Wood Christopher, Bianchi Matt Travis, Yun Chang-Ho, Shin Chol, Thomas Robert Joseph
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Division of Sleep Medicine, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
Front Physiol. 2020 Dec 3;11:592978. doi: 10.3389/fphys.2020.592978. eCollection 2020.
A new concept of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep is proposed, that of multi-component integrative states that define stable and unstable sleep, respectively, NREM, NREM REM, and REM. Three complementary data sets are used: obstructive sleep apnea (20), healthy subjects (11), and high loop gain sleep apnea (50). We use polysomnography (PSG) with beat-to-beat blood pressure monitoring, and electrocardiogram (ECG)-derived cardiopulmonary coupling (CPC) analysis to demonstrate a bimodal, rather than graded, characteristic of NREM sleep. Stable NREM (NREM) is characterized by high probability of occurrence of the <1 Hz slow oscillation, high delta power, stable breathing, blood pressure dipping, strong sinus arrhythmia and vagal dominance, and high frequency CPC. Conversely, unstable NREM (NREM) has the opposite features: a fragmented and discontinuous <1 Hz slow oscillation, non-dipping of blood pressure, unstable respiration, cyclic variation in heart rate, and low frequency CPC. The dimension of NREM stability raises the possibility of a comprehensive which captures sleep onset (e.g., ventrolateral preoptic area-based sleep switch) processes, synaptic homeostatic delta power kinetics, and the interaction of global and local sleep processes as reflected in the spatiotemporal evolution of cortical "UP" and "DOWN" states, while incorporating the complex dynamics of autonomic-respiratory-hemodynamic systems during sleep. Bimodality of REM sleep is harder to discern in health. However, individuals with combined obstructive and central sleep apnea allows ready recognition of REM and REM (stable and unstable REM sleep, respectively), especially when there is a discordance of respiratory patterns in relation to conventional stage of sleep.
提出了一种关于非快速眼动（NREM）和快速眼动（REM）睡眠的新概念，即分别定义稳定和不稳定睡眠的多成分整合状态，包括NREM、NREM REM和REM。使用了三个互补的数据集：阻塞性睡眠呼吸暂停患者（20例）、健康受试者（11例）和高环路增益睡眠呼吸暂停患者（50例）。我们使用多导睡眠图（PSG）结合逐搏血压监测以及心电图（ECG）衍生的心肺耦合（CPC）分析来证明NREM睡眠具有双峰特征，而非分级特征。稳定的NREM（NREM）的特征是<1 Hz慢振荡出现的概率高、δ波功率高、呼吸稳定、血压呈勺型、窦性心律失常强烈且迷走神经占优势以及高频CPC。相反，不稳定的NREM（NREM）具有相反的特征：<1 Hz慢振荡破碎且不连续、血压非勺型、呼吸不稳定、心率周期性变化以及低频CPC。NREM稳定性这一维度增加了一种全面描述的可能性，该描述涵盖睡眠起始过程（例如，基于腹外侧视前区的睡眠开关）、突触稳态δ波功率动力学以及皮质“UP”和“DOWN”状态的时空演变所反映的全局和局部睡眠过程的相互作用，同时纳入睡眠期间自主呼吸 - 血液动力学系统的复杂动态。REM睡眠的双峰性在健康状态下更难辨别。然而，患有阻塞性和中枢性睡眠呼吸暂停合并症的个体能够很容易地识别出REM和REM（分别为稳定和不稳定的REM睡眠），尤其是当呼吸模式与传统睡眠阶段不一致时。
