Mousa Saafi, Latchford Gary, Weighall Anna, Nash Hannah, Murray-Leslie Rebecca, Reuber Markus, Relton Samuel D, Graham Christopher D
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
School of Education, University of Sheffield, Sheffield, UK.
Epilepsy Behav. 2021 Apr;117:107867. doi: 10.1016/j.yebeh.2021.107867. Epub 2021 Mar 5.
Poor sleep is reported by many with nonepileptic attack disorder (NEAD) with correlations evident between self-reported sleep quality and mood and functional impairment. However, it is contended that self-reported sleep impairment in NEAD is a subjective phenomenon, which represents a general tendency to over-report symptoms or misinterpret bodily states in those with NEAD. The present study was therefore designed to investigate the extent of subjective and objective sleep impairments in those with NEAD. Over six nights we prospectively recorded comparable nightly objective (actigraphy) and subjective (consensus sleep diary) sleep parameters in a sample of 17 people with NEAD, and an age- and gender-matched normative control group (N = 20). Participants recorded daily measures of attacks, dissociation, and mood. Alongside higher subjective sleep impairment, the NEAD group had significantly worse objective sleep on several metrics compared to the normative controls, characterized by disrupted sleep (frequent awakenings and wake after sleep onset, low efficiency). Exploratory analyses using mixed effects models showed that attacks were more likely to occur on days preceded by longer, more restful sleep. This study, which had good ecological validity, evidences the presence of objective sleep impairment in NEAD, suggesting that in patient reports of problems with sleep should be given careful consideration in clinical practice.
许多非癫痫性发作障碍（NEAD）患者都报告存在睡眠不佳的情况，自我报告的睡眠质量与情绪及功能损害之间存在明显的相关性。然而，有人认为NEAD患者自我报告的睡眠障碍是一种主观现象，这代表了NEAD患者普遍存在的过度报告症状或错误解读身体状态的倾向。因此，本研究旨在调查NEAD患者主观和客观睡眠障碍的程度。在六个晚上的时间里，我们前瞻性地记录了17名NEAD患者以及一个年龄和性别匹配的正常对照组（N = 20）的可比夜间客观（活动记录仪）和主观（共识睡眠日记）睡眠参数。参与者记录了每日发作、解离和情绪的测量数据。与正常对照组相比，NEAD组除了主观睡眠障碍更严重外，在几个指标上的客观睡眠也明显更差，其特征是睡眠中断（频繁觉醒和睡眠开始后觉醒，效率低下）。使用混合效应模型的探索性分析表明，在更长、更安稳的睡眠后的日子里更容易发生发作。这项具有良好生态效度的研究证明了NEAD患者存在客观睡眠障碍，这表明在临床实践中应仔细考虑患者关于睡眠问题的报告。
