Adachi M
Department of Bioclimatology and Medicine, Kyushu University, Beppu.
Fukuoka Igaku Zasshi. 1995 Feb;86(2):40-57.
Portable 24-hour polygraphic monitorings were performed on 109 cases with neurological or cardiovascular disorders, sleep disturbances and metabolic diseases to clarify its usefulness and limitations. Moreover, an evaluation of autonomic nervous activity was done in different stages of sleep in normal young (n = 9), normal middle-aged subjects (n = 8) and patients with ischemic heart disease (n = 7) using power spectral analysis of heart rate. The parameters recorded in this study were electroencepharogram(EEG), electrooculogram, electromyogram of chin muscles, electrocardiogram, respiratory curve, walking pulse and body position. Using polygraphic monitoring, the patients with cardiac arrhythmia showed abnormal EEG in 20% and those with neurological events in 86.7%. The improvement of sleep structure was found after pacemaker implantation in the patients with bradyarrhythmias (75%). Time spans of slow wave sleep and REM sleep of patients with ischemic heart disease decreased significantly from 120.9 +/- 40.6 min to 79.1 +/- 25.3 min, 112.8 +/- 16.5 min to 63.6 +/- 23.6 min, respectively (p < 0.05). RR50, that is number of R -R intervals greater than 50msec compared to the preceding R-R interval, decreased significantly in each stage of sleep in the patients with ischemic heart disease compared to normal subjects (stage 2: 18.3 +/- 6.1/min to 3.8 +/- 3.0/min, p < 0.01; SWS: 7.8 +/- 8.0/min to 3.2 +/- 2.5/min, p < 0.05; REM: 17.9 +/- 6.0/min to 4.4 +/- 4.3/min, p < 0.01). The HF power in all stages of sleep showed a trend of the decrease in the patients with ischemic heart disease. In REM sleep, the LF power in patients with ischemic disease was lower significantly compared to that in normal middle-aged subjects (6.1 +/- 3.2 to 12.1 +/- 4.1, p < 0.05). The L/H ratio also decreased significantly (1.08 +/- 0.30 vs. 2.35 +/- 1.03, p < 0.05). The slope of 1/fx above 0.15Hz in IHD patients was less in stage 2 (-0.404 +/- 0.280 vs. -0.849 +/- 0.183, p < 0.01) and in REM sleep (-0.294 +/- 0.368 vs. -0.665 +/- 0.291, p < 0.05). Above results suggest the involvement of a decrease of sympathetic activity in addition to decrease of parasympathetic activity especially in REM sleep in the patients with ischemic heart disease. In conclusion, polygraphic monitoring is useful for a detection of abnormality of EEG and an evaluation of autonomic activity in cardiovascular disorders.
对109例患有神经或心血管疾病、睡眠障碍及代谢疾病的患者进行了便携式24小时多导睡眠监测，以明确其有效性和局限性。此外，采用心率功率谱分析，对正常青年（n = 9）、正常中年受试者（n = 8）及缺血性心脏病患者（n = 7）睡眠不同阶段的自主神经活动进行了评估。本研究记录的参数包括脑电图（EEG）、眼电图、颏肌肌电图、心电图、呼吸曲线、行走脉搏及体位。通过多导睡眠监测发现，心律失常患者中有20%脑电图异常，神经疾病患者中有86.7%脑电图异常。缓慢性心律失常患者植入起搏器后睡眠结构得到改善（75%）。缺血性心脏病患者的慢波睡眠和快速眼动睡眠时长显著缩短，分别从120.9±40.6分钟降至79.1±25.3分钟、从112.8±16.5分钟降至63.6±23.6分钟（p<0.05）。与正常受试者相比，缺血性心脏病患者在睡眠各阶段的RR50（即比前一个R-R间期长大于50毫秒的R-R间期数量）显著降低（第二阶段：18.3±6.1/分钟降至3.8±3.0/分钟，p<0.01；慢波睡眠：7.8±8.0/分钟降至3.2±2.5/分钟，p<0.05；快速眼动睡眠：17.9±6.0/分钟降至4.4±4.3/分钟，p<0.01）。缺血性心脏病患者在睡眠各阶段的高频功率均呈下降趋势。在快速眼动睡眠中，缺血性心脏病患者的低频功率显著低于正常中年受试者（6.1±3.2对12.1±4.1，p<0.05）。低频/高频比值也显著降低（1.08±0.30对
