Pseudo-hypersomnia and pre-sleep behaviour with bilateral paramedian thalamic lesions.
Pseudo-hypersomnia and pre-sleep behaviour with bilateral paramedian thalamic lesions.
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双侧丘脑旁正中病变引起的假性失眠和睡前行为。
DOI：
10.1093/brain/116.6.1549
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Goldberg,MP
中科院分区：
文献类型：
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作者：
Guilleminault,C;Quera-Salva,MA;Goldberg,MP
摘要研究了3例双侧丘脑旁正中区病变患者的睡眠/觉醒状态。用红外摄像机和多导生理记录仪进行长期监测。尽管这些受试者表现出睡眠姿势、闭眼和每天15-17小时缺乏活动的睡眠行为方面，但他们在白天没有发展出正常的非快速眼动（NREM）和快速眼动（REM）睡眠状态。EEG表明，在与这种“睡眠样”行为相关的数小时内，存在低振幅、不规则、弥漫性θ和α范围频率的混合物。在急性损伤后一段时间进行的多次睡眠潜伏期测试给出了不同的结果，但是虽然第一阶段的NREM睡眠可能已经出现了三到四个时期，但其他睡眠状态从未出现。患者是冷漠和“昏昏欲睡”，但只能在正常的昼夜睡眠周期，即在夜间睡眠。甚至在几年后，在其中一个获得随访记录的受试者中，冷漠行为和睡眠“姿势”在一天的大部分时间都存在，即使受试者，如果要求的话，可以全天充分执行任务。患有这种病变的受试者不表现出“睡眠过度”，而是表现出“去觉醒”或“亚觉醒”，无法在正常昼夜节律界限之外发展睡眠。然而，这些受试者，至少在最初，也缺乏完全清醒。他们有一个强迫性睡眠姿势的行为障碍，并留在清醒和睡眠之间的过渡。
SUMMARYThe sleep/wake status of three patients with bilateral lesions involving the paramedian thalamic regions was investigated. Long-term monitoring with infrared video camera and polygraphy were performed. In spite of presenting a behavioural aspect of sleep with sleep posture, eyes closed and lack of activity for 15–17 h per day, these subjects did not develop the normal non-rapid eye movement (NREM) and rapid eye movement (REM) sleep states during the daytime. The EEG indicated presence of a mixture of low amplitude, irregular, diffuse theta and alpha range frequencies during hours associated with this ‘sleep-like’ behaviour. Multiple sleep latency tests performed some time after the acute insult gave varying results, but while stage 1 NREM sleep might have been noted for three to four epochs, other states of sleep never appeared. Patients were apathetic and ‘drowsy’ but could develop sleep only during the normal circadian period for sleep, i.e. during the night. Even several years later, in one of the subjects in whom follow-up recordings were obtained, apathetic behaviour and sleep ‘posturing’ were present during much of the day, even though the subject, if requested, could perform tasks adequately all day long. Subjects with such lesions do not present a ‘hypersomnia’ but a ‘de-arousal’ or ‘subwakefulness’ with inability to develop sleep outside the normal circadian boundaries for its appearance. However, these subjects, at least initially, also lacked full wakefulness. They have a behavioural impairment with a compulsive sleep posture and are left in the transition between wakefulness and sleep.