)%、睡眠周期次数减少(3.65±1.40 VS 4.19±1.25,P<0.05)。2)与女性癫痫患者比较,男性癫痫患者的BMI(24.04±2.86 VS 20.08±3.01,P<0.05)、总觉醒时间(121.63±74.73 VS 77.26±59.47,P<0.05)、WASO(19.43±15.12 VS 12.24±11.71,P<0.05)%、AHI增加(15.25±20.09 VS7.93±16.35,P<0.05),睡眠效率下降(76.43±15.58 VS 84.98±11.84,P<0.05),N3睡眠期比例减少(11.57±8.79 VS16.04±6.76,P<0.05)。3)与全面性起源癫痫患者比较,局灶性起源癫痫患者的年龄较大(49.93±21.94 VS 33.25±14.42,P<0.05),夜间癫痫活动较多(76.2%VS 33.3%,P<0.05)。4)癫痫患者的夜间癫痫发作均发生N1、N2睡眠期;IEDs在N1、N2、N3、REM睡眠期的分布分别为37.0%、40.7%、14.8%、7.4%。结论:1)男性癫痫患者更易出现睡眠结构紊乱。2)癫痫活动在NREM睡眠期较为活跃,而在REM睡眠期受到抑制。

Objective： To analyze the characteristics of sleep architecture in epilepsy patients by polysomnogram（ PSG）. To explore the relationship between epileptic activities and sleep. Methods： This was a retrospective study. A total of 54 adult patients（ older than 16 years） meeting the clinical diagnostic criteria of epilepsy and 58 normal controls were included in the study. All subjects underwent overnight ambulatory video-polysomnography with 16 channel electroencephalograph（ EEG）. The epileptic patients were retrospectively divided into two groups according to the sex,epilepsy type. The parameters of sleep architecture were analyzed between epileptics and normal controls,male and female epileptics,generalized epilepsy and focal epilepsy,separately. Results： 1） Compared with controls,epileptic patients had a decrease in the wake after sleep open（ WASO） % and the number of sleep cycle（ 16. 90 ± 14. 32 VS 53. 95 ± 60. 08,3. 65 ± 1. 40 VS 4. 19 ± 1. 25,P 〈 0. 05）. 2） Compared with female epileptics,male epileptics had an increase in body mass index（ BMI）,total arouse time,WASO%,apnea hypopnea index（ AHI）（ 24. 04 ± 2. 86 VS 20. 08 ± 3. 01,121. 63 ± 74. 73 VS 77. 26 ± 59. 47,19. 43 ± 15. 12 VS 12. 24 ± 11. 71,15. 25 ± 20. 09 VS 7. 93 ± 16. 35,P 〈 0. 05）,and a decrease in sleep efficiency and N3%（ 76. 43 ± 15. 58 VS 84. 98 ± 11. 84,11. 57 ± 8. 79 VS 16. 04 ± 6. 76,P 0. 05）. 3） Compared with generalized epileptic patients,focal epileptic patients had an increase in age and epileptic activity（ 49. 93 ± 21. 94 VS 33. 25 ± 14. 42,76. 2% VS 33. 3%,P 〈 0. 05）. 4） Nocturnal seizures in epilepsy occurred during N1 or N2 sleep stage. The distribution of interictal epileptic discharges（ IEDs） in N1,N2,N3,and REM sleep stage were 37. 0%,40. 7%,14. 8%,37. 0%,respectively. Conclusion： 1） The sleep architecture disorder had an adverse occurrence in male epileptics. 2） Nocturnal epileptic activities were activated in NREM sleep stage,but inhibited in REM sleep stage.