Hudson J I, Pope H G, Sullivan L E, Waternaux C M, Keck P E, Broughton R J
Clinical Neurophysiology Laboratory, McLean Hospital, Belmont, Massachusetts 02178.
Biol Psychiatry. 1992 Dec 1;32(11):958-75. doi: 10.1016/0006-3223(92)90058-8.
Primary insomnia, major depression, and narcolepsy are usually considered to be separate disorders, distinguished by different polysomnographic profiles. But do polysomnographic data provide adequate evidence to segregate the three disorders, or might they display fundamentally the same sleep disturbance, differing only in degree? To test the viability of these two alternate hypotheses, the authors performed a meta-analysis of controlled polysomnographic studies of these disorders. A summary measure of degree of sleep disturbance was constructed from five variables: wakefulness after sleep onset, percentage of stage 1 sleep, percentage of stage 3 + 4 sleep, rapid eye movement (REM) latency, and REM density. The results of available studies for each variable were combined using a weighted average of effect sizes. An overall "sleep disturbance index" was then calculated by combining the estimates for the five above listed variables. On both the individual measures and especially on the summary index, insomnia, depression, and narcolepsy were arrayed on a simple continuum of progressively more severe sleep disturbance--congruent with the clinical observation that these disorders display progressively more disturbed sleep. These findings suggest that sleep can be disturbed in only a limited number of ways: in evaluating sleep architecture, it may not be possible to elaborate much beyond a single axis of good-to-bad sleep. Thus, polysomnographic measures may not provide adequate evidence to classify insomnia, depression, and narcolepsy as separate entities.
原发性失眠、重度抑郁症和发作性睡病通常被认为是不同的疾病，可通过不同的多导睡眠图特征加以区分。但多导睡眠图数据是否能提供足够的证据来区分这三种疾病，或者它们是否可能表现出根本相同的睡眠障碍，只是程度不同而已？为了检验这两种不同假设的可行性，作者对这些疾病的对照多导睡眠图研究进行了荟萃分析。睡眠障碍程度的综合指标由五个变量构建而成：睡眠开始后的清醒时间、1期睡眠百分比、3 + 4期睡眠百分比、快速眼动（REM）潜伏期和REM密度。每个变量的现有研究结果通过效应量的加权平均值进行合并。然后通过合并上述五个变量的估计值来计算总体“睡眠障碍指数”。无论是在个体指标上，尤其是在综合指数上，失眠、抑郁症和发作性睡病都排列在一个睡眠障碍逐渐加重的简单连续体上——这与这些疾病睡眠障碍逐渐加重的临床观察结果一致。这些发现表明，睡眠可能只以有限的几种方式受到干扰：在评估睡眠结构时，可能无法在单一的从良好睡眠到不良睡眠的轴之外进行更详细的阐述。因此，多导睡眠图测量可能无法提供足够的证据将失眠、抑郁症和发作性睡病分类为不同的实体。
