The significance of the sympathetic nervous system in the pathophysiology of periodic leg movements in sleep
The significance of the sympathetic nervous system in the pathophysiology of periodic leg movements in sleep
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DOI：
10.1093/sleep/30.6.755
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发表时间：
2007-06-01
期刊：
影响因子：
5.6
通讯作者：
Mathis, Johannes
中科院分区：
文献类型：
--
作者：
Guggisberg, Adrian G.;Hess, Christian W.;Mathis, Johannes
研究目的：睡眠中的周期性腿部运动 (PLMS) 经常伴有觉醒和自主神经激活，但这些表现的病理生理学意义尚不清楚。设计：将与特发性 PLMS 相关的心率变异性 (HRV)、HRV 频谱和脑电图 (EEG) 频谱的变化与睡眠期间孤立腿部运动和呼吸相关腿部运动相关的变化进行比较。此外，还评估了肌电图活动、HRV 变化和 EEG 变化之间的相关性。地点：睡眠实验室。患者：对 24 名符合周期性腿部运动障碍 (n = 8)、阻塞性睡眠呼吸暂停综合征 (n = 7) 或正常多导睡眠图 (n = 9) 标准的受试者进行整夜多导睡眠图研究。测量和结果：频谱 HRV 变化在所有 EEG 变化之前开始，最多在 EEG 变化之前 6 秒开始。所有类型的腿部运动的开始。最初较弱的自主神经激活，随后是交感神经激活，EEG delta 活动增加，最后进展为高频 EEG 节律增加。运动开始后，HRV 表明迷走神经激活，EEG 表明纺锤体活动减少。根据 HRV 频谱测量，PLMS 的交感神经激活程度高于所有其他运动类型。在 EEG 中，孤立腿部运动和呼吸相关腿部运动的伽马同步开始时间比 PLMS 早 1 到 2 秒。在自主神经激活和肌电图活动之间以及自主神经激活和 EEG delta 活动之间发现了显着相关性，但在高频 EEG 节律和 EMG 活动或 HRV 变化之间没有发现显着相关性。 结论：这些结果表明交感神经系统在 PLMS 的产生中发挥着主要作用。
Study Objectives: Periodic leg movements in sleep (PLMS) are frequently accompanied by arousals and autonomic activation, but the pathophysiologic significance of these manifestations is unclear.Design: Changes in heart rate variability (HRV), HRV spectra, and electroencephalogram (EEG) spectra associated with idiopathic PLMS were compared with changes associated with isolated leg movements and respiratory-related leg movements during sleep. Furthermore, correlations between electromyographic activity, HRV changes, and EEG changes were assessed.Setting: Sleep laboratory.Patients: Whole-night polysomnographic studies of 24 subjects fulfilling the criteria of either periodic leg movements disorder (n = 8), obstructive sleep apnea syndrome (n = 7), or normal polysomnography (n = 9) were used.Measurements and Results: Spectral HRV changes started before all EEG changes and up to 6 seconds before the onset of all types of leg movements. An initial weak autonomic activation was followed by a sympathetic activation, an increase of EEG delta activity, and finally a progression to increased higher-frequency EEG rhythms, After movement onset, HRV indicated a vagal activation, and, the EEG, a decrease in spindle activity. Sympathetic activation, as measured by HRV spectra, was greater for PLMS than for all other movement types. In EEG, gamma synchronization began I to 2 seconds earlier for isolated leg movements and respiratory-related leg movements than for PLMS. Significant correlations were found between autonomic activations and electromyographic activity, as well as between autonomic activations and EEG delta activity, but not between higher-frequency EEG rhythms and EMG activity or HRV changes.Conclusions: These results suggest a primary role of the sympathetic nervous system in the generation of PLMS.