STUDY OBJECTIVES:To explore the sleep onset process in primary insomnia patients, new rules for scoring 4-second epochs were implemented to score sleep and artifacts during initial sleep onset. Conventional scorings in 20-second and 60-second epochs were also obtained. METHODS:The start of the initial 60-second epoch of stage 1 was used to define "time zero" (t0). Sleep onset periods from 11 patients and 11 individually age- and sex-matched controls spanned from 5 minutes before t0 through 29 minutes after t0. Using the new rules, the periods were scored blind to group assignment. This t0 time-referenced the data analysis to one plausible midpoint in the sleep onset process. In parallel, latencies were time-referenced from good night time. RESULTS:Reliability in scoring sleep and artifacts was adequate (kappa = 0.68 & 0.63, respectively, p <0.001). Group differences in sleep latencies were marginal in 60-second and 20-second scoring but significant with a definition of 4-second sleep latency. Patients had more 4-second epochs scored as awake (Mantel-Haenszel chi2 = 271, d.f. = 1, p <0.001) and containing artifact (M-H chi2 = 143, p <0.001). Patients took longer to achieve 30 continuous 4-second epochs of NREM sleep (Breslow chi2 = 4.03, d.f. = 1, p = 0.045) after t0. Patients accumulated sleep more slowly with all 3 scoring rules after t0. A slower rate of accumulating sleep after t0 was detected only with the 4-second scoring (p = 0.047). CONCLUSIONS:Evidence was present for momentary state-switching instabilities in the patients during the initial sleep onset process. Using rules for scoring small epochs may reveal such instabilities more readily than traditional scoring methods.

译文

研究目的:为了探讨原发性失眠患者的睡眠发作过程,实施了对4秒内评分的新规则,以对初始睡眠发作期间的睡眠和假象进行评分。还获得了20秒和60秒内的常规得分。
方法:从阶段1的最初60秒开始,开始定义“时间零”(t0)。 11位患者和11位年龄和性别相匹配的对照的睡眠发作期从t0之前的5分钟到t0之后的29分钟。使用新规则,对期间进行了盲目评分以进行小组分配。这在睡眠发作过程中将数据分析时间参考了一个合理的中点。同时,从晚安时间开始,延迟就以时间为基准。
结果:对睡眠和伪像评分的可靠性足够(kappa分别为0.68和0.63,p <0.001)。在60秒和20秒的评分中,睡眠延迟的组间差异很小,但以4秒的睡眠延迟定义很明显。患者在清醒时得分更高的4秒时间段(Mantel-Haenszel chi2 = 271,d.f. = 1,p <0.001)并且包含伪影(M-H chi2 = 143,p <0.001)。患者在t0后花了更长的时间才能达到NREM睡眠连续30个4秒钟的时间(Breslow chi2 = 4.03,d.f。= 1,p = 0.045)。在t0之后,使用所有3个评分规则,患者的睡眠积累都更加缓慢。仅在4秒评分中才检测到t0之后积累睡眠的速度较慢(p = 0.047)。
结论:存在证据表明患者在最初的睡眠发作过程中存在短暂的状态转换不稳定性。使用规则对小时期进行评分可能比传统的评分方法更容易揭示这种不稳定性。

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