Saper Clifford B
Department of Neurology, Beth Israel Deaconess Medical Center, 300 Brookline Avenue, Boston, MA 02215, USA.
Continuum (Minneap Minn). 2013 Feb;19(1 Sleep Disorders):19-31. doi: 10.1212/01.CON.0000427215.07715.73.
The basic circuitries that regulate wake-sleep cycles are described, along with how these are affected by different disease states and how those alterations lead to the clinical manifestations of those disorders.
The discovery of both sleep-promoting neurons in the ventrolateral preoptic nucleus and wake-promoting neurons, such as the lateral hypothalamic orexin (also called hypocretin) neurons, has allowed us to recognize that these two populations of neurons are mutually antagonistic (ie, inhibit each other) and form a "flip-flop switch," a type of circuit that results in rapid and complete transition in behavioral state. The same principle applies to the circuitry controlling transitions between REM sleep and non-REM (NREM) sleep.
The flip-flop switch circuitry of the wake-sleep regulatory system produces the typical sleep pattern seen in healthy adults, with consolidated waking during the day and alternation between NREM and REM sleep at night. Breakdown in this circuitry both results in and explains the manifestations of a variety of sleep disorders including insomnia, narcolepsy with cataplexy, and REM sleep behavior disorder.
描述调节觉醒-睡眠周期的基本神经回路，以及这些回路如何受到不同疾病状态的影响，以及这些改变如何导致这些疾病的临床表现。
腹外侧视前核中促进睡眠的神经元以及促进觉醒的神经元（如下丘脑外侧的食欲素神经元，也称为下丘脑泌素神经元）的发现，使我们认识到这两类神经元相互拮抗（即相互抑制），并形成一种“触发器开关”，这是一种能导致行为状态快速、完全转变的神经回路类型。同样的原理也适用于控制快速眼动睡眠和非快速眼动睡眠之间转换的神经回路。
觉醒-睡眠调节系统的触发器开关神经回路产生了健康成年人典型的睡眠模式，白天清醒状态巩固，夜间非快速眼动睡眠和快速眼动睡眠交替出现。该神经回路的破坏既导致又解释了多种睡眠障碍的表现，包括失眠、发作性睡病伴猝倒以及快速眼动睡眠行为障碍。
