SLEEP DISORDERS - DISORDERS OF AROUSAL
SLEEP DISORDERS - DISORDERS OF AROUSAL
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DOI：
10.1126/science.159.3819.1070
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发表时间：
1968-01-01
期刊：
影响因子：
56.9
通讯作者：
BROUGHTON, RJ
中科院分区：
文献类型：
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作者：
BROUGHTON, RJ
典型的睡眠障碍如遗尿症、梦游症、噩梦和睡眠恐怖症，优先发生在从慢波睡眠中唤醒的过程中，几乎与快速眼动（REM）做梦状态无关。这里报告的数据表明，与正常受试者的生理差异，即使个体倾向于特定攻击模式的类型，在整个晚上都存在。至少在遗尿症的情况下，这一事件似乎只是将这些差异强化到临床上明显的水平。所有4种睡眠障碍都有一些共同的特征。这些都是以前被证明是由于唤醒本身。通过诱发电位技术获得的新数据表明，非快速眼动睡眠后的混乱期的这些常见症状与大脑反应性的改变有关，至少与视觉系统有关。区分个体发作类型的症状（即排尿、长时间的意识模糊性神游、明显的恐怖）似乎是基于整个睡眠过程中出现的生理变化，这些变化在从慢波睡眠唤醒时明显加重。这些变化可能在某种程度上与白天的心理冲突有关。迄今为止，已证明无法证明潜在的因果心理活动、做梦或其他形式的心理活动，甚至无法证明在袭击前的睡眠中存在心理空白。最好把这种发作看作是性唤起障碍。慢波睡眠唤醒事件为这些发作奠定了基础，这是一个正常的周期性事件。事实上，这是一个人经常经历的最强烈的复发性觉醒。当个体经历强烈的唤醒或压力时，这些生理变化使个体易于发生某些类型的攻击，对这些生理变化的详细研究可能是有益的;通过心理学或药理学手段逆转这些变化，以及对非REM睡眠周期性唤醒过程的生理和心理特征进行更精细的调查。
Classical sleep disorders of nocturnal enuresis, somnambulism, the nightmare, and the sleep terror occur preferentially during arousal from slow-wave sleep and are virtually never associated with the rapid-eye-movement [REM] dreaming state. Data reported here indicate that physiological differences from normal subjects, of a type predisposing the individual to a particular attack pattern, are present throughout the night. The episode, at least in the case of enuresis, appears to be simply a reinforcement of these differences to a clinically overt level. A number of features are common to all 4 sleep disorders. These were shown previously to be attributable to the arousal itself. New data obtained by means of evoked potential techniques suggest that these common symptoms of the confusional period that follows non-REM sleep are related to alterations of cerebral reactivity, at least of the visual system. Symptoms distinguishing the individual attack types (that is, micturition, prolonged confusional fugues, overt terror) appear to be based upon physiological changes present throughout sleep which are markedly accentuated during arousal from slow-wave sleep. These changes may in some way be related to diurnal psychic conflicts. To date, it has proved impossible to demonstrate potentially causal psychological activity, dreaming or other forms of mental activity, or even a psychological void in sleep just preceding the attacks. The attacks are best considered disorders of arousal. The slow-wave sleep arousal episode which sets the stage for these attacks is a normal cyclic event. Indeed it is the most intense reccurrent arousal that an individual regularly experiences. Detailed studies of those physiological changes that predispose individuals to certain types of attacks when they undergo intense arousal or stress may be informative; the reversal of these changes by psychological or pharmacological means, and more refined investigations of the physiological and psychological characteristics of the process of cyclic arousal from non-REM sleep.