How should disrupted nocturnal sleep be characterized in narcolepsy type 1?
How should disrupted nocturnal sleep be characterized in narcolepsy type 1?
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1 型发作性睡病的夜间睡眠中断应如何表征？
DOI：
10.1093/sleep/zsac096
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发表时间：
2022
期刊：
影响因子：
5.6
通讯作者：
Trotti,LynnMarie
中科院分区：
文献类型：
--
作者：
Maski,Kiran;Trotti,LynnMarie
夜间睡眠中断（DNS）是1型发作性睡病（NT 1）的常见特征，部分反映了由食欲素缺乏引起的睡眠/觉醒不稳定性，食欲素是睡眠/觉醒状态的关键调节剂[1]。尽管其在NT 1患者中的患病率明显较高，但DNS尚未在各项研究中得到一致的定义[2]。目的DNS测量可以使用各种传统的多导睡眠图指标，如睡眠效率，入睡后觉醒和觉醒指数，以及对睡眠-觉醒状态失调的更具体评估，包括睡眠阶段转换，睡眠发作的数量和长度以及状态空间，有时利用机器学习技术[2-6]。关于如何通过自我报告的措施最好地捕获DNS的患者体验，甚至更少达成共识。Barateau等人的工作。在这个问题上睡眠[7]是一个重要的进步，在NT 1患者中表征主观DNS并检查其潜在的健康和福祉影响。作者考虑了单个DNS问题（“目前，您的夜间睡眠有多受干扰？”），从他们的多项目嗜睡症严重程度量表（NSS）[8]中选择非常多、很多、不太多或根本没有），在NT 1患者的大样本中，包括那些接受和未接受治疗的患者以及治疗前和治疗期间具有配对反应的纵向样本。在未经治疗的患者中，主观DNS严重程度与睡眠质量和睡眠不稳定性的多个客观指标以及包括总体嗜睡症严重程度、生活质量和情绪在内的临床特征相关。在接受治疗的患者中，主观DNS在很大程度上与客观睡眠质量/稳定性指标无关，但仍与临床特征相关。用一系列广泛的药物治疗，包括促醒剂、抗抑郁药和羟丁酸盐，改善了纵向样本的DNS评分。虽然作者主张将NSS上的这一单一项目用于临床DNS评估，但仍存在一些重要问题。
Disrupted nocturnal sleep (DNS) is a common feature of narcolepsy type 1 (NT1) that in part reflects the sleep/wake instability caused by deficiency of orexin, a critical regulator of sleep/wake states [1]. Despite its apparent high prevalence among patients with NT1, DNS has not yet been consistently defined across studies [2]. Objective DNS measurement may use a variety of traditional polysomnographic indicators such as sleep efficiency, wake after sleep onset, and arousal index, as well as more specific assessments of sleep–wake state dysregulation, including sleep stage transitions, number and length of sleep bouts, and state space, sometimes harnessing machine learning techniques [2–6]. There is even less consensus about how best to capture the patient experience of DNS via self-reported measures. The work by Barateau et al. in this issue of SLEEP [7] is an important advance in characterizing subjective DNS in people with NT1 and examining its potential health and well-being effects. The authors considered the single DNS question (“Currently, how disturbed is your nighttime sleep?”, with choices of very much, much, not too much, or not at all) from their multi-item Narcolepsy Severity Scale (NSS)[8] in a large sample of NT1 patients, including those on and not on treatment and a longitudinal sample with paired responses before and during treatment. In untreated patients, subjective DNS severity was associated with multiple objective measures of sleep quality and sleep instability, as well as with clinical features including overall narcolepsy severity, quality of life, and mood. In treated patients, subjective DNS was largely unrelated to objective sleep quality/stability measures but still showed associations with clinical features. Treatment with a broad array of medications, including wake-promoting agents, antidepressants, and oxybate, improved DNS scores in the longitudinal sample. While the authors advocate for this single item on the NSS to be used for clinical DNS assessment, a number of important questions remain.