Alakuijala Anniina, Sarkanen Tomi, Partinen Markku
Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland; Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland.
Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland; Department of Neurology, The Central Finland Central Hospital, Jyväskylä, Finland.
Sleep Med. 2015 Jan;16(1):39-44. doi: 10.1016/j.sleep.2014.07.024. Epub 2014 Nov 7.
After the pandemic H1N1 influenza ASO3-adjuvanted vaccine, Pandemrix©, was used in late 2009 and early 2010, the incidence of narcolepsy increased in many European countries. This incidence mainly increased in children and adolescents and, to a lesser degree, in adults.
PATIENTS/METHODS: 125 unmedicated patients, aged 4 to 61 years, were included in this case-series study. Of these, 69 were diagnosed to have an H1N1-vaccine-related narcolepsy and 57 had sporadic narcolepsy. Most of these patients had: an actigraphy recording of 1-2 weeks, polysomnography, a Multiple Sleep Latency Test (MSLT), and cerebrospinal fluid hypocretin-1 concentration analysis.
Patients with H1N1-vaccine-related narcolepsy had shorter diagnostic delays, lower periodic leg movement index during sleep, earlier sleep-wake rhythm, and were younger in age at diagnosis, compared with sporadic cases. They also had shorter sleep latency and more sleep onset REM periods in MSLT, but these results were strongly age-dependent. Actigraphy showed quantitatively less sleep and more sleep fragmentation than polysomnography.
Regarding polysomnographic and actigraphic characteristics, there were no dramatic deviations between H1N1-vaccine-related and sporadic narcolepsy. Circadian rhythms indicated some interesting new findings with respect to the H1N1-vaccine-related disease. An actigraphy recording of 1-2 weeks is useful when studying the nocturnal aspects of narcolepsy and sleep-wake rhythms of narcoleptic patients.
2009年末至2010年初使用大流行H1N1流感ASO3佐剂疫苗“Pandemrix©”后，许多欧洲国家发作性睡病的发病率有所上升。这种发病率主要在儿童和青少年中增加，在成年人中增加程度较小。
患者/方法：本病例系列研究纳入了125例年龄在4至61岁之间未接受药物治疗的患者。其中，69例被诊断为与H1N1疫苗相关的发作性睡病，57例为散发性发作性睡病。这些患者大多进行了：1 - 2周的活动记录仪记录、多导睡眠图、多次睡眠潜伏期试验（MSLT）以及脑脊液下丘脑分泌素-1浓度分析。
与散发性病例相比，与H1N1疫苗相关的发作性睡病患者诊断延迟时间更短，睡眠期间周期性腿部运动指数更低，睡眠 - 觉醒节律更早，诊断时年龄更小。他们在MSLT中的睡眠潜伏期也更短，睡眠开始时快速眼动期更多，但这些结果强烈依赖于年龄。活动记录仪显示，与多导睡眠图相比，睡眠量在数量上更少，睡眠片段化更多。
关于多导睡眠图和活动记录仪特征，与H1N1疫苗相关的发作性睡病和散发性发作性睡病之间没有显著差异。昼夜节律显示了一些关于与H1N1疫苗相关疾病的有趣新发现。在研究发作性睡病的夜间情况和发作性睡病患者的睡眠 - 觉醒节律时，1 - 2周的活动记录仪记录很有用。
