慢性创伤性脑损伤中的睡眠障碍
Sleep disorders in chronic traumatic brain injury.
作者信息
Verma Arunima, Anand Vivek, Verma Narayan P
机构信息
B. G. Tricounty Neurology and Sleep Clinic, Warren, MI, USA.
出版信息
J Clin Sleep Med. 2007 Jun 15;3(4):357-62.
STUDY OBJECTIVE
To examine the spectrum of sleep disorders in patients with chronic traumatic brain injury (TBI) and determine if the severity of sleep disorder is related to severity of chronic TBI.
METHODS
Patients who underwent evaluation for sleep disorder/s following a TBI were included in this retrospective analysis. Sixty adult patients with TBI (age 20-69 yr; 38 M and 22 F), who presented with sleep-related complaints 3 months to 2 years following TBI, were studied. None had sleep complaints prior to the TBI. Orophrayngeal, chin, and TMJ examinations were considered benign. The severity of injury was assessed by the Global Assessment of Functioning (GAF) scale. Polysomnograms (PSGs) were performed on 54 patients (90%), 28 of whom underwent multiple sleep latency tests (MSLTs) because they scored >11 on the Epworth Sleepiness Scale (ESS). The Beck Depression Inventory (BDI) scale was administered if there was sleep maintenance insomnia, and the Hamilton Anxiety Scale (HAS) was administered if there was sleep onset insomnia.
RESULTS
The TBI severity was mild in 40%, moderate in 20%, and severe in 40%. The Epworth Sleepiness Scale (ESS) score was elevated (>11) in 52%. Hypersomnia was the presenting complaint in 50%, mostly due to sleep apnea, narcolepsy, and periodic limb movement disorder (PLMD). Insomnia was the presenting complaint in 25%, half with sleep maintenance insomnia and high BDI scores, and the remainder with sleep onset insomnia and high HAS scores. Parasomnia was the presenting complaint in 25%; the most frequent parasomnia was REM behavior disorder (RBD). GAF scores were significantly correlated (p < 0.05) with some of the measures of sleep disruption (stage 1, sleep efficiency, and wake during sleep), but not with others (wake before sleep, stage-shifts, PLMI, PLMA and AHI) on the PSG. Fifty-three percent (15/28) had a mean sleep onset latency <5 minutes, and 32% (9/28), also had two or more sleep onset rapid eye movement periods (SOREMPs) on the MSLT.
CONCLUSION
The results of this study demonstrate that a full spectrum of common sleep disorders occurs in patients with chronic TBI. The severity of chronic TBI as measured by GAF scores is correlated with some of the measures of sleep disruption but not others, indicating a complex and multifactorial pathogenesis.
研究目的
研究慢性创伤性脑损伤（TBI）患者的睡眠障碍谱，并确定睡眠障碍的严重程度是否与慢性TBI的严重程度相关。
方法
本回顾性分析纳入了因TBI后接受睡眠障碍评估的患者。研究了60例成年TBI患者（年龄20 - 69岁；男性38例，女性22例），这些患者在TBI后3个月至2年出现与睡眠相关的主诉。TBI之前均无睡眠主诉。口咽部、下巴和颞下颌关节检查均正常。采用功能总体评定量表（GAF）评估损伤严重程度。54例患者（90%）进行了多导睡眠图（PSG）检查，其中28例因Epworth嗜睡量表（ESS）评分>11而接受了多次睡眠潜伏期试验（MSLT）。如果存在睡眠维持性失眠，则使用贝克抑郁量表（BDI）；如果存在入睡性失眠，则使用汉密尔顿焦虑量表（HAS）。
结果
40%的TBI严重程度为轻度，20%为中度，4%为重度。52%的患者Epworth嗜睡量表（ESS）评分升高（>11）。50%的患者以过度嗜睡为主诉，主要原因是睡眠呼吸暂停、发作性睡病和周期性肢体运动障碍（PLMD）。25%的患者以失眠为主诉，其中一半为睡眠维持性失眠且BDI评分高，其余为入睡性失眠且HAS评分高。25%的患者以异态睡眠为主诉；最常见的异态睡眠是快速眼动睡眠行为障碍（RBD）。GAF评分与PSG上的一些睡眠中断指标（第1阶段、睡眠效率和睡眠期间觉醒）显著相关（p < 0.05），但与其他指标（睡前觉醒、阶段转换、周期性肢体运动指数、周期性肢体运动次数和呼吸暂停低通气指数）无关。53%（15/28）的患者平均入睡潜伏期<5分钟，32%（9/28）的患者在MSLT上也有两个或更多的入睡快速眼动期（SOREMPs）。
结论
本研究结果表明，慢性TBI患者存在一系列常见的睡眠障碍。用GAF评分衡量的慢性TBI严重程度与一些睡眠中断指标相关，但与其他指标无关，这表明其发病机制复杂且具有多因素性。
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