Lockley Steven W, Dijk Derk-Jan, Kosti Ourania, Skene Debra J, Arendt Josephine
School of Biomedical and Molecular Sciences, University of Surrey, Guildford, UK.
J Sleep Res. 2008 Jun;17(2):207-16. doi: 10.1111/j.1365-2869.2008.00656.x.
Blind people report disturbances in alertness, mood and performance. In laboratory studies, these waking functions can only be maintained when the wake-dependent deterioration is opposed by appropriately-timed endogenous circadian rhythms. We aimed to quantify whether variations in waking function experienced by blind people living in society were dependent on the phase relationship between the sleep-wake cycle and the circadian pacemaker. The time course of alertness, mood and performance was assessed in 52 blind subjects with and without circadian rhythm disorders every 2 h for 2 days per week for 4 weeks. Sleep-wake timing and circadian phase were assessed from diaries and weekly measurements of urinary 6-sulphatoxymelatonin rhythms, respectively. In those subjects who woke at either a normal circadian phase (n = 26) or abnormally early (n = 5), alertness, mood and performance deteriorated significantly with increased time awake (P < 0.05). In 17 non-entrained ('free-running') subjects, waking function varied significantly with circadian phase such that subjects rated themselves most sleepy (P = 0.03) and most miserable (P = 0.02) when they were awake during the time of peak melatonin production. The internal phase relationship between sleep-wake behaviour and the circadian melatonin rhythm in entrained subjects contributed to predictable differences in the daily profile of alertness, mood and performance. Disruption of this phase relationship in non-entrained blind individuals with circadian rhythm sleep disorders resulted in impaired waking function during the day equivalent to that usually only experienced when awake during the night. Treatment for circadian rhythm disorders should be targeted in normalizing these phase relationships.
盲人报告存在警觉性、情绪和表现方面的障碍。在实验室研究中，只有当内源性昼夜节律适时对抗与清醒相关的机能衰退时，这些清醒状态下的机能才能得以维持。我们旨在量化生活在社会中的盲人所经历的清醒机能变化是否依赖于睡眠 - 清醒周期与昼夜节律起搏器之间的相位关系。对52名有或没有昼夜节律障碍的盲人受试者，每周2天，每天每2小时评估一次警觉性、情绪和表现的时间进程，持续4周。分别根据日记以及每周测量的尿6 - 硫酸氧褪黑素节律来评估睡眠 - 清醒时间和昼夜节律相位状况。在那些在正常昼夜节律相位醒来的受试者（n = 26）或异常早醒的受试者（n = 5）中，随着清醒时间增加，警觉性、情绪和表现显著恶化（P < 0.05）。在17名无节律同步（“自由运转”）的受试者中，清醒机能随昼夜节律相位有显著变化，以至于当他们在褪黑素分泌高峰时段清醒时，自我感觉最困倦（P = 0.03）且最难受（P = 0.02）。节律同步的受试者中，睡眠 - 清醒行为与昼夜褪黑素节律之间的内部相位关系导致了警觉性、情绪和表现在每日变化模式上的可预测差异。在患有昼夜节律睡眠障碍的无节律同步的盲人个体中，这种相位关系的破坏导致白天清醒机能受损，程度等同于通常仅在夜间清醒时所经历的情况。昼夜节律障碍的治疗应旨在使这些相位关系正常化。
