Liu Yaping, Zhang Jihui, Lam Venny, Ho Crover Kwok Wah, Zhou Junying, Li Shirley Xin, Lam Siu Ping, Yu Mandy Wai Man, Tang Xiangdong, Wing Yun-Kwok
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
J Clin Sleep Med. 2015 Aug 15;11(8):885-94. doi: 10.5664/jcsm.4940.
To determine the diagnostic values, longitudinal stability, and HLA association of the sleep stage transitions in narcolepsy.
To compare the baseline differences in the sleep stage transition to REM sleep among 35 patients with type 1 narcolepsy, 39 patients with type 2 narcolepsy, 26 unaffected relatives, and 159 non-narcoleptic sleep patient controls, followed by a reassessment at a mean duration of 37.4 months.
The highest prevalence of altered transition from stage non-N2/N3 to stage R in multiple sleep latency test (MSLT) and nocturnal polysomnography (NPSG) was found in patients with type 1 narcolepsy (92.0% and 57.1%), followed by patients with type 2 narcolepsy (69.4% and 12.8%), unaffected relatives (46.2% and 0%), and controls (39.3% and 1.3%). Individual sleep variables had varied sensitivity and specificity in diagnosing narcolepsy. By incorporating a combination of sleep variables, the decision tree analysis improved the sensitivity to 94.3% and 82.1% and enhanced specificity to 82.4% and 83% for the diagnosis of type 1 and type 2 narcolepsy, respectively. There was a significant association of DBQ1*0602 with the altered sleep stage transition (OR = 16.0, 95% CI: 1.7-149.8, p = 0.015). The persistence of the altered sleep stage transition in both MSLT and NPSG was high for both type 1 (90.5% and 64.7%) and type 2 narcolepsy (92.3% and 100%), respectively.
Altered sleep stage transition is a significant and stable marker of narcolepsy, which suggests a vulnerable wake-sleep dysregulation trait in narcolepsy. Altered sleep stage transition has a significant diagnostic value in the differential diagnosis of hypersomnias, especially when combined with other diagnostic sleep variables in decision tree analysis.
确定发作性睡病中睡眠阶段转换的诊断价值、纵向稳定性及与 HLA 的关联。
比较 35 例 1 型发作性睡病患者、39 例 2 型发作性睡病患者、26 例未患病亲属及 159 例非发作性睡病睡眠患者对照在睡眠阶段转换至快速眼动睡眠（REM 睡眠）方面的基线差异，随后在平均 37.4 个月的时间进行重新评估。
在多次睡眠潜伏期试验（MSLT）和夜间多导睡眠图（NPSG）中，从非 N2/N3 期转换至 R 期改变的最高患病率在 1 型发作性睡病患者中被发现（分别为 92.0%和 57.1%），其次是 2 型发作性睡病患者（分别为 69.4%和 12.8%）、未患病亲属（分别为 46.2%和 0%）及对照（分别为 39.3%和 1.3%）。个体睡眠变量在发作性睡病诊断中具有不同的敏感性和特异性。通过纳入多种睡眠变量组合，决策树分析将 1 型和 2 型发作性睡病诊断的敏感性分别提高至 94.3%和 82.1%，特异性分别提高至 82.4%和 83%。DBQ1*0602 与睡眠阶段转换改变存在显著关联（比值比 = 16.0，95%可信区间：1.7 - 149.8，p = 0.015）。1 型（分别为 90.5%和 64.7%）和 2 型发作性睡病（分别为 92.3%和 100%）在 MSLT 和 NPSG 中睡眠阶段转换改变的持续性均较高。
睡眠阶段转换改变是发作性睡病的一个重要且稳定的标志物，这表明发作性睡病存在易损的觉醒 - 睡眠调节异常特征。睡眠阶段转换改变在过度嗜睡症的鉴别诊断中具有重要诊断价值，尤其是在决策树分析中与其他诊断性睡眠变量联合使用时。
