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目的 通过定量分析发作性睡病快速眼球运动(REM)期下颏肌电增高程度,探讨其与临床的相关性.方法 对66例发作性睡病患者进行多导睡眠监测和日间多次小睡潜伏期试验(MSLT),通过定量患者夜间REM期下颏肌电并进行分组:下颏肌电增高则为REM期无肌张力丧失(RSWA)组(n=31),其余为无RSWA组(n=35).收集患者一般临床资料、多导睡眠监测及MSLT数据,对患者进行爱泼沃斯嗜睡量表(ESS)、蒙特利尔认知评估量表等神经心理学评估,并进行相关统计学分析.结果 与发作性睡病无RSWA组比较,RSWA组ESS得分高[(17.9±4.1)分和(15.4±4.9)分;t=2.236,P=0.029]、平均每次嗜睡发作时间(min)长(38.3 ±28.4和19.2±11.2;=2.931,P=0.030)、猝倒型比例高[58.1％ (18/31)和28.6％ (10/35);x2=6.281,P=0.012].多导睡眠参数中,发作性睡病RSWA组较无RSWA组睡眠潜伏期(min)缩短(2.00(0.50,3.50)和3.00(1.75,9.50),Z=3.007,P=0.003),觉醒总次数(次/晚)多(31.4±14.4和22.9±13.1,t=2.368,P =0.021),微觉醒指数[(13.0±7.2)次/h和(9.2±6.5)次/h,t=2.080,P=0.042]及自发性微觉醒指数增高[(11.9±7.1)次/h和(8.1±5.4)次/h,t=2.500,P=0.015].两组在睡眠结构上无明显差异.MSLT参数中,发作性睡病RSWA组较无RSWA组平均REM潜伏期(min)缩短(3.5±1.7和5.3±4.5,t=-2.190,P=0.027).猝倒危险因素Logistic回归分析显示,时相性下颏肌电值(OR=1.103,95％ CI 1.008 ～1.207,P=0.033)、紧张性下颏肌电值(OR=1.339,95％ CI 1.111～1.615,P =0.002)与猝倒发生相关.结论 发作性睡病伴RSWA组睡眠片段化,日间嗜睡程度更重,猝倒型比例高,发作性睡病时相性下颏肌电值及紧张性下颏肌电值增高,发生猝倒的风险越大.

Objective To quantitatively research the chin electromyography (EMG) increasing level of narcolepsy in rapid eye movement(REM) period,and analyze its association with clinical features and rapid eye movement sleep without atonia (RSWA).Methods Sixty-six patients with narcolepsy underwent video-polysomnography (video-PSG) and multiple sleep latency test (MSLT),and were grouped by quantitative research of the chin EMG levels during overnight REM (patients with elevated level belongs to RSWA group (n =31)).The data from general clinical data,video-PSG and MSLT and neuropsychological assessment (Epworth Sleepiness Scale (ESS) and Montreal Cognitive Assessment) were analyzed statistically.Results Compared with narcolepsy without RSWA group (n =35),narcolepsy with RSWA group showed higher ESS score (17.9 ± 4.1 vs 15.4 ± 4.9,t =2.236,P =0.029),longer average time (min) per drowsiness (38.3 ±28.4 vs 19.2 ± 11.2,t=2.931,P=0.030),higher incidence of cataplexy (58.1％ (18/31) vs 28.6％ (10/35);x2 =6.281,P =0.012).In the polysomnography parameters,narcolepsy with RSWA group had shorter sleep latency (2.00 (0.50,3.50) min vs 3.00(1.75,9.50) min;Z =3.007,P =0.003),higher total arousal index (31.4 ± 14.4 vs 22.9 ± 13.1;t =2.368,P =0.021),and micro arousal index ((13.0 ±7.19)/h vs (9.2 ±6.5)/h;t =2.080,P =0.042) and spontaneous arousal index((11.9±7.1)/hvs(8.1 ±5.4)/h;t=2.500,P=0.015).There was no significant difference in sleep structure between the narcolepsy with RSWA group and narcolepsy without RSWA group.In MSLT parameters,shorter average REM sleep latency (min) appeared in narcolepsy with RSWA group(3.5 ± 1.7 vs 5.3 ± 4.5,t =-2.190,P =0.027).Logistic regression analysis showed that the phase of the chin EMG (OR=1.103,95％ CI 1.008-1.207,P=0.033) and tension chin EMG (OR =1.339,95％ CI 1.111-1.615,P =0.002)were significantly associated with cataplexy.Conclusions Narcolepsy with RSWA group showed sleep fragmentation,severer daytime sleepiness,and higher risk of cataplexy.Therefore,narcolepsy patients with high chin EMG had a higher prevalence of cataplexy.