Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Sleep Center, Emory University School of Medicine, Atlanta, GA, USA.
J Sleep Res. 2019 Jun;28(3):e12689. doi: 10.1111/jsr.12689. Epub 2018 Apr 6.
Symptoms of the central disorders of hypersomnolence extend beyond excessive daytime sleepiness to include non-restorative sleep, fatigue and cognitive dysfunction. They share much in common with myalgic encephalomyelitis/chronic fatigue syndrome, recently renamed systemic exertion intolerance disease, whose additional features include post-exertional malaise and orthostatic intolerance. We sought to determine the frequency and correlates of systemic exertion intolerance disease in a hypersomnolent population. One-hundred and eighty-seven hypersomnolent patients completed questionnaires regarding sleepiness and fatigue; questionnaires and clinical records were used to assess for systemic exertion intolerance disease. Sleep studies, hypocretin and cataplexy were additionally used to assign diagnoses of hypersomnolence disorders or sleep apnea. Included diagnoses were idiopathic hypersomnia (n = 63), narcolepsy type 2 (n = 25), persistent sleepiness after obstructive sleep apnea treatment (n = 25), short habitual sleep duration (n = 41), and sleepiness with normal sleep study (n = 33). Twenty-one percent met systemic exertion intolerance disease criteria, and the frequency of systemic exertion intolerance disease was not different across sleep diagnoses (p = .37). Patients with systemic exertion intolerance disease were no different from those without this diagnosis by gender, age, Epworth Sleepiness Scale, depressive symptoms, or sleep study parameters. The whole cohort reported substantial fatigue on questionnaires, but the systemic exertion intolerance disease group exhibited more profound fatigue and was less likely to respond to traditional wake-promoting agents (88.6% versus 67.7%, p = .01). Systemic exertion intolerance disease appears to be a common co-morbidity in patients with hypersomnolence, which is not specific to hypersomnolence subtype but may portend a poorer prognosis for treatment response.
中枢性嗜睡障碍的症状不仅包括日间过度嗜睡，还包括睡眠质量差、疲劳和认知功能障碍。它们与肌痛性脑脊髓炎/慢性疲劳综合征（最近更名为全身性运动不耐受疾病）有很多共同之处，后者的其他特征包括活动后不适和直立不耐受。我们试图确定嗜睡人群中全身性运动不耐受疾病的频率和相关性。187 例嗜睡患者完成了关于嗜睡和疲劳的问卷；使用问卷和临床记录评估全身性运动不耐受疾病。此外，还进行了睡眠研究、下丘脑分泌素和猝倒来诊断嗜睡障碍或睡眠呼吸暂停。包括的诊断为特发性嗜睡症（n=63）、发作性睡病 2 型（n=25）、阻塞性睡眠呼吸暂停治疗后持续嗜睡（n=25）、习惯性睡眠时间短（n=41）和睡眠正常但嗜睡（n=33）。21%符合全身性运动不耐受疾病标准，不同睡眠诊断之间全身性运动不耐受疾病的频率没有差异（p=0.37）。全身性运动不耐受疾病患者在性别、年龄、Epworth 嗜睡量表、抑郁症状或睡眠研究参数方面与无此诊断的患者无差异。整个队列在问卷中都报告了明显的疲劳，但全身性运动不耐受疾病组的疲劳更严重，对传统的促醒药物反应更差（88.6%对 67.7%，p=0.01）。全身性运动不耐受疾病似乎是嗜睡患者的常见合并症，它与嗜睡亚型无关，但可能预示着对治疗反应的预后较差。
