Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy.
Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy.
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DOI：
10.5664/jcsm.4940
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发表时间：
2015-08
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影响因子：
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通讯作者：
Yaping Liu;Jihui Zhang;V. Lam;C. Ho;Junying Zhou;Shirley Xin Li;S. Lam;M. Yu;Xiangdong Tang;Y. Wing
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文献类型：
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作者：
Yaping Liu;Jihui Zhang;V. Lam;C. Ho;Junying Zhou;Shirley Xin Li;S. Lam;M. Yu;Xiangdong Tang;Y. Wing
目的确定发作性睡病睡眠阶段转换的诊断价值、纵向稳定性和HLA相关性。方法：比较35例1型发作性睡病患者、39例2型发作性睡病患者、26例未受影响的亲属和159例非发作性睡病患者对照的睡眠阶段过渡到REM睡眠的基线差异，然后在平均持续时间为37.4个月时进行重新评估。结果在1型发作性睡病患者中，多次睡眠潜伏期试验（MST）和夜间多导睡眠图（NPSG）中非N2/N3期向R期转换的发生率最高其次是2型发作性睡病患者（69.4%和12.8%）、未患病亲属（46.2%和0%）和对照组（39.3%和1.3%）。个体睡眠变量在诊断发作性睡病中具有不同的敏感性和特异性。通过结合睡眠变量，决策树分析将1型和2型发作性睡病诊断的敏感性分别提高到94.3%和82.1%，特异性分别提高到82.4%和83%。DBQ 1 *0602与睡眠阶段转换改变显著相关（OR = 16.0，95%CI：1.7-149.8，p = 0.015）。在1型发作性睡病（90.5%和64.7%）和2型发作性睡病（92.3%和100%）中，在MMP 4和NPSG中改变的睡眠阶段转换的持续性分别很高。结论睡眠时相转换改变是发作性睡病的一个重要而稳定的指标，提示发作性睡病患者存在易受影响的觉醒-睡眠调节障碍。改变的睡眠阶段转换在睡眠过度的鉴别诊断中具有重要的诊断价值，特别是当与决策树分析中的其他诊断性睡眠变量相结合时。
OBJECTIVES To determine the diagnostic values, longitudinal stability, and HLA association of the sleep stage transitions in narcolepsy. METHODS To compare the baseline differences in the sleep stage transition to REM sleep among 35 patients with type 1 narcolepsy, 39 patients with type 2 narcolepsy, 26 unaffected relatives, and 159 non-narcoleptic sleep patient controls, followed by a reassessment at a mean duration of 37.4 months. RESULTS The highest prevalence of altered transition from stage non-N2/N3 to stage R in multiple sleep latency test (MSLT) and nocturnal polysomnography (NPSG) was found in patients with type 1 narcolepsy (92.0% and 57.1%), followed by patients with type 2 narcolepsy (69.4% and 12.8%), unaffected relatives (46.2% and 0%), and controls (39.3% and 1.3%). Individual sleep variables had varied sensitivity and specificity in diagnosing narcolepsy. By incorporating a combination of sleep variables, the decision tree analysis improved the sensitivity to 94.3% and 82.1% and enhanced specificity to 82.4% and 83% for the diagnosis of type 1 and type 2 narcolepsy, respectively. There was a significant association of DBQ1*0602 with the altered sleep stage transition (OR = 16.0, 95% CI: 1.7-149.8, p = 0.015). The persistence of the altered sleep stage transition in both MSLT and NPSG was high for both type 1 (90.5% and 64.7%) and type 2 narcolepsy (92.3% and 100%), respectively. CONCLUSION Altered sleep stage transition is a significant and stable marker of narcolepsy, which suggests a vulnerable wake-sleep dysregulation trait in narcolepsy. Altered sleep stage transition has a significant diagnostic value in the differential diagnosis of hypersomnias, especially when combined with other diagnostic sleep variables in decision tree analysis.