发作性睡病伴或不伴猝倒的幻觉：与帕金森病的对比。
Hallucinations in narcolepsy with and without cataplexy: contrasts with Parkinson's disease.
机构信息
Sleep Disorders Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris 6 University, Paris, France.
出版信息
Sleep Med. 2011 May;12(5):497-504. doi: 10.1016/j.sleep.2011.03.006. Epub 2011 Apr 12.
BACKGROUND
Narcolepsy and Parkinson's disease (PD) are associated with hallucinations, excessive daytime sleepiness, REM sleep behavior disorder (RBD), as well as complete (narcolepsy with cataplexy) vs. partial (PD, narcolepsy without cataplexy) hypocretin-1 deficiency.
OBJECTIVE
To compare the hallucinations associated with narcolepsy to those of PD.
METHODS
One hundred patients with narcolepsy (with and without cataplexy) and 100 patients with PD were consecutively interviewed about their hallucinations (frequency, phenomenology, insight into unreality and association with sleep) as well as their risk factors.
RESULTS
Hallucinations occurred more frequently and with more motor and multimodal aspects in narcolepsy with cataplexy (59%) than in narcolepsy without cataplexy (28%) and PD (26%). Compared to PD, the hallucinations in narcolepsy were less frequently of the passage/presence type (passage: brief visions of a person or animal passing sideways; presence: perception that a living character or an animal is behind or near the subject, without the subject actually seeing, hearing or touching it), more frequently auditory and more often associated with sleep. However, in 40% of the patients with narcolepsy and 54% of the patients with PD, the hallucinations occurred while the patients were wide awake. Patients with cataplexy had reduced immediate insight into the unreality of their hallucinations compared to patients with PD, but the delusions were exceptional (2%), transient and based on hallucinations in both groups. The risk factors for hallucinations were sleep paralysis and RBD in narcolepsy and motor disability and sleepiness in PD.
CONCLUSIONS
The multimodal, dreamlike aspect of hallucinations in narcolepsy with cataplexy could transiently impair the patients' insight. The high frequency of these hallucinations (compared to those in narcolepsy without cataplexy or PD) suggests that complete (more than partial) hypocretin-1 deficiency promotes hallucinations.
背景
发作性睡病和帕金森病（PD）都与幻觉、日间嗜睡、快速眼动睡眠行为障碍（RBD）有关，也与下丘脑分泌素-1 完全（发作性睡病伴猝倒）与部分（PD、发作性睡病不伴猝倒）缺乏有关。
目的
比较发作性睡病与 PD 相关的幻觉。
方法
连续对 100 例发作性睡病（伴或不伴猝倒）患者和 100 例 PD 患者进行访谈，了解其幻觉（频率、表现、对不真实的认识和与睡眠的关系）及其危险因素。
结果
在伴有猝倒的发作性睡病中，幻觉的发生率更高，且具有更多的运动和多模态表现（59%），而在不伴猝倒的发作性睡病（28%）和 PD（26%）中则较低。与 PD 相比，发作性睡病中的幻觉较少为通过/存在型（通过：短暂的视觉幻觉，一个人或动物从旁边经过；存在：感知到一个活着的人物或动物在主体的后面或附近，而主体实际上并没有看到、听到或触摸到它），更常见于听觉幻觉，且更常与睡眠相关。然而，在 40%的发作性睡病患者和 54%的 PD 患者中，幻觉发生在患者完全清醒时。猝倒患者对幻觉不真实的即时认识能力低于 PD 患者，但妄想是罕见的（2%），是短暂的，且基于两组患者的幻觉。幻觉的危险因素是发作性睡病中的睡眠瘫痪和 RBD，以及 PD 中的运动障碍和嗜睡。
结论
伴有猝倒的发作性睡病中幻觉的多模态、梦境般的表现可能会暂时损害患者的洞察力。这些幻觉的高发生率（与不伴猝倒的发作性睡病或 PD 相比）表明，下丘脑分泌素-1 的完全（多于部分）缺乏促进了幻觉的产生。
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