摘要
目的:探讨抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者的睡眠障碍情况。方法:选取2014年1月至2021年1月在武汉市长江航运总医院门诊及住院收治的抗NMDAR脑炎恢复期患者12例，年龄和性别匹配的健康对照组12例。所有对象均进行体质量指数（BMI）评价及视频多导睡眠图（VPSG）监测，比较2组睡眠总时间、睡眠总效率、入睡潜伏期、非快速眼动（NREM）睡眠N1期占比、NREM睡眠N2期占比、NREM睡眠N3~4期占比、REM睡眠占比、意识模糊觉醒例数、周期性肢体运动、呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2），评估抗NMDAR脑炎患者急性期及恢复期睡眠情况。结果:抗NMDAR脑炎患者恢复期睡眠结构没有变化，但从VPSG记录显示，4例患者出现了多次意识模糊觉醒，意识模糊觉醒例数与健康对照组比较，差异有统计学意义（P=0.047）；12例急性期患者中有7例表现失眠，占比58.3%，而在恢复期6例患者出现白天过度嗜睡，占比50.0%，2例出现失眠，仅占比16.7%。结论:抗NMDAR脑炎患者会出现多种睡眠问题，从急性期到恢复期有睡眠模式的变化，急性期以失眠为主，恢复期出现白天过度嗜睡，在NREM睡眠期出现意识模糊觉醒。
Abstract
Objective:To explore the sleep disorders in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.Methods:A total of 12 patients with anti-NMDAR encephalitis admitted to the outpatient department and inpatient department of Wuhan General Hospital of the Yangtze River Shipping in the recovery period were included. Twelve age- and sex-matched healthy participants were included as controls. All people were evaluated in body mass index (BMI) and video-polysomnography (VPSG). Data were compared between the two groups, including the total sleep time, total sleep efficiency, sleep latency, non-rapid eye movement (NREM) sleep N1 period, NREM sleep N2 period, NREM sleep N 3 to 4 period, REM sleep, number of cases of blurred arousals, periodic limb movements, AHI, and LSaO2. The sleep status of patients with anti-NMDAR encephalitis at acute and recovery stages were evaluated.Results:The sleep structure of the patients with anti-NMDAR encephalitis did not change during recovery. Four patients showed blurred arousal on V-PSG, compared with healthy controls. The number of cases of blurred arousals had a statistical difference between the two groups (P=0.047). In the acute stage, 7 cases (58.3%) showed insomnia; while during the recovery stage, 6 cases (50.0%) had hypersomnia, and only 2 cases (16.7%) showed insomnia.Conclusion:Sleep disturbances are frequent in patients with anti-NMDAR encephalitis. They show a temporal pattern, predominantly insomnia at onset and hypersomnia during recovery, and can occur with confusional arousals during NREM sleep.
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