Sleep Disorder Unit, Pitié-Salpêtrière University Hospital (APHP), Paris, France.
Sorbonne University, Paris, France.
J Sleep Res. 2020 Dec;29(6):e12946. doi: 10.1111/jsr.12946. Epub 2019 Nov 19.
To understand the mechanisms of N3 sleep interruptions in patients with sleepwalking episodes and/or sleep terrors (SW/ST), we evaluated whether autonomic reactions preceded or accompanied behavioural arousals from NREM sleep stage N3. In 20 adult patients with SW/ST and 20 matched controls without parasomnia, heart rate and pulse wave amplitude were measured beat-to-beat during the 10 beats preceding and during the 15 beats succeeding a motor arousal from N3 sleep. Respiratory rate and amplitude were measured during the same 25 successive beats. In patients with SW/ST, the N3 arousals were associated with a 33% increase in heart rate, a 57% decrease in pulse wave amplitude (indicating a major vasoconstriction), a 24% increase in respiratory rate and a doubling of respiratory amplitude. Notably, tachycardia and vasoconstriction started 4 s before motor arousals. A similar profile (tachycardia and vasoconstriction gradually increasing from the 4 s preceding arousal and post-arousal increase of respiratory amplitude, but no polypnea) was also observed, with a lower amplitude, during the less frequent 38 quiet N3 arousals in control subjects. Parasomniac arousals were associated with greater tachycardia, vasoconstriction and polypnea than quiet arousals, with the same pre-arousal gradual increases in heart rate and vasoconstriction. Autonomic arousal occurs 4 s before motor arousal from N3 sleep in patients with SW/ST (with a higher adrenergic reaction than in controls), suggesting that an alarming event during sleep (possibly a worrying sleep mentation or a local subcortical arousal) causes the motor arousal.
为了了解睡眠行走发作和/或睡眠恐怖症（SW/ST）患者 N3 睡眠中断的机制，我们评估了自主反应是否先于或伴随非快速眼动睡眠阶段 N3 的行为唤醒。在 20 名患有 SW/ST 的成年患者和 20 名无睡眠障碍的匹配对照者中，在从 N3 睡眠中发生运动唤醒之前的 10 个心跳和在唤醒之后的 15 个心跳中逐拍测量心率和脉搏波幅度。在同一 25 个连续心跳中测量呼吸率和幅度。在患有 SW/ST 的患者中，N3 唤醒与心率增加 33%、脉搏波幅度降低 57%（表示主要血管收缩）、呼吸率增加 24%和呼吸幅度增加一倍相关。值得注意的是，心动过速和血管收缩在运动唤醒前 4 秒开始。在对照组中，较少见的 38 次安静 N3 唤醒中也观察到了类似的情况（心动过速和血管收缩逐渐从唤醒前 4 秒增加，唤醒后呼吸幅度增加，但无过度通气），但幅度较低。与安静唤醒相比，睡眠障碍性唤醒与更大的心动过速、血管收缩和过度通气相关，心率和血管收缩的预唤醒逐渐增加。在 SW/ST 患者中，从 N3 睡眠中的运动唤醒前 4 秒发生自主唤醒（比对照组具有更高的肾上腺素反应），这表明睡眠期间发生了警报事件（可能是令人担忧的睡眠思维或局部皮质下唤醒）导致了运动唤醒。
