Edinger J D, Marsh G R, McCall W V, Erwin C W, Lininger A W
Veterans Administration, Durham, North Carolina 27705.
Sleep. 1991 Feb;14(1):13-7.
Twenty patients with difficulties initiating and maintaining sleep (DIMS) were monitored in their homes for three consecutive nights using ambulatory polysomnography (PSG). Following each night of monitoring, patients provided subjective ratings of sleep disturbance and tolerance of the PSG equipment. Friedman analyses of variance performed on the objective and subjective parameters showed that the sample, as a whole, evidenced no systematic first night effects (FNE) in response to monitoring. Inspection of the data from each individual subject, nevertheless, showed that half of the sample did experience multiple FNE. Further, several scales from the Minnesota Multiphasic Personality Inventory discriminated those patients who showed multiple FNE from those who did not. However, far more striking was the finding that clinically and statistically significant intrasubject variability across nights was observed for each sleep parameter measured. Given this finding, a single ambulatory PSG study may not fully convey the nature of the sleep disturbance experienced by the DIMS patient even when FNE are absent. We thus, recommend multiple ambulatory sleep studies for those clinical and research situations in which it is necessary to document patients' night-to-night sleep variability. In contrast, when the goal of the PSG study is that of determining a sleep diagnosis, a single ambulatory study, in combination with other clinical data, may be sufficient.
二十名存在入睡和维持睡眠困难（DIMS）的患者在家中连续三晚使用便携式多导睡眠图（PSG）进行监测。在每晚监测之后，患者对睡眠干扰和PSG设备的耐受性提供主观评分。对客观和主观参数进行的弗里德曼方差分析表明，作为一个整体，该样本在对监测的反应中未显示出系统性的首夜效应（FNE）。然而，对每个个体受试者的数据检查显示，样本中有一半确实经历了多次首夜效应。此外，明尼苏达多相人格问卷中的几个量表区分了那些出现多次首夜效应的患者和未出现的患者。然而，更引人注目的发现是，对于所测量的每个睡眠参数，在各晚之间观察到了临床上和统计学上显著的受试者内变异性。鉴于这一发现，即使没有首夜效应，单次便携式PSG研究可能也无法完全传达DIMS患者所经历的睡眠障碍的性质。因此，我们建议对于那些有必要记录患者夜间睡眠变异性的临床和研究情况，进行多次便携式睡眠研究。相比之下，当PSG研究的目标是确定睡眠诊断时，单次便携式研究结合其他临床数据可能就足够了。
