Mayer Geert, Rodenbeck Andrea, Kesper Karl
Hephata Klinik, Schimmelpfengstr. 6, 34613 Schwalmstadt, Germany; Philipps Universität Marburg, Baldinger Str., 35043 Marburg, Germany.
Evangelisches Krankenhaus Göttingen-Weende gGmbH, Department of Pneumology & Sleep Medicine, Pappelweg 5, 37120 Bovenden, Germany; Studienzentrum Wilhelmshöhe, Wilhelmshöher Allee 259, 34131 Kassel, Germany.
Sleep Med. 2017 Jul;35:1-6. doi: 10.1016/j.sleep.2017.03.023. Epub 2017 Apr 18.
To estimate the effect of the compound sodium oxybate (SO) on chin muscle tone in sleep, a re-analysis of the results of the international multicenter study SXB-15 was performed, applying a validated semi-automatic analysis of muscle tone. This analysis distinguishes short (<0.5 s) and long (>0.5 s) muscle activity indices per hour (SMI, LMI) in 116 patients with narcolepsy-cataplexy. While stable stimulant medication was permitted, tricyclics and SSRIs were withdrawn. Polysomnographies were performed at baseline (V5), four weeks after titration of SO to 4.5 g, 6 g, or 9 g or placebo (V6) and after another four weeks on stable SO dose (V7).
SMI and LMI decreased significantly during light sleep. LMI remained stable in all SO groups during slow wave sleep (SWS), but decreased significantly during REM sleep. SMI decreased non-significantly, but consistently during SWS and REM in the 9 g group only. A subgroup analysis of patients who stayed on stimulants showed that they had higher SMIs and LMIs in all groups. Patients who had been treated with anticataplectic medication prior to study inclusion had lower LMIs in the 9 g group during REM sleep in all visits.
SO has a differential effect on muscle tone that is dose and sleep stage dependent. Low dosages increase short muscle activity, possibly enabling the occurrence of parasomnias. High doses are especially efficacious in REM sleep, suggesting that SO could be used to treat REM sleep behavior disorder. Comedication with stimulants and prior medication with anticataplectic medication exerts an influence on muscle tone.
为评估复方γ-羟丁酸钠（SO）对睡眠时颏肌肌张力的影响，我们对国际多中心研究SXB-15的结果进行了重新分析，采用了经过验证的肌张力半自动分析方法。该分析区分了116例发作性睡病-猝倒症患者每小时的短（<0.5秒）和长（>0.5秒）肌肉活动指数（SMI、LMI）。在允许使用稳定剂量兴奋剂的同时，停用了三环类药物和选择性5-羟色胺再摄取抑制剂（SSRI）。在基线期（V5）、将SO滴定至4.5g、6g或9g或安慰剂四周后（V6）以及在稳定的SO剂量下再过四周后（V7）进行多导睡眠图检查。
在浅睡眠期间，SMI和LMI显著降低。在慢波睡眠（SWS）期间，所有SO组的LMI保持稳定，但在快速眼动睡眠（REM）期间显著降低。仅在9g组中，SMI在SWS和REM期间虽降低不显著，但持续下降。对继续使用兴奋剂的患者进行的亚组分析表明，他们在所有组中的SMI和LMI都较高。在研究纳入前接受过抗猝倒药物治疗的患者，在所有访视中9g组REM睡眠期间的LMI较低。
SO对肌张力有不同的影响，这取决于剂量和睡眠阶段。低剂量增加短肌肉活动，可能导致出现异态睡眠。高剂量在REM睡眠中特别有效，表明SO可用于治疗REM睡眠行为障碍。与兴奋剂合用以及之前使用抗猝倒药物会对肌张力产生影响。
