Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.
Sleep Med. 2009 Dec;10(10):1146-50. doi: 10.1016/j.sleep.2009.03.008. Epub 2009 May 21.
Short mean latencies to the first epoch of non-rapid eye movement sleep stage 1 (NREM1) and the presence of >or= 2 sleep onset REM (SOREM) periods on multiple sleep latency test (MSLT) occur in both narcolepsy-cataplexy (NC) and behaviourally induced insufficient sleep syndrome (BIISS). It is not known whether specific MSLT findings help differentiate the two disorders.
We analyzed MSLT data including sleep latencies to and between different sleep stages of 60 age-, gender- and body mass index (BMI)-matched subjects (hypocretin-deficient NC, actigraphy-confirmed BIISS, healthy controls: each 20).
Mean latency (in minutes) to NREM1 sleep was significantly shorter in NC (1.8+/-1.5) than in BIISS (4.7+/-2.1, p<0.001) and controls (11.4+/-3.3, p<0.001). Mean latency to NREM2 sleep was similar in NC (8.6+/-4.7) and BIISS (8.1+/-2.7, p=0.64); latency to either NREM2 or rapid eye movement (REM) sleep (i.e., the sum of the sleep latency to NREM1 and the duration of the first NREM1 sleep sequence), however, was shorter in NC (4.4+/-2.9) than in BIISS (7.9+/-3.5, p<0.001). Referring to all naps with SOREM periods, the sequence NREM1-REM-NREM2 was more common (71%) in NC than in BIISS (15%, p<0.001), reflecting the shorter latency from NREM1 to NREM2 in BIISS (3.7+/-2.5) than in NC (6.1+/-5.9, p<0.001).
Our findings show that both sleepiness (as measured by NREM1 sleep latency) and REM sleep propensity are higher in NC than in BIISS. Furthermore, our finding of frequent REM sleep prior to NREM2 sleep in NC is in line with the recent assumption of an insufficient NREM sleep intensity in NC. Together with detailed clinical interviews, sleep logs, actigraphy, and nocturnal polysomnography, mean sleep latencies to NREM1 <or= 2.5 min, the presence of multiple SOREM periods, and the sequence NREM1-REM-NREM2 may be the best MSLT measures to discriminate NC from BIISS.
在多次睡眠潜伏期试验（MSLT）中，非快速眼动睡眠期 1（NREM1）的第一潜伏期较短，以及存在>或= 2 个睡眠起始 REM（SOREM）期，这两种情况都发生在发作性睡病伴猝倒症（NC）和行为性诱导睡眠不足综合征（BIISS）中。目前尚不清楚特定的 MSLT 发现是否有助于区分这两种疾病。
我们分析了 MSLT 数据，包括 60 名年龄、性别和体重指数（BMI）匹配的受试者（下丘脑分泌素缺乏性 NC、活动记录仪确认的 BIISS、健康对照组：每组 20 名）的不同睡眠阶段的睡眠潜伏期。
NC（1.8+/-1.5）的 NREM1 睡眠潜伏期明显短于 BIISS（4.7+/-2.1，p<0.001）和对照组（11.4+/-3.3，p<0.001）。NC（8.6+/-4.7）和 BIISS（8.1+/-2.7，p=0.64）的 NREM2 睡眠潜伏期相似；然而，NREM2 或快速眼动（REM）睡眠的潜伏期（即 NREM1 睡眠潜伏期与第一 NREM1 睡眠序列持续时间之和），NC（4.4+/-2.9）明显短于 BIISS（7.9+/-3.5，p<0.001）。参考所有 REM 期睡眠潜伏期，NC 中 NREM1-REM-NREM2 序列更为常见（71%），而 BIISS 中则为 15%（p<0.001），这反映了 BIISS 中从 NREM1 到 NREM2 的潜伏期较短（3.7+/-2.5），而 NC 中则为 6.1+/-5.9（p<0.001）。
我们的研究结果表明，NC 的嗜睡程度（通过 NREM1 睡眠潜伏期测量）和 REM 睡眠倾向均高于 BIISS。此外，我们发现 NC 中 REM 睡眠常在 NREM2 睡眠之前出现，这与 NC 中存在不足的 NREM 睡眠强度的新假设相一致。结合详细的临床访谈、睡眠日志、活动记录仪和夜间多导睡眠图，NREM1 潜伏期<或= 2.5 分钟、存在多个 SOREM 期和 NREM1-REM-NREM2 序列可能是区分 NC 和 BIISS 的最佳 MSLT 指标。
