NURSING STUDY OF EXCESSIVE SLEEPINESS IN NARCOLEPSY

虽然有一些关于白天警觉性的信息， 未经治疗的发作性睡病受试者，在实验室环境中进行的研究， 没有研究描述白天的睡眠模式和白天 在实验室环境外接受治疗的发作性睡病患者的警觉性。 因此，使用24小时动态EEG监测仪，我们将确定：1）如果 治疗的发作性睡病受试者在以下方面与匹配的对照受试者相当： 白天的警觉性，24小时内的睡眠量，以及 24小时内的睡眠分布; 2）如果有 睡眠发作的时间和持续时间 在治疗的发作性睡眠受试者中的当天;以及3）如果存在特定的 明显诱发睡眠发作的活动或特定活动 抑制睡眠发作的药物吗 25例接受治疗的发作性睡病患者 和25名匹配的对照受试者将记录详细的睡眠日记， 接受24小时动态脑电图监测。 此外，比较 发作性睡病组和对照组的睡眠时间和持续时间， 将分析来自发作性睡病受试者的记录以确定 睡眠发作是否发生在可预测的时间间隔或更有可能发生， 发生在某些情况下。 经常、有规律地小睡，夜间睡眠时间有规律 经常被规定减少睡眠发作的频率， 使用兴奋剂。 尽管这些处方通常需要 病人的生活方式发生了重大改变， 致力于系统测试各种睡眠时间表。 因此 本研究的第二个主要目标是测试计划的有效性， 午睡和其他睡眠时间表，以减少过多的白天 发作性睡病患者经历的嗜睡。 80例治疗 发作性睡病受试者将在测试前一周记录睡眠日记， 完成嗜睡症症状状态检查表（NSSC），并接受24 小时的动态脑电图监测 在完成这些初步的 研究中，受试者将被随机分配至四种治疗之一 组：1）午睡治疗组，2）规律就寝组，3）联合治疗组 4）对照组。 分配到午睡组的受试者将 连续三周每天小睡两次 被分配的科目 到规律就寝组会选择一个规律的时间起床， 退休后，按照这个时间表工作三周。 第三组 受试者每天将进行两次短暂的预定小睡，并遵循定期的 起退时间表。 对照组受试者不会改变他们的 治疗期间的睡眠模式。 睡眠日记将被保留 在整个治疗期间。 在两周结束时，受试者将 再次完成NSSC并进行24小时动态EEG监测。 由于受试者将在整个研究期间服用常规药物， 这项研究将有可能比较他们白天对兴奋剂的警觉性 单独治疗与使用联合治疗时的日间警觉性 方法（兴奋剂和预定的睡眠时间）。 这些研究完成后，应该会进一步定义睡眠唤醒 发作性睡病的模式，给时间生物学的见解，时间 发作性睡病的睡眠时间分布，并评估其有效性 控制白天过度嗜睡的计划睡眠时间 发作性睡病患者的经验。

Although some information is available about the daytime alertness of untreated narcoleptic subjects, studies in a laboratory environment, there are no studies which describe the daytime sleep patterns and daytime alertness of treated narcoleptics outside the laboratory setting. Therefore, using 24 hour ambulatory EEG monitors we will determine: 1) If treated narcoleptic subjects are comparable to matched control subjects in terms of daytime alertness, amount of sleep in a 24 hour period, and distribution of sleep across a 24 hour period; 2) If there is an recognizable pattern to the timing and duration of sleep attacks across the day in treated narcoleptic subjects; and 3) If there are particular activities which apparently induce sleep attacks or particular activities which apparently inhibit sleep attacks? Twenty-five treated narcoleptics and 25 matched control subjects will keep a detailed sleep diary while undergoing 24 hour ambulatory EEG monitoring. In addition, to comparing the timing and duration of sleep in narcoleptic and control groups, recordings from the narcoleptic subjects will be analyzed to determine whether sleep attacks occur at predictable intervals or are more likely to occur in certain circumstances. Frequent, regularly scheduled naps and regular hours for nocturnal sleep are often prescribed to decrease the frequency of sleep attacks and limit the use of stimulants. Even though these prescriptions often require substantial alterations in the patient's lifestyle, little effort has been devoted to systematic testing of various sleep schedules. Therefore, the second major goal of this study is to test the effectiveness of scheduled naps and other sleep schedules in reducing the excessive daytime sleepiness experienced by narcoleptic patients. Eighty treated narcoleptic subjects will keep a sleep diary one week prior to testing, complete the Narcolepsy Symptom Status Checklist (NSSC), and undergo 24 hours of ambulatory EEG monitoring. After completing these preliminary studies, subjects will be randomly assigned to one of four treatment groups: 1) nap therapy group, 2) regular bedtime group, 3) combination group, and 4) control group. Subjects assigned to the nap group will take two brief, scheduled naps per day for three weeks. The subjects assigned to the regular bedtime group will select a regular time for arising and retiring, and follow that schedule for three weeks. The third group of subjects will take two, brief scheduled naps each day and follow a regular schedule for arising and retiring. Control subjects will not alter their sleep patterns during the treatment period. Sleep diaries will be kept throughout the treatment period. At the end of two weeks, subjects will again complete the NSSC and undergo 24 hour ambulatory EEG monitoring. Since subjects will be taking their usual medications throughout the study, it will be possible to compare their daytime alertness on stimulant therapy alone with their daytime alertness when using a combined treatment approach (stimulants and scheduled sleep periods). These studies, when complete, should further define the sleep wake patterns in narcoleptics, give chronobiological insights into the temporal distribution of sleep periods in narcolepsy, and assess the effectiveness of scheduled sleep periods for controlling excessive daytime sleepiness experienced by patients with narcolepsy.