Pupillometric assessment of sleepiness in narcolepsy.
Pupillometric assessment of sleepiness in narcolepsy.
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DOI：
10.3389/fpsyt.2011.00035
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发表时间：
2011
影响因子：
4.7
通讯作者：
Carley DW
中科院分区：
文献类型：
--
作者：
Prasad B;Choi YK;Weaver TE;Carley DW
目的：白天过度嗜睡在普通人群中非常普遍，是发作性睡病的标志，并且与显着的发病率相关。睡意的临床评估仍然具有挑战性，常见的客观多次睡眠潜伏期测试 (MSLT) 和主观 Epworth 睡意量表 (ESS) 方法相关性较差。我们在一项前瞻性观察性试点研究中，对一组未接受药物治疗的发作性睡病患者和健康对照者检查了瞳孔不安指数（PUI）作为睡意客观测量指标的相对效用。方法：在相同的实验条件下对发作性睡病（n = 20；未治疗>2 周）和对照（n = 56）参与者进行测试；对所有参与者进行夜间多导睡眠监测，然后进行日间测试方案，包括：MSLT、PUI、嗜睡视觉模拟量表 (VAS)、ESS 和精神运动警惕性测试 (PVT)。结果：发作性睡病组和对照组在精神运动表现以及客观和主观嗜睡的各项指标（包括 PUI）方面存在显着差异。在整个样本中，PUI 与客观（平均睡眠潜伏期，SL）和主观（ESS 和 VAS）困倦显着相关，但没有任何困倦测量与表现（PVT）相关。在发作性睡病患者中，VAS 与 PVT 测量值相关。在对照组中，平均 PUI 是唯一与主观睡意相关的客观睡意测量值。最后，在 ANCOVA 模型中，SL 和 ESS 可以显着预测 PUI 作为睡意的衡量标准。结论：PUI 在量化和区分发作性睡病与睡眠充足的健康对照者的嗜睡方面的作用值得进一步研究，因为它是一种便携式、简短且客观的测试。
Purpose: Excessive daytime sleepiness is highly prevalent in the general population, is the hallmark of narcolepsy, and is linked to significant morbidity. Clinical assessment of sleepiness remains challenging and the common objective multiple sleep latency test (MSLT) and subjective Epworth sleepiness scale (ESS) methods correlate poorly. We examined the relative utility of pupillary unrest index (PUI) as an objective measure of sleepiness in a group of unmedicated narcoleptics and healthy controls in a prospective, observational pilot study. Methods: Narcolepsy (n = 20; untreated for >2 weeks) and control (n = 56) participants were tested under the same experimental conditions; overnight polysomnography was performed on all participants, followed by a daytime testing protocol including: MSLT, PUI, sleepiness visual analog scale (VAS), ESS, and the psychomotor vigilance test (PVT). Results: The narcolepsy and control groups differed significantly on psychomotor performance and each measure of objective and subjective sleepiness, including PUI. Across the entire sample, PUI correlated significantly with objective (mean sleep latency, SL) and subjective (ESS and VAS) sleepiness, but none of the sleepiness measures correlated with performance (PVT). Among narcoleptics, VAS correlated with PVT measures. Within the control group, mean PUI was the only objective sleepiness measure that correlated with subjective sleepiness. Finally, in an ANCOVA model, SL and ESS were significantly predictive of PUI as measure of sleepiness. Conclusion: The role of PUI in quantifying and distinguishing sleepiness of narcolepsy from sleep-satiated healthy controls merits further investigation as it is a portable, brief, and objective test.