夜间快速眼动睡眠无张力可作为鉴别 1 型和 2 型发作性睡病的诊断参数。

Nocturnal Rapid Eye Movement Sleep Without Atonia can Be a Diagnostic Parameter in Differentiating Narcolepsy Type 1 From Type 2.

机构信息

Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and.

Ankara Yildirim Beyazit Diskapi Training and Research Hospital, Ankara, Turkey .

出版信息

J Clin Neurophysiol. 2021 May 1;38(3):237-241. doi: 10.1097/WNP.0000000000000688.

DOI:10.1097/WNP.0000000000000688

PMID:32141986

Abstract

PURPOSE

We aimed to compare rapid eye movement sleep without atonia (RSWA), tonic RSWA, and phasic RSWA indices during polysomnography as a potential biomarker between narcolepsy type 1 and type 2.

METHODS

Medical files, polysomnography, and multiple sleep latency tests of patients with narcolepsy were evaluated retrospectively. A total of three adolescents and 31 adult patients were included. We calculated the total number of rapid eye movement (REM) epochs with tonic and phasic activity in accordance with the American Academy of Sleep Medicine manual scoring rules, version 2.4. We defined tonic RSWA index as the ratio of total number of REM sleep stage epochs with only tonic activity to total REM sleep stage epochs, phasic RSWA index as the ratio of total number of REM sleep stage epochs with only phasic activity to total REM sleep stage epochs, and RSWA index as the ratio of total number of REM stage sleep epochs with RSWA to total REM sleep stage epochs on the polysomnography.

RESULTS

Clinically and polysomnographically diagnosed 25 patients with narcolepsy type 1 and 9 patients with narcolepsy type 2 were included. The median age of the subjects was 30 (10, 61) and 36 (18, 64), respectively. Eleven narcolepsy type 1 patients (44%) and 4 narcolepsy type 2 patients (44.44%) were women. The RSWA index of ≥ 3% yielded a sensitivity of 76% and specificity of 88.9% (AUC = 0.77 (0.09), 95% confidence interval = 0.58 to 0.97, p = 0.01), and the tonic RSWA index of ≥ 2.2% yielded a sensitivity of 72% and specificity of 77.8% (area under the curve = 0.74 (0.1), 95% confidence interval = 0.54-0.94, p = 0.03).

CONCLUSIONS

As an electrophysiological biomarker, RSWA and tonic RSWA indices can be sensitive and specific polysomnography parameters in distinguishing narcolepsy type 1 from narcolepsy type 2.

摘要

目的

我们旨在比较快速眼动睡眠无张力（RSWA）、强直性 RSWA 和相性 RSWA 指数作为 1 型和 2 型发作性睡病的潜在生物标志物。

方法

回顾性评估发作性睡病患者的病历、多导睡眠图和多次睡眠潜伏期试验。共纳入 3 名青少年和 31 名成年患者。我们根据美国睡眠医学学会手册评分规则 2.4 计算强直和相性活动的 REM 睡眠期的 REM 睡眠期总数。我们将强直性 RSWA 指数定义为仅强直性活动的 REM 睡眠期总数与 REM 睡眠期总数的比值，相性 RSWA 指数定义为仅相性活动的 REM 睡眠期总数与 REM 睡眠期总数的比值，以及 RSWA 指数为 REM 睡眠期的 REM 睡眠期总数与多导睡眠图上 REM 睡眠期的比值。

结果

临床和多导睡眠图诊断为 25 例 1 型发作性睡病和 9 例 2 型发作性睡病患者。受试者的中位年龄分别为 30（10，61）和 36（18，64）。11 例 1 型发作性睡病患者（44%）和 4 例 2 型发作性睡病患者（44.44%）为女性。RSWA 指数≥3%的敏感性为 76%，特异性为 88.9%（AUC=0.77（0.09），95%置信区间=0.58 至 0.97，p=0.01），强直性 RSWA 指数≥2.2%的敏感性为 72%，特异性为 77.8%（曲线下面积=0.74（0.1），95%置信区间=0.54 至 0.94，p=0.03）。