Kawai Ryoko, Watanabe Akiko, Fujita Shiho, Hirose Marina, Esaki Yuichi, Arakawa Chiaki, Iwata Nakao, Kitajima Tsuyoshi
Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Department of Laboratory Medicine, Fujita Health University Hospital, Toyoake, Aichi, Japan.
Sleep Med. 2020 Apr;68:9-17. doi: 10.1016/j.sleep.2019.04.008. Epub 2019 Apr 26.
The minimum narcolepsy criteria "mean sleep latency (MSL) ≤8 min and ≥2 sleep onset rapid eye movement (REM) periods (SOREMPs) on polysomnography (PSG) and the multiple sleep latency test (MSLT)," according to The International Classification of Sleep Disorders, Third Edition (ICSD-3), are not specific to narcolepsy. Recently, the characteristic sleep stage sequences preceding SOREMPs in narcolepsy have received attention, but their diagnostic utility remains unclear.
We retrospectively reviewed PSG/MSLT records and chart data for 102 Japanese patients with hypersomnia and at least one SOREMP. We examined the sporadic rates of two sleep stage sequences preceding the SOREMPs-wakefulness or stage 1 to REM (W/S1→R) and stage 2 to REM (S2→R)-comparing these between patient groups with narcolepsy type 1 (N = 28), narcolepsy type 2 (N = 19), and other hypersomnia (N = 55). We also examined the utility of three simple indices using the occurrence of W/S1→R SOREMPs for distinguishing between narcolepsy and other hypersomnia in patients who satisfied the minimum narcolepsy criteria.
W/S1→R SOREMPs were significantly more frequent in narcolepsy than in other hypersomnia, and this tendency was also observed even in the patients who satisfied the minimum narcolepsy criteria. The three indices had moderate sensitivities and specificities for distinguishing between narcolepsy and other hypersomnia in patients satisfying the minimum narcolepsy criteria.
The W/S1→R pattern was observed significantly more frequently in narcolepsy than in other hypersomnia, suggesting it may help with differentiating narcolepsy from other hypersomnia in patients demonstrating the narcolepsy criteria, although its ability to do so may be modest.
根据《国际睡眠障碍分类》第三版（ICSD - 3），发作性睡病的最低标准“平均睡眠潜伏期（MSL）≤8分钟，且在多导睡眠图（PSG）和多次睡眠潜伏期试验（MSLT）中≥2次睡眠始发快速眼动（REM）期（SOREMPs）”并非发作性睡病所特有。最近，发作性睡病中SOREMPs之前的特征性睡眠阶段序列受到了关注，但其诊断效用仍不明确。
我们回顾性分析了102例患有嗜睡症且至少有一次SOREMP的日本患者的PSG/MSLT记录和病历数据。我们检查了SOREMPs之前两种睡眠阶段序列——清醒或1期到REM（W/S1→R）以及2期到REM（S2→R）的散在发生率，并在1型发作性睡病患者组（N = 28）、2型发作性睡病患者组（N = 19）和其他嗜睡症患者组（N = 55）之间进行比较。我们还使用W/S1→R SOREMPs的出现情况，研究了三个简单指标在满足发作性睡病最低标准的患者中区分发作性睡病和其他嗜睡症的效用。
W/S1→R SOREMPs在发作性睡病中比在其他嗜睡症中明显更频繁，即使在满足发作性睡病最低标准的患者中也观察到了这种趋势。这三个指标在满足发作性睡病最低标准的患者中区分发作性睡病和其他嗜睡症时具有中等的敏感性和特异性。
在发作性睡病中观察到W/S1→R模式的频率明显高于其他嗜睡症，这表明它可能有助于在表现出发作性睡病标准的患者中将发作性睡病与其他嗜睡症区分开来，尽管其区分能力可能有限。
