心肺耦合频谱图作为一种评估自身免疫性脑炎患者睡眠障碍的动态方法。
Cardiopulmonary Coupling Spectrogram as an Ambulatory Method for Assessing Sleep Disorders in Patients With Autoimmune Encephalitis.
机构信息
From the Department of Neurology (J.L., Y.H., Y.W., L.L., X.H., Z.L., W.Q., Y.S.), The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou; Department of Neurology (Yi Lu), The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen; and Clinical Data Center (Yaxin Lu), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Neurology. 2024 May;102(10):e209302. doi: 10.1212/WNL.0000000000209302. Epub 2024 Apr 25.
BACKGROUND AND OBJECTIVES
Sleep disorders are a common and important clinical feature in patients with autoimmune encephalitis (AE); however, they are poorly understood. We aimed to evaluate whether cardiopulmonary coupling (CPC), an electrocardiogram-based portable sleep monitoring technology, can be used to assess sleep disorders in patients with AE.
METHODS
Patients fulfilling the diagnostic criteria of AE were age- and sex-matched with recruited healthy control subjects. All patients and subjects received CPC testing between August 2020 and December 2022. Demographic data, clinical information, and Pittsburgh Sleep Quality Index (PSQI) scores were collected from the medical records. Data analysis was performed using R language programming software.
RESULTS
There were 60 patients with AE (age 26.0 [19.8-37.5] years, male 55%) and 66 healthy control subjects (age 30.0 [25.8-32.0] years, male 53%) included in this study. Compared with healthy subjects, patients with AE had higher PSQI scores (7.00 [6.00-8.00] vs 3.00 [2.00-4.00], < 0.001), lower sleep efficiency (SE 80% [71%-87%] vs 92% [84%-95%], < 0.001), lower percentage of high-frequency coupling (25% [14%-43%] vs 45% [38%-53%], < 0.001), higher percentage of REM sleep (19% ± 9% vs 15% ± 7%, < 0.001), higher percentage of wakefulness (W% 16% [11%-25%] vs 8% [5%-16%], = 0.074), higher low-frequency to high-frequency ratio (LF/HF 1.29 [0.82-2.40] vs 0.91 [0.67-1.29], = 0.001), and a higher CPC-derived respiratory disturbance index (9.78 [0.50-22.2] vs 2.95 [0.40-6.53], < 0.001). Follow-up evaluation of 14 patients showed a decrease in the PSQI score (8.00 [6.00-9.00] vs 6.00 [5.00-7.00], = 0.008), an increased SE (79% [69%-86%] vs 89% [76%-91%], = 0.030), and a decreased W% (20% [11%-30%] vs 11% [8%-24], = 0.035). Multiple linear regression indicated that SE (-7.49 [-9.77 to -5.21], < 0.001) and LF/HF ratio (0.37 [0.13-0.6], = 0.004) were independent factors affecting PSQI scores in patients with AE.
DISCUSSION
Sleep disorders with autonomic dysfunction are common in patients with AE. Improvements in the PSQI score and SE precede the restoration of sleep microstructural disruption in the remission stage. CPC parameters may be useful in predicting sleep disorders in patients with AE.
背景与目的
睡眠障碍是自身免疫性脑炎（AE）患者常见且重要的临床特征，但目前了解甚少。我们旨在评估基于心电图的便携式睡眠监测技术——心搏量耦合（CPC）是否可用于评估 AE 患者的睡眠障碍。
方法
符合 AE 诊断标准的患者与招募的健康对照者按年龄和性别匹配。所有患者和对照者均于 2020 年 8 月至 2022 年 12 月期间接受 CPC 测试。从病历中收集人口统计学数据、临床信息和匹兹堡睡眠质量指数（PSQI）评分。使用 R 语言编程软件进行数据分析。
结果
本研究纳入 60 例 AE 患者（年龄 26.0[19.8-37.5]岁，男性占 55%）和 66 例健康对照者（年龄 30.0[25.8-32.0]岁，男性占 53%）。与健康对照者相比，AE 患者的 PSQI 评分更高（7.00[6.00-8.00] vs. 3.00[2.00-4.00]， < 0.001），睡眠效率更低（80%[71%-87%] vs. 92%[84%-95%]， < 0.001），高频耦合比例更低（25%[14%-43%] vs. 45%[38%-53%]， < 0.001），快速眼动（REM）睡眠比例更高（19%±9% vs. 15%±7%， < 0.001），觉醒比例更高（16%[11%-25%] vs. 8%[5%-16%]， = 0.074），低频与高频比值更高（LF/HF 1.29[0.82-2.40] vs. 0.91[0.67-1.29]， = 0.001），CPC 衍生的呼吸干扰指数更高（9.78[0.50-22.2] vs. 2.95[0.40-6.53]， < 0.001）。对 14 例患者的随访评估显示 PSQI 评分降低（8.00[6.00-9.00] vs. 6.00[5.00-7.00]， = 0.008），睡眠效率增加（79%[69%-86%] vs. 89%[76%-91%]， = 0.030），觉醒比例降低（20%[11%-30%] vs. 11%[8%-24%]， = 0.035）。多元线性回归表明，睡眠效率（-7.49[-9.77 至-5.21]， < 0.001）和 LF/HF 比值（0.37[0.13-0.6]， = 0.004）是影响 AE 患者 PSQI 评分的独立因素。
讨论
AE 患者常伴有自主神经功能障碍的睡眠障碍。PSQI 评分和睡眠效率的改善先于 REM 睡眠微结构破坏的恢复。CPC 参数可能有助于预测 AE 患者的睡眠障碍。
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