Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China; The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, Shijiazhuang, Hebei, 050000, PR China; Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, 050000, PR China.
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China; The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, Shijiazhuang, Hebei, 050000, PR China; Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, 050000, PR China.
Sleep Med. 2023 Sep;109:170-180. doi: 10.1016/j.sleep.2023.07.003. Epub 2023 Jul 6.
This study aimed to explore the characteristics of sleep disorders and their relationship with abnormal white-matter integrity in patients with sporadic amyotrophic lateral sclerosis. One hundred and thirty-six patients and 80 healthy controls were screened consecutively, and 56 patients and 43 healthy controls were ultimately analyzed. Sleep disorders were confirmed using the Pittsburgh sleep quality index, the Epworth sleepiness scale, and polysomnography; patients were classified into those with poor and good sleep quality. White-matter integrity was assessed using diffusion tensor imaging and compared between groups to identify the white-matter tracts associated with sleep disorders. The relationship between scores on the Pittsburgh sleep quality index and impaired white-matter tracts was analyzed using multiple regression. Poor sleep quality was more common in patients (adjusted odds ratio, 4.26; p = 0.005). Compared to patients with good sleep quality (n = 30), patients with poor sleep quality (n = 26; 46.4%) showed decreased fractional anisotropy, increased mean diffusivity, and increased radial diffusivity of projection and commissural fibers, and increased radial diffusivity of the right thalamus. The Pittsburgh score showed the best fit with the mean fractional anisotropy of the right anterior limb of the internal capsule (r = - 0.355, p = 0.011) and the mean radial diffusivity of the right thalamus (r = 0.309, p = 0.028). We conclude that sleep disorders are common in patients with sporadic amyotrophic lateral sclerosis and are associated with reduced white-matter integrity. The pathophysiology of amyotrophic lateral sclerosis may contribute directly to sleep disorders.
本研究旨在探讨散发性肌萎缩侧索硬化症患者睡眠障碍的特征及其与异常白质完整性的关系。连续筛选了 136 名患者和 80 名健康对照者，最终分析了 56 名患者和 43 名健康对照者。使用匹兹堡睡眠质量指数、爱泼沃斯嗜睡量表和多导睡眠图确认睡眠障碍；将患者分为睡眠质量差和睡眠质量好两组。使用弥散张量成像评估白质完整性，并比较组间差异，以确定与睡眠障碍相关的白质束。使用多元回归分析匹兹堡睡眠质量指数评分与受损白质束之间的关系。（调整后的优势比，4.26；p=0.005）。与睡眠质量好的患者（n=30）相比，睡眠质量差的患者（n=26；46.4%）显示出投射纤维和联合纤维的各向异性分数降低、平均弥散度增加、径向弥散度增加，以及右侧丘脑的径向弥散度增加。匹兹堡评分与右侧内囊前肢的平均各向异性分数（r=-0.355，p=0.011）和右侧丘脑的平均径向弥散度（r=0.309，p=0.028）拟合度最佳。我们得出结论，睡眠障碍在散发性肌萎缩侧索硬化症患者中很常见，并且与白质完整性降低有关。肌萎缩侧索硬化症的病理生理学可能直接导致睡眠障碍。
