Department of Neurology, Division of Sleep Medicine, Louisiana State University School of Medicine Shreveport, LA 71103, USA.
J Clin Sleep Med. 2013 Jul 15;9(7):675-80. doi: 10.5664/jcsm.2836.
The AASM Manual for the Scoring of Sleep and Associated Events (Manual) has provided standardized definitions for tonic and phasic REM sleep without atonia (RSWA). This study used Manual criteria to characterize REM sleep in patients with narcolepsy and idiopathic hypersomnia (IH).
A retrospective review of PSG data from ICSD-2 defined patients with narcolepsy or IH, performed by two board certified sleep medicine physicians. Data compiled included REM sleep epochs and the presence in REM sleep of epochs scored as sustained muscle activity (tonic), and excessive transient muscle activity (phasic) as defined by Manual criteria.
PSG data from 8 narcolepsy patients (mean age: 27.5 years; age range: 11-55) showed mean ± standard deviation values for: total REM sleep epochs 205 ± 46.1; RSWA/ phasic epochs 56.1 ± 25.4; and RSWA/tonic epochs 15.0 ± 10.7. PSG data from 8 IH patients (mean age: 33.1 years; age range: 20-57) showed mean ± standard deviation values of total REM sleep epochs 163.8 ± 67.9; RSWA/phasic epochs 6.2 ± 3.5; and RSWA/tonic epochs 0.2 ± 0.4. Comparison revealed intergroup differences in phasic REM sleep (p < 0.01) and tonic REM sleep (p < 0.01) were significantly increased in narcoleptics compared to IH.
Our retrospective analysis showed that RSWA phasic activity and RSWA tonic activity are significantly increased in patients meeting ICSD-2 criteria for narcolepsy compared to patients meeting ICSD-2 criteria for IH. This robust difference, with further validation, could be useful as electrophysiological criteria differentiating the two disorders and understanding the physiological differences.
《睡眠和相关事件的 AASM 手动评分》（手册）为无动性睡眠发作（RSWA）的强直和阵发 REM 睡眠提供了标准化定义。本研究使用手册标准来描述嗜睡症和特发性过度睡眠症（IH）患者的 REM 睡眠。
对 ICSD-2 定义的嗜睡症或 IH 患者的 PSG 数据进行回顾性审查，由两名经过委员会认证的睡眠医学医生进行。汇编的数据包括 REM 睡眠期和 REM 睡眠中按照手册标准评定为持续肌肉活动（强直）和过度短暂肌肉活动（阵发）的睡眠期。
8 名嗜睡症患者（平均年龄：27.5 岁；年龄范围：11-55 岁）的 PSG 数据显示：总 REM 睡眠期为 205 ± 46.1；RSWA/阵发期为 56.1 ± 25.4；RSWA/强直期为 15.0 ± 10.7。8 名 IH 患者（平均年龄：33.1 岁；年龄范围：20-57 岁）的 PSG 数据显示：总 REM 睡眠期为 163.8 ± 67.9；RSWA/阵发期为 6.2 ± 3.5；RSWA/强直期为 0.2 ± 0.4。组间比较显示，在 REM 睡眠的阵发期（p < 0.01）和 REM 睡眠的强直期（p < 0.01），嗜睡症患者与 IH 患者之间存在差异，且差异具有统计学意义。
我们的回顾性分析显示，与符合 ICSD-2 标准的 IH 患者相比，符合 ICSD-2 标准的嗜睡症患者的 RSWA 阵发活动和 RSWA 强直活动明显增加。这种强有力的差异，经过进一步验证，可能有助于作为区分两种疾病和理解生理差异的电生理标准。
