Lanza Giuseppe, Lanuzza Bartolo, Aricò Debora, Cantone Mariagiovanna, Cosentino Filomena Irene Ilaria, Pennisi Manuela, Bella Rita, Pennisi Giovanni, Ferri Raffaele
Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero, 73 - 94018 Troina (EN), Italy.
Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero, 73 - 94018 Troina (EN), Italy.
Sleep Med. 2015 Jan;16(1):138-42. doi: 10.1016/j.sleep.2014.08.016. Epub 2014 Nov 13.
Changes to transcranial magnetic stimulation (TMS) have been reported in obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS), although no direct comparison study is available. The aim of this new investigation is to assess and compare cortical excitability of OSAS and RLS patients using the same methodology and under the same experimental conditions.
Fourteen patients with OSAS and 12 with RLS were compared to 14 age-matched controls. All patients were untreated and had a severe degree of disease. Resting motor threshold (rMT), cortical silent period (CSP) and motor evoked potentials MEPs, as well as intracortical inhibition (ICI) and facilitation at interstimulus interval (ISI) of 3 and 10 ms, respectively, were explored from the right first dorsal interosseous muscle, during wakefulness.
rMT was higher in OSAS than in RLS and controls. CSP was shorter in RLS only when compared to apneic patients, whereas it was similar between OSAS and controls. OSAS subjects exhibited slightly prolonged central motor conductivity, whereas MEP amplitude was smaller in both patient groups. The ICI ratio at ISI of 3 ms was decreased in RLS patients only.
Distinct changes of responses at TMS were found, probably connected with the different neurophysiological substrates underlying OSAS and RLS and could not be interpreted as a mere reflection of the effects of sleep architecture alteration. TMS can be considered an additional tool for the understanding of clinical and pathophysiological aspects of sleep disorders, and possibly for the evaluation of the effect of therapy.
尽管尚无直接比较研究，但已有报道称阻塞性睡眠呼吸暂停综合征（OSAS）和不宁腿综合征（RLS）患者的经颅磁刺激（TMS）存在变化。这项新研究的目的是在相同方法和相同实验条件下评估和比较OSAS和RLS患者的皮质兴奋性。
将14例OSAS患者和12例RLS患者与14例年龄匹配的对照者进行比较。所有患者均未接受治疗且病情严重。在清醒状态下，从右侧第一背侧骨间肌检测静息运动阈值（rMT）、皮质静息期（CSP）和运动诱发电位（MEP），以及分别在3和10毫秒的刺激间隔下的皮质内抑制（ICI）和易化作用。
OSAS患者的rMT高于RLS患者和对照者。仅与呼吸暂停患者相比时，RLS患者的CSP较短，而OSAS患者与对照者的CSP相似。OSAS患者的中枢运动传导时间略有延长，而两组患者的MEP波幅均较小。仅RLS患者在3毫秒刺激间隔时的ICI比率降低。
发现TMS反应存在明显变化，这可能与OSAS和RLS潜在的不同神经生理底物有关，不能单纯解释为睡眠结构改变影响的反映。TMS可被视为理解睡眠障碍临床和病理生理方面的一种额外工具，也可能用于评估治疗效果。
