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.
ZHANG Yu, YUAN Chengmei, XIAO Zeping. Research advances in the electroencephalographic characteristics and treatment of paradoxical insomnia. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2024, 44(5): 658-662 doi:10.3969/j.issn.1674-8115.2024.05.016
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）。这类患者常主诉患严重失眠，但无睡眠紊乱的客观证据，并且患者睡眠相关的日间功能受损情况与其所述的睡眠缺失程度不成比例［1-2］。Para-I主要特征为高估睡眠潜伏时间（sleep latency，SL）、低估总睡眠时间（total sleep time，TST）。这种对于睡眠质量的失实评价严重影响了诊断及治疗的有效实施。目前，临床对其重视还不足，相关发病机制不甚明了，也缺乏较好的治疗方案。本文主要从临床表现、脑电特征及治疗这3个方面对Para-I的相关研究以及最新进展做一综述。
1 Para-I的临床表现
1.1 概念演变
1990年睡眠障碍国际分类（International Classification of Sleep Disorders，ICSD）第1版［3］中对主客观睡眠不一致的现象进行了讨论，并将其命名为SSM；2005年ICSD第2版［2］取消了SSM的相关描述，在慢性失眠障碍中提出Para-I这一亚型，并提出了定量诊断的参考标准：TST≥6.5 h且睡眠效率（sleep efficiency，SE）>85%。但这一标准存在较多的争议，因此在2014年出版的ICSD第3版中仅在慢性失眠障碍中保留了Para-I的概念。
近年来研究发现失眠认知行为治疗（cognitive behavioral therapy for insomnia，CBTI）［41-44］、基于正念的失眠治疗（mindfulness-based therapy for insomnia，MBTI）［45］等可能是改善Para-I患者主客观睡眠不一致的有效手段。
The manuscript was drafted by ZHANG Yu, and revised by XIAO Zeping and YUAN Chengmei. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
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... 近年来研究发现失眠认知行为治疗（cognitive behavioral therapy for insomnia，CBTI）［41-44］、基于正念的失眠治疗（mindfulness-based therapy for insomnia，MBTI）［45］等可能是改善Para-I患者主客观睡眠不一致的有效手段. ...
... 近年来研究发现失眠认知行为治疗（cognitive behavioral therapy for insomnia，CBTI）［41-44］、基于正念的失眠治疗（mindfulness-based therapy for insomnia，MBTI）［45］等可能是改善Para-I患者主客观睡眠不一致的有效手段. ...
... 近年来研究发现失眠认知行为治疗（cognitive behavioral therapy for insomnia，CBTI）［41-44］、基于正念的失眠治疗（mindfulness-based therapy for insomnia，MBTI）［45］等可能是改善Para-I患者主客观睡眠不一致的有效手段. ...
