John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, Kolling Institute of Medical Research, The University of Sydney, RNSH, St. Leonards, NSW 2650, Australia.
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, Kolling Institute of Medical Research, The University of Sydney, RNSH, St. Leonards, NSW 2650, Australia.
J Psychosom Res. 2018 Sep;112:90-98. doi: 10.1016/j.jpsychores.2018.07.007. Epub 2018 Jul 19.
To determine the extent of daytime sleepiness in adults with spinal cord injury (SCI) and investigate the contribution of fatigue and autonomic function to sleepiness status.
Participants included 45 adults with SCI attending outpatient services or living in the community and 44 able-bodied controls. The Oxford Sleep Resistance Test (OSLER) was used to assess daytime sleepiness, while eye blink rate duration (electrooculography) and the Iowa Fatigue Scale assessed fatigue. Heart rate variability (HRV) was used to assess autonomic function. Survival analysis (Kaplan Meier) was used to estimate the rate of loss in participation in the OSLER task, as a measure of daytime sleepiness. Repeated measures ANOVA was used to determine HRV differences between groups. Regression analysis was used to establish factors that contributed to daytime sleepiness.
Participants with high lesions ("T3 and above") had significantly increased daytime sleepiness. OSLER results revealed only 33% of those with high lesions remained awake during the task. Those with high lesions also had significantly reduced sympathetic activity while no differences in parasympathetic activity were found between groups. Lesion completeness had no effect. Standardized variation in heart rate, slow eye blinks, low frequency HRV and self-reported fatigue contributed to daytime sleepiness.
Neurological lesions at "T3 or above" have an increased risk of daytime sleepiness, impacting on independence in daily functional tasks and work performance. Autonomic imbalance alters cardiovascular control, affecting health and wellbeing. The interaction of these factors requires further investigation.
确定脊髓损伤（SCI）成人的日间嗜睡程度，并探讨疲劳和自主功能对嗜睡状态的贡献。
参与者包括 45 名在门诊就诊或居住在社区的 SCI 成人和 44 名身体健康的对照组。使用牛津睡眠抵抗测试（OSLER）评估日间嗜睡，同时使用眼动率持续时间（眼电图）和爱荷华疲劳量表评估疲劳。心率变异性（HRV）用于评估自主功能。生存分析（Kaplan-Meier）用于估计 OSLER 任务参与率的损失，作为日间嗜睡的衡量标准。重复测量方差分析用于确定组间 HRV 差异。回归分析用于确定导致日间嗜睡的因素。
高病变（“T3 及以上”）参与者的日间嗜睡明显增加。OSLER 结果显示，只有 33%的高病变患者在任务中保持清醒。高病变者的交感神经活动明显减少，而组间副交感神经活动无差异。病变的完整性没有影响。心率的标准化变化、缓慢的眼动、低频 HRV 和自我报告的疲劳与日间嗜睡有关。
T3 或以上的神经病变增加了日间嗜睡的风险，影响了日常功能任务和工作表现的独立性。自主神经失衡改变了心血管控制，影响了健康和幸福感。这些因素的相互作用需要进一步研究。
