Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
Bernstein Center Freiburg and Faculty of Biology, University of Freiburg, Freiburg, Germany.
Sleep. 2017 Sep 1;40(9). doi: 10.1093/sleep/zsx117.
Objective sleep impairments in insomnia disorder (ID) are insufficiently understood. The present study evaluated whether whole-night sleep stage dynamics derived from polysomnography (PSG) differ between people with ID and matched controls and whether sleep stage dynamic features discriminate them better than conventional sleep parameters.
Eighty-eight participants aged 21-70 years, including 46 with ID and 42 age- and sex-matched controls without sleep complaints, were recruited through www.sleepregistry.nl and completed two nights of laboratory PSG. Data of 100 people with ID and 100 age- and sex-matched controls from a previously reported study were used to validate the generalizability of findings. The second night was used to obtain, in addition to conventional sleep parameters, probabilities of transitions between stages and bout duration distributions of each stage. Group differences were evaluated with nonparametric tests.
People with ID showed higher empirical probabilities to transition from stage N2 to the lighter sleep stage N1 or wakefulness and a faster decaying stage N2 bout survival function. The increased transition probability from stage N2 to stage N1 discriminated people with ID better than any of their deviations in conventional sleep parameters, including less total sleep time, less sleep efficiency, more stage N1, and more wake after sleep onset. Moreover, adding this transition probability significantly improved the discriminating power of a multiple logistic regression model based on conventional sleep parameters.
Quantification of sleep stage dynamics revealed a particular vulnerability of stage N2 in insomnia. The feature characterizes insomnia better than-and independently of-any conventional sleep parameter.
失眠障碍（ID）中的客观睡眠障碍理解不足。本研究评估了多导睡眠图（PSG）得出的整个睡眠阶段动态是否在 ID 患者和匹配对照组之间存在差异，以及睡眠阶段动态特征是否比传统睡眠参数更好地对他们进行区分。
招募了 88 名年龄在 21-70 岁之间的参与者，包括 46 名 ID 患者和 42 名年龄和性别匹配的无睡眠抱怨对照组，通过 www.sleepregistry.nl 招募并完成了两晚的实验室 PSG。使用之前报告的研究中 100 名 ID 患者和 100 名年龄和性别匹配的对照组的数据来验证研究结果的普遍性。第二晚除了获得传统的睡眠参数外，还获得了每个阶段的阶段间转移概率和阶段持续时间分布的概率。使用非参数检验评估组间差异。
ID 患者从 N2 期向较轻的 N1 期或觉醒状态过渡的经验概率更高，且 N2 期的阶段持续时间衰减功能更快。与任何传统睡眠参数的偏差相比，从 N2 期到 N1 期的过渡概率能更好地对 ID 患者进行区分，包括总睡眠时间更少、睡眠效率更低、N1 期更多和睡眠后觉醒时间更长。此外，添加此过渡概率显著提高了基于传统睡眠参数的多逻辑回归模型的区分能力。
睡眠阶段动态的量化揭示了 N2 期在失眠中的特别脆弱性。该特征比任何传统睡眠参数更好地描述失眠症，并且是独立的。
