Chronic vagus nerve stimulation improves alertness and reduces rapid eye movement sleep in patients affected by refractory epilepsy.
Chronic vagus nerve stimulation improves alertness and reduces rapid eye movement sleep in patients affected by refractory epilepsy.
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DOI：
10.1093/sleep/26.5.607
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发表时间：
2003-08
期刊：
影响因子：
5.6
通讯作者：
P. Rizzo;M. Beelke;F. De Carli;P. Canovaro;L. Nobili;A. Robert;P. Tanganelli;G. Regesta;F. Ferrillo
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文献类型：
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作者：
P. Rizzo;M. Beelke;F. De Carli;P. Canovaro;L. Nobili;A. Robert;P. Tanganelli;G. Regesta;F. Ferrillo
目的探讨难治性癫痫患者迷走神经刺激后睡眠结构变化的存在性和实现性。方法对10例难治性癫痫患者的夜间睡眠进行多导睡眠图研究。受试者在基线条件下和慢性迷走神经刺激后均被记录。评估整个晚上的睡眠参数。在第一个非快速眼动睡眠周期计算慢波活动的平均功率值。睡眠-觉醒日记评估夜间和白天睡眠的数量，而视觉模拟量表评估睡眠和清醒的质量。两种情况之间的差异进行了参数和非参数统计评价。结果：迷走神经刺激显著减少快速眼动睡眠（所有迷走神经刺激强度大于1.5毫安的受试者均如此，但刺激强度小于1.5毫安的患者除外），同时觉醒次数、睡眠后醒来百分比和第一阶段睡眠增加。睡眠-觉醒调查问卷的数据显示，夜间睡眠和白天小睡的时间都减少了，白天的警觉性提高了，而清醒的质量在全球范围内得到了改善。光谱分析显示，在非快速眼动睡眠期间，delta功率增强。结论：我们的数据表明迷走神经刺激对白天警觉性（提高）和夜间快速眼动睡眠（降低）都有重要影响。这些影响可以解释为迷走神经刺激对调节睡眠-觉醒和快速眼动/非快速眼动睡眠周期的神经结构的不稳定作用的结果。低强度的迷走神经刺激似乎只能提高警觉性；高强度的迷走神经刺激似乎能够发挥辅助的快速眼动睡眠衰减效应。
OBJECTIVE Our study aimed to evaluate the existence and entity of changes in sleep structure following vagus nerve stimulation in patients with refractory epilepsy. METHOD A polysomnographic study was performed on the nocturnal sleep of 10 subjects with refractory epilepsy. Subjects were recorded both in baseline conditions and after chronic vagus nerve stimulation. Sleep parameters of the entire night were evaluated. Mean power value of slow-wave activity was computed in the first non-rapid eye movement sleep cycle. A sleep-wake diary evaluated quantity of both nocturnal and daytime sleep, while visual-analog scales assessed quality of sleep and wake. The differences between the 2 conditions underwent parametric and nonparametric statistical evaluation. RESULTS Vagus nerve stimulation produced a significant reduction in REM sleep (in all subjects with vagus nerve stimulus intensity greater than 1.5 milliampere, but not in the only patient with a stimulus intensity less than 1.5 milliampere), along with an increase in the number of awakenings, percentage of wake after sleep onset, and stage 1 sleep. Data from a sleep-wake questionnaire show a decrease in both nocturnal sleep and daytime naps and an increased daytime alertness, while the quality of wakefulness is globally improved. Spectral analysis shows an enhancement of delta power during non-rapid eye movement sleep. CONCLUSIONS Our data demonstrate major effects of vagus nerve stimulation on both daytime alertness (which is improved) and nocturnal rapid eye movement sleep (which is reduced). These effects could be interpreted as the result of a destabilizing action of vagus nerve stimulation on neural structures regulating sleep-wake and rapid eye movement/non-rapid eye movement sleep cycles. Lower intensity vagus nerve stimulation seems only to improve alertness; higher intensity vagus nerve stimulation seems able to exert an adjunctive rapid eye movement sleep-attenuating effect.