摘要
目的 探讨睡眠纺锤波能否对噪声干扰易感慢性睡眠障碍患者实施认知行为治疗(CBT-I)疗效起到预测作用,以期实现对该类患者的临床个体化精准治疗目标.方法 选择在夜间睡眠时段(22∶00～06∶00)公路、铁道旁及飞机航线附近噪音暴露环境相对固定(50～60分贝,每次持续时间10～15 s)条件下的居民为观察对象,采用匹兹堡睡眠质量指数(PSQI)量表和多导睡眠监测(PSG)检查进行主观及客观睡眠情况评估.根据结果分为睡眠正常(26例)组和睡眠障碍(30例)组,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估两组的情绪状态.根据PSQI量表筛选睡眠障碍患者,对失眠患者开展PSG并根据结果中睡眠期纺锤波情况再分为:纺锤波偏高组(12例)和纺锤波偏低组(18例),同期进行8周的团体认知行为治疗.结果 睡眠正常组的PSQI量表、SAS及SDS量表评分低于睡眠障碍组(P<0.05);PSG结果显示,睡眠正常组与睡眠障碍组比较,N2期平均睡眠时间长(P<0.05),睡眠期纺锤波次数增多(P<0.05),睡眠期纺锤波指数增高(P<0.05);两组睡眠纺锤波平均持续时间差异无显著性(P>0.05).睡眠障碍组经团体认知行为治疗后,纺锤波偏高组睡眠情况改善,PSQI量表评分、SAS及SDS量表评分较治疗前降低,睡眠潜伏期缩短、N2和N3期睡眠时间延长、睡眠期纺锤波次数增加(均P<0.05);N1期、REM期、睡眠纺锤波指数、睡眠纺锤波平均持续时间较治疗前变化差异无显著性(均P>0.05).纺锤波指数偏低者的睡眠情况较治疗前无明显变化,PSQ量表评分、SAS及SDS程度、睡眠结构参数与治疗前比较差异均无显著性(均P>0.05).结论 噪声干扰睡眠,睡眠期纺锤波指数与机体抗噪能力相关,睡眠期纺锤波指数偏低者对认知行为治疗效果较差,睡眠期纺锤波可作为预测睡眠障碍患者实施CBT-I临床疗效的生物学标志.
Abstract
Aim To investigate whether sleep spindles can predict the effect of CBT-I(cognitive behavior therapy for insomnia)in noise-susceptible patients with chronic insomnia disorder,so as to achieve the target of clinical individualized precise treatment for these patients.Methods People who were exposed to a relatively constant noise environment(50～60 dB,lasting 10～15 s each time)were selected during sleeping hours(22:00～06:00)at night,near roads,railways and airplane routes.Subjective and objective sleep conditions were assessed by Pittsburgh Sleep Quality Index(PSQI)and Polysleep Monitoring(PSG).The subjects were divided into a normal sleep quality group(26 cases)and an insomnia disorder group(30 cases)according to the results.The emotional states of the two groups were evaluated by Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS).The people with insomnia disorder were screened with PSQI,and then PSG was carried out on the insomnia people.According to the results of sleep spindles,they were divided into a high spindles group(12 cases)and a low spindles group(18 cases),and 8 weeks of group cognitive behavioral therapy were also given at the same time.Results The scores of PSQI,SAS and SDS in the normal sleep quality group were lower than those in the insomnia disorder group,and the difference was statistically significant(P<0.05).The results of PSG showed that the average sleep time in N2 phase of normal sleep quality group and insomnia disorder group were(236.4±53.53)min and(191.4±60.42)min,respectively,the difference was statistically significant(t=2.933,P<0.05).The average number of spindles in the normal sleep quality group(179.0±75.70)was higher than that in the insomnia disorder group(87.37±52.61),and the difference was statistically significant(t=5.315,P<0.05).The average spindle index of normal sleep quality group(25.43±12.15)was higher than that of insomnia disorder group(16.6±14.02),and the difference was statistically significant(t=2.498,P<0.05).The mean duration of sleep spindles was not significantly different between the two groups(t=-0.457,P>0.05).After the group cognitive behavioral therapy,the sleep condition of the insomnia disorder group with high sleep spindle index was improved,the score of PSQI,SAS and SDS were reduced,the sleep latency was shortened,the time of N2 and N3 sleep was prolonged,and the number of sleep spindles was increased,the differences were statistically significant(P<0.05).N1 phase,REM phase,sleep spindle index and mean duration of sleep spindle had no significant changes compared with that before treatment(P>0.05).Compared with that before treatment,there was no significant difference in the sleep condition of patients with lower spindle index in sleep period.Compared with that before treatment,there was no significant difference in the score of PSQI,SAS,SDS,and sleep structure parameters(P>0.05).Conclusion Studying noise interfering with sleep,the spindle index in sleep is related to the body's anti-noise ability.The lower spindle index in sleep is less effective in cognitive behavioral therapy.The spindle index in sleep can be used as a biological marker to predict the clinical effect of CBT-I in patients with insomnia disorder.
基金项目
重庆市卫健委医学科研项目(2022WSJK043)
国家自然科学基金面上项目(81971241)
NETL
NSTL
万方数据