Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany.
Department of Psychology, University of Warwick, Coventry, UK.
Sleep Med Rev. 2016 Apr;26:95-107. doi: 10.1016/j.smrv.2015.04.004. Epub 2015 May 9.
Patients with primary dystonia, the third most prevalent movement disorder, suffer from a markedly reduced quality of life. This might, at least in part, be mediated by non-motor symptoms, including sleep disturbances. Characterising and treating sleep disturbances might provide new inroads to improve relevant patient-centred outcomes. This review evaluates the state of research on sleep in patients with dystonia and outlines an agenda for future research. A literature search was performed in July 2014 using PubMed, Medline via Ovid, PsycInfo, PsycArticles via Proquest and Embase via Ovid. Search results were screened for eligibility by two independent raters. Peer-reviewed publications reporting on sleep in patients with primary dystonia were included. Of 1445 studies identified through the search strategy, 18 met the inclusion criteria. In total, the included studies reported on 708 patients diagnosed with focal dystonia (cervical dystonia or blepharospasm), torsion dystonia, and dopa-responsive dystonia. The results indicate that at least half of the patients with focal cranial dystonia suffer from sleep disturbances, but excessive daytime sleepiness is uncommon. Sleep disturbance is associated with depressive symptoms. The frequency and duration of dystonic movements is markedly reduced during sleep. Reduced sleep quality appears to persist after treatment with botulinum toxin that successfully reduces motor symptoms. The findings are limited by a high clinical and methodological heterogeneity. Future research is needed to i) further characterize subjective and PSG sleep in patients with different types of dystonia, ii) determine the aetiology of sleep disturbances (e.g., abnormal brain function associated with dystonia, side effects of medication, psychological reasons), and iii) test whether targeted sleep interventions improve sleep and quality of life in patients with primary dystonia.
原发性肌张力障碍患者是第三大常见运动障碍疾病，其生活质量明显下降。这可能至少部分是由非运动症状引起的，包括睡眠障碍。对睡眠障碍进行特征描述和治疗可能为改善相关以患者为中心的治疗结果提供新的途径。本综述评估了肌张力障碍患者睡眠研究的现状，并概述了未来研究的议程。2014 年 7 月，我们通过 PubMed、Ovid 旗下的 Medline、PsycInfo、Proquest 旗下的 PsycArticles 和 Ovid 旗下的 Embase 进行了文献检索。两名独立评估者对检索结果进行了筛选以评估其是否符合纳入标准。纳入了报告原发性肌张力障碍患者睡眠情况的同行评议出版物。通过检索策略共确定了 1445 项研究，其中 18 项符合纳入标准。总共纳入的研究报告了 708 例诊断为局灶性肌张力障碍（颈肌张力障碍或眼睑痉挛）、扭转痉挛和多巴反应性肌张力障碍的患者。结果表明，至少一半的局灶性颅肌张力障碍患者存在睡眠障碍，但白天过度嗜睡并不常见。睡眠障碍与抑郁症状有关。在睡眠期间，肌张力障碍运动的频率和持续时间明显减少。在使用成功减少运动症状的肉毒毒素治疗后，睡眠质量似乎仍然下降。研究结果受到临床和方法学高度异质性的限制。未来的研究需要：i）进一步描述不同类型肌张力障碍患者的主观和 PSG 睡眠；ii）确定睡眠障碍的病因（例如，与肌张力障碍相关的异常大脑功能、药物的副作用、心理原因）；iii）测试针对睡眠的干预措施是否能改善原发性肌张力障碍患者的睡眠和生活质量。
