Hypocretin/orexin signalling varies among sleep-wake behaviours, impacts upon cardiovascular autonomic control and is impaired in patients with narcolepsy with cataplexy (NC). However, evidence concerning disturbed cardiovascular autonomic control in NC patients is contrasting, and limited mainly to waking behaviour. We thus investigated whether control of cardiovascular variability is altered in NC patients during wakefulness preceding sleep, light (1-2) and deep (3-4) stages of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Polysomnographic recordings and finger blood pressure measurements were performed on nine drug-free male NC patients and nine matched healthy control subjects during spontaneous sleep-wake behaviour in a standardized laboratory environment. Indices of autonomic function were computed based on spontaneous fluctuations of systolic blood pressure (SBP) and heart period (HP). During wakefulness before sleep, NC patients showed significant decreases in indices of vagal HP modulation, cardiac baroreflex sensitivity and amplitude of central autonomic (feed-forward) cardiac control compared with control subjects. During NREM sleep, the negative correlation between HP and subsequent SBP values was greater in NC patients than in control subjects, suggesting a greater contribution of central autonomic commands to cardiac control. Collectively, these results provide preliminary evidence that autonomic control of cardiac variability by baroreflex and central autonomic (feed-forward) mechanisms is altered in NC patients during spontaneous sleep-wake behaviour, and particularly during wakefulness before sleep.

译文

:促胰泌素/促尿素信号转导在睡眠-觉醒行为之间变化,影响心血管自主控制,并且在发作性发作性猝死(NC)患者中受损。然而,有关NC患者心血管自主神经控制紊乱的证据却相反,并且主要限于苏醒行为。因此,我们调查了在睡眠前觉醒,非快速眼动(NREM)睡眠的浅(1-2)和深度(3-4)阶段以及快速眼动(REM)睡眠的NC患者中是否改变了心血管患者的心血管变异控制。在标准实验室环境中,在自发性睡眠-觉醒行为期间,对9名无毒品的男性NC患者和9名匹配的健康对照受试者进行了多导睡眠图记录和手指血压测量。根据收缩压(SBP)和心脏周期(HP)的自发波动计算自主神经功能的指标。在睡眠前的清醒过程中,与对照组相比,NC患者的迷走神经HP调节指数,心脏压力反射敏感性和中枢自主神经(前馈)心脏控制幅度明显降低。在NREM睡眠期间,NC患者的HP与随后的SBP值之间的负相关性大于对照组,这表明中枢自主神经命令对心脏控制的贡献更大。总的来说,这些结果提供了初步的证据,即在自发性觉醒行为期间,特别是在睡前觉醒期间,通过压力反射和中枢自主神经(前馈)机制对心脏变异的自主控制发生了改变。

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