摘要目的 探索失眠障碍不同亚型患者记忆能力和客观睡眠参数之间的差异及其相关性.方法 收集2012年8月至2014年2月在安徽医科大学第一附属医院记忆睡眠障碍门诊就诊的失眠障碍患者89例,其中入睡困难11例,早醒20例,维持困难20例,混合性(至少有2种以上睡眠主诉)38例,用九盒迷宫测试记忆(物体、空间、工作及参考)、多导睡眠图评估患者的睡眠情况.结果 4种类型患者的空间(H=15.404,P=0.002)和工作(H=10.126,P=0.018)记忆错误数差异有统计学意义,即早醒组[6.00(5.00,8.00)、5.00(4.00,6.00)]和混合组[5.00(3.75,7.25)、5.00(2.75,7.00)]的空间记忆和工作记忆均比维持困难组差[2.50(2.00,4.00)、2.00(1.00,4.00);t空间=3.938、3.428,t工作=2.803、2.840;均P＜0.05].4种类型患者之间的睡眠效率(H=7.929,P=0.048)、快速眼动期(REM)睡眠时间(F =2.840,P=0.043)和REM睡眠占总睡眠时间百分比(REM％;H=7.913,P=0.048)差异也存在统计学意义,即混合组[69.7％(50.5％,78.7％)]的睡眠效率比早醒组[81.0％(64.8％,86.4％)]和维持困难组[80.2％(62.6％,88.9％)]低(t=2.242、2.352,均P＜0.05),早醒组[61.6±27.1、16.9％(13.1％,21.9％)]和混合组[56.9±31.4、16.9％ (11.5％,21.2％)]的REM时间(min)和REM％均比维持困难组低[80.9 ±32.7、22.3％(18.5％,25.5％);qREM时间=3.791、5.397,tREM％ =2.513、2.612,均P＜0.05].工作和空间记忆错误数与REM时间(r=-0.387、-0.348,均P＜0.05)和REM％(r=-0.350、-0.354,均P＜0.05)呈负相关.结论 失眠障碍各亚型患者之间的空间和工作记忆能力不同,客观睡眠参数也存在细微差异,且记忆变差可能与REM睡眠减少有关.

abstractsObjective To explore the differences of memory functions and objective sleep parameters and their correlations in patients with insomnia disorder in different subtypes.Methods Eightynine patients with insomnia disorder,including 11 patients with difficulty initiating sleep(DIS),20 patients with early morning awakening(EMA),20 patients with difficulty maintaining sleep (DMS) and 38 patients with mixed sleep symptoms(MS) were enrolled between August 2012 and February 2014 in the Memory and Sleep Disorders Clinic of the First Affiliated Hospital of Anhui Medical University.Memory functions,including objective memory,spatial memory,working memory and reference memory were detected with nine boxes maze,and objective sleep profiles were assessed using polysomnography.Results The error numbers of spatial(H =15.404,P =0.002) and working (H =10.126,P =0.018) memories were significantly different among the 4 subtypes of patients,with more errors of spatial and working memory in the EMA (6.00 (5.00,8.00),5.00 (4.00,6.00)) and MS (5.00 (3.75,7.25),5.00 (2.75,7.00)) groups compared with the DMS (2.50 (2.00,4.00),2.00 (1.00,4.00)) group (tspstial =3.938,3.428;t =2.803,2.840;all P ＜ 0.05).Sleep efficiency(H =7.929,P =0.048),REM sleep time(F =2.840,P =0.043) and the percentage of REM sleep time on total sleep time (REM％;H =7.913,P =0.048) were also significantly different among the 4 subtypes of patients,with lower sleep efficiency in the MS(69.7％ (50.5％,78.7％)) group compared with the EMA (81.0％ (64.8％,86.4％)) and DMS (80.2％ (62.6％,88.9％)) groups (t =2.242,2.352;all P ＜ 0.05),less REM sleep time (min) and REM％ in the EMA(61.6 ±27.1,16.9％ (13.1％,21.9％)) and MS(56.9 ±31.4,16.9％ (11.5％,21.2％)) groups compared with the DMS (80.9 ± 32.7,22.3％ (18.5％,25.5％)) group (qREM time =3.791,5.397;tREM％ =2.513,2.612;all P ＜0.05).The error numbers of working memory and spatial memory negatively correlated with the REM sleep time (r =-0.387,-0.348;all P ＜ 0.05) and REM％ (r =-0.350,-0.354;all P ＜ 0.05).Conclusions There are discrepancies in the spatial and working memories and subtle differences in the objective sleep parameters among the patients with different subtypes of insomnia disorder.The worse memories in insomnia disorder patients might be associated with the decreased REM sleep.