NURSING STUDY OF EXCESSIVE SLEEPINESS IN NARCOLEPSY

尽管可以获得一些关于日间警觉的信息 未经治疗的发作性睡病患者，在实验室环境中进行研究，在那里 没有研究描述白天的睡眠模式和白天 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小时动态脑电监测仪，我们将确定：1)是否 接受治疗的发作性睡病患者在以下方面与匹配的对照组患者相似 白天的警觉性，24小时的睡眠时间，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的可识别模式 接受治疗的发作性睡病患者的一天；3)如果有特殊的 明显导致睡眠发作或特定活动的活动 明显抑制睡眠发作的药物？25名接受治疗的发作性睡病患者 25名匹配的对照组受试者将在睡眠期间记录详细的睡眠日记 进行24小时动态脑电监测。此外，为了比较 发作性睡病患者和对照组的睡眠时间和持续时间， 发作性睡病受试者的录音将被分析以确定 睡眠发作是以可预测的间隔发生，还是更有可能发生 在某些情况下发生。 经常有规律的午睡和规律的夜间睡眠时间 经常被处方来减少睡眠发作的频率并限制 兴奋剂的使用。尽管这些处方通常需要 患者的生活方式发生了实质性的变化，几乎没有付出什么努力 致力于对各种睡眠时间表进行系统测试。因此， 这项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有助于减少白天的过度活动 发作性睡病患者经历的嗜睡。治疗了80人 发作性睡病的受试者将在测试前一周记下睡眠日记， 完成发作性睡病症状状态量表(NSSC)，并接受24 数小时的动态脑电监测。在完成这些初步工作后 研究中，受试者将被随机分配到四种治疗中的一种 分组：1)午睡治疗组，2)规律就寝时间组，3)结合 4)对照组。分配到NAP组的受试者将参加 每天安排两次短暂的午睡，持续三周。指定的科目 到规律就寝时间组会选择规律的起床时间和 退休，然后按照这个时间表做三个星期。第三组 受试者每天安排两次短暂的午睡，并遵循常规的 上岗和退职的时间表。对照受试者不会改变其 治疗期间的睡眠模式。将保留睡眠日记 在整个治疗期间。在两周结束时，受试者将 再次完成NSSC，进行24小时动态脑电监测。 由于受试者将在整个过程中服用他们通常使用的药物 研究表明，可以比较他们白天对兴奋剂的警觉性 单独治疗和使用联合治疗时的白天警觉性 治疗方法(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觉醒 发作性睡病患者的模式，给出了对时间的生物学洞察 发作性睡病患者的睡眠周期分布及疗效评估 用于控制白天过度困倦的预定睡眠时段 患有发作性睡病的患者会有这种感觉。

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.