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觉醒障碍与慢波睡眠第一阶段的时间:临床和法医学意义。

Disorders of Arousal and timing of the first period of slow wave sleep: Clinical and forensic implications.

作者信息

Pressman Mark R

机构信息

Pressman Sleep and Science Forensics, LLC, Ardmore, PA, USA.

Lankenau Institute for Medical Research and, Division of Pulmonary and Critical Care Medicine, Lankenau Medical Center, Wynnewood, PA, USA.

出版信息

Sleep Med X. 2022 Sep 21;4:100057. doi: 10.1016/j.sleepx.2022.100057. eCollection 2022 Dec.

Abstract

The timing of first period of slow wave sleep (SWS) is often used as a proxy for determining if and when Disorders of Arousal (DOA) such as sleepwalking are likely to occur or did occur in the past. In criminal cases employing a "sleepwalking defense" the prosecution may argue that nocturnal violence or sexually aggressive behavior occurred too early in the sleep period to be associated with SWS. Expert witness opinion on the expected latency to SWS (LSWS) has varied from minutes after sleep onset to ≥60 min. A search of PubMed was conducted for LSWS and for any reports of DOAs occurring from stage N2. A total of 21 studies reported LSWS in normal controls, clinically diagnosed sleepwalkers, in otherwise normal sleepers following different types of sleep deprivation and due to the effects of alcohol. Five studies reported episodes of DOA from N2 sleep. The shortest mean LSWS of 6.4 min was found with a combination of total sleep deprivation and alcohol. In a group of normal research subjects, a LSWS mean of 10.7 min was noted. LSWS in DOA patients occurred as early as a mean of 12.4 min. Two sleep studies performed on Kenneth Parks, acquitted of the murder of his mother-in-law by a sleepwalking defense, reported LSWSs of 9.7 and 10 min. Sleep deprivation but not alcohol was found to decrease LSWS significantly. Expert opinions on LSWS should be based on scientific peer reviewed publications documenting empirical sleep evidence and can be much shorter than is generally reported.

摘要

慢波睡眠(SWS)第一阶段的时间通常被用作一种指标,来确定诸如梦游等觉醒障碍(DOA)是否可能发生或过去是否已经发生。在采用“梦游辩护”的刑事案件中,检方可能会辩称,夜间暴力或性侵犯行为发生在睡眠周期太早的阶段,与慢波睡眠无关。关于慢波睡眠预期潜伏期(LSWS)的专家证人意见各不相同,从入睡后几分钟到≥60分钟不等。我们在PubMed上搜索了慢波睡眠预期潜伏期以及任何从N2期发生觉醒障碍的报告。共有21项研究报告了正常对照者、临床诊断的梦游者、不同类型睡眠剥夺后及酒精影响下的其他正常睡眠者的慢波睡眠预期潜伏期。五项研究报告了N2期睡眠出现觉醒障碍的发作情况。在总睡眠剥夺和酒精共同作用下,发现最短的平均慢波睡眠预期潜伏期为6.4分钟。在一组正常研究对象中,观察到平均慢波睡眠预期潜伏期为10.7分钟。觉醒障碍患者的慢波睡眠预期潜伏期最早平均为12.4分钟。对肯尼斯·帕克斯进行的两项睡眠研究报告了其慢波睡眠预期潜伏期分别为9.7分钟和10分钟,他因梦游辩护而被宣告谋杀岳母罪名不成立。发现睡眠剥夺而非酒精会显著缩短慢波睡眠预期潜伏期。关于慢波睡眠预期潜伏期的专家意见应基于经同行评审的科学出版物,这些出版物记录了实证睡眠证据,且可能比一般报道的要短得多。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c55/9520070/bbbc6a6f1461/gr1.jpg

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