创伤性脑损伤中睡眠障碍的患病率及后果
Prevalence and consequences of sleep disorders in traumatic brain injury.
作者信息
Castriotta Richard J, Wilde Mark C, Lai Jenny M, Atanasov Strahil, Masel Brent E, Kuna Samuel T
机构信息
Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston, TX 77030, USA.
出版信息
J Clin Sleep Med. 2007 Jun 15;3(4):349-56.
STUDY OBJECTIVES
Determine prevalence and consequences of sleepiness and sleep disorders after traumatic brain injury (TBI).
METHODS
Prospective evaluation with polysomnography (PSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS) and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ).
SETTING
Three academic medical centers with level I trauma centers, accredited sleep disorders centers, and rehabilitative medicine programs. Participants; Eighty-seven (87) adults at least 3 months post TBI.
MEASUREMENTS AND RESULTS
Abnormal sleep studies were found in 40 subjects (46%), including 20 (23%) with obstructive sleep apnea (OSA), 10 (11%) with posttraumatic hypersomnia (PTH), 5 (6%) with narcolepsy, and 6 (7%) with periodic limb movements in sleep (PLMS). Among all subjects, 22 (25%) were found to have objective excessive daytime sleepiness with MSLT score <10 minutes. There was no correlation between ESS score and MSLT (r = 0.10). There were no differences in age, race, sex, or education between the sleepy and non-sleepy subjects. Likewise, there were no differences in severity of injury or time after injury between sleepy and non-sleepy subjects. Sleepy subjects had a greater body mass index (BMI) than those who were not sleepy (p = 0.01). OSA was more common in obese subjects (BMI > or =30, p < 0.001). Sleepy subjects demonstrated poorer PVT scores (p < 0.05), better self-reported sleep related quality of life (FOSQ scores [p < 0.05]), and no differences in POMS.
CONCLUSIONS
There is a high prevalence of sleep disorders (46%) and of excessive daytime sleepiness (25%) in subjects with TBI. Sleepy subjects may be more impaired than comparable non-sleepy TBI subjects, yet be unaware of problems. Given the high prevalence of OSA (23%), PTH (11%), and narcolepsy (7%) in this population, there is a clinical indication for NPSG and MSLT.
研究目的
确定创伤性脑损伤（TBI）后嗜睡和睡眠障碍的患病率及后果。
方法
采用多导睡眠图（PSG）、多次睡眠潜伏期试验（MSLT）、爱泼沃斯思睡量表（ESS）进行前瞻性评估，并进行神经心理学测试，包括精神运动警觉性测试（PVT）、情绪状态剖面图（POMS）和睡眠功能结果问卷（FOSQ）。
研究地点
三个拥有一级创伤中心、经认可的睡眠障碍中心和康复医学项目的学术医疗中心。参与者：87名TBI后至少3个月的成年人。
测量与结果
40名受试者（46%）睡眠研究异常，其中20名（23%）患有阻塞性睡眠呼吸暂停（OSA），10名（11%）患有创伤后嗜睡症（PTH），5名（6%）患有发作性睡病，6名（7%）患有睡眠期周期性肢体运动（PLMS）。在所有受试者中，22名（25%）通过MSLT评分<10分钟被发现存在客观的日间过度嗜睡。ESS评分与MSLT之间无相关性（r = 0.10）。嗜睡和非嗜睡受试者在年龄、种族、性别或教育程度上无差异。同样，嗜睡和非嗜睡受试者在损伤严重程度或受伤时间上也无差异。嗜睡受试者的体重指数（BMI）高于非嗜睡者（p = 0.01）。OSA在肥胖受试者中更常见（BMI≥30，p < 0.001）。嗜睡受试者的PVT评分较差（p < 0.05），自我报告的睡眠相关生活质量较好（FOSQ评分[p < 0.05]），POMS无差异。
结论
TBI受试者中睡眠障碍（46%）和日间过度嗜睡（25%）的患病率很高。嗜睡受试者可能比可比的非嗜睡TBI受试者受损更严重，但却未意识到问题。鉴于该人群中OSA（23%）、PTH（11%）和发作性睡病（7%）的高患病率，有临床指征进行整夜多导睡眠图（NPSG）和MSLT检查。
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