矛盾性失眠脑电特征及治疗的研究进展

doi:10.3969/j.issn.1674-8115.2024.05.016

摘要/Abstract

摘要：

矛盾性失眠（paradoxical insomnia，Para-I）又被称为假性失眠（pseudoinsomnia）或失眠状态错觉（sleep state misperception，SSM）。这类患者通常主诉患有严重失眠，但缺乏睡眠紊乱的客观证据，日间功能受损情况与患者所述的睡眠缺失程度不成比例。高估睡眠潜伏时间（sleep latency，SL）、低估总睡眠时间（total sleep time，TST）是Para-I的主要特征。这种睡眠质量的错误评价妨碍了对睡眠障碍的诊断、严重程度及临床疗效的评估。Para-I的发病机制仍不清楚，可能与抑郁水平、焦虑水平、人格特征、社会关系质量、大脑结构和功能的特殊改变有关。基于多导睡眠监测（polysomnography，PSG）的失眠相关研究发现，非快速眼动睡眠（non-rapid eye movement sleep，NREM睡眠）和快速眼动睡眠（rapid eye movement sleep，REM睡眠）的改变可能与失眠患者的主客观睡眠不一致程度有关。PSG是诊断睡眠障碍的重要手段。它可以通过同步监测脑电图（electroencephalogram，EEG）、肌电图（electromyogram，EMG）、眼动电图（electrooculogram，EOG）、口鼻气流、胸腹呼吸运动、血氧饱和度、心电图（electrocardiogram，ECG）、鼾声等多项参数对睡眠结构及相关的生理行为变化进行分析。近年来，越来越多的研究开始借助PSG对Para-I的睡眠EEG及治疗进行探索并取得了一定的进展。该文就Para-I的脑电特征和治疗的最新进展做一综述，以期为Para-I的精准治疗提供新的思路。

关键词: 矛盾性失眠, 主客观睡眠不一致, 多导睡眠监测, 失眠认知行为治疗

Abstract:

Paradoxical insomnia (Para-I), also known as pseudoinsomnia or sleep state misperception, is a condition in which the patient complains of severe insomnia but has no objective evidence of sleep disorder, and daytime functioning may be disrupted disproportionately to the degree of patient-reported sleep loss. Para-I is characterized by overestimation of sleep latency (SL) and underestimation of total sleep time (TST). Incorrect assessment of sleep quality hinders the diagnosis, evaluation of severity, and assessment of clinical efficacy of sleep disorders. The pathogenesis of Para-I remains unclear, but may be related to factors such as depression, anxiety, personality traits, social relationships and specific changes in brain structure and function. Studies on the polysomnography (PSG) of the patients with insomnia have found that changes in non-rapid eye movement (NREM) and rapid eye movement (REM) sleep may be related to the degree of subjective-objective sleep discrepancy. PSG is a valuable diagnostic tool for sleep disorders. It allows for the analysis of sleep structure and related physiological and behavioral changes by monitoring various parameters, including electroencephalogram (EEG), electromyogram (EMG), electrooculogram (EOG), oro-nasal airflow, thoracic and abdominal respiratory motions, oxygen saturation, electrocardiogram (ECG) and snoring. In recent years, studies have increasingly explored the sleep EEG and treatment of Para-I with PSG, resulting in significant progress. This article reviews the latest advances in the electroencephalographic characteristics and treatment of Para-I, providing new ideas for precise treatment.

Key words: paradoxical insomnia (Para-I), subjective-objective sleep discrepancy, polysomnography (PSG), cognitive behavioral therapy for insomnia

中图分类号:

R749

张毓, 苑成梅, 肖泽萍. 矛盾性失眠脑电特征及治疗的研究进展[J]. 上海交通大学学报（医学版）, 2024, 44(5): 658-662.

ZHANG Yu, YUAN Chengmei, XIAO Zeping. Research advances in the electroencephalographic characteristics and treatment of paradoxical insomnia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(5): 658-662.

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