【作者】 宋崇升； 王健； 邹义壮； 张进国； 李亚军；

【Author】 Chongsheng SONG Jian WANG Yizhuang ZOU Jinguo ZHANG Yajun LI (Beijing Huilongguan Hospital)

【机构】 北京回龙观医院；

【摘要】 【目的】探讨精神分裂症睡眠生理心理特征,以及与临床症状及药物的关系。【方法】对104例精神分裂症患者评定匹兹堡睡眠质量指数(PSQI)、阳性阴性症状量表(PANSS)、护士观察量表(NOSIE)、生活质量量表(QOL)及治疗副反应量表(TESS),并对其中30例服用利培酮的患者进行连续两夜的多导睡眠图检查(PSG),其中合并佐匹克隆9例,合并苯二氮卓类催眠药11例,其余未服催眠药10例。以30例正常被试作对照,连续监测两夜PSG并评定PSQI。【结果】(1)PANNS量表总分与PSQI有一定相关(0.26,P<0.05),PANNS量表思维障碍因子与PSQI的入睡时间(0.26,P<0.05)、激活因子与PSQI睡眠效率(0.28,P<0.05)相关显NOSIE量表中的延缓因子著;NOSIE量表中的精神病因子与PSQI入睡时间(0.23,P<0.05),与PSQI入睡时间(0.25,P<0.05),及睡眠时间(0.25,P<0.05)相关显著(0.26,P<0.05);TESS量表与PSQI中的睡眠障碍(0.39,P<0.05),日间功能(0.32,P<0.05),总分(0.32,P<0.05)。(2)PANNS量表总分与PSQ入睡潜伏期(-0.43,P<0.05)PANNS量表补充因子与PSG总睡眠时间(0.40,P<0.05),激活因子与NREMⅢ期(0.41,P<0.05),NREMⅣ期(0.39,P<0.05),NREMⅣ期时间(0.38,P<0.05)相关显著;PANNS量表的抑郁量表与NREMⅢ期时间(0.38,P<0.05)等相关显著;(3)PSQI中的睡眠障碍因子与PSG中的与NREMⅠ期(0.56,P<0.05),NREMⅡ期(0.52,P<0.05),清醒期时间百分比(0.45,P<0.05),睡眠潜伏期(0.45,P<0.05),睡眠效率(-0.39,P<0.05);PSQI中的催眠药物因子与PSG中的NREMⅢ期(-0.43,P<0.05),NREMⅣ期(0.56,P<0.05),Ⅲ期时间(-0.46,P<0.05),Ⅱ期时间百分比(0.64,P<0.05),Ⅲ期时间百分比(-0.38,P<0.05),Ⅳ期时间百分比(0.47,P<0.05),Ⅳ期时间(0.52,P<0.05)等相关显著。(4)精神分裂症患者与正常对照组PSG与PSQI各指标的比较。PSG:总睡眠时间(338.00±117.00,422.00±60.00),NREMⅠ期(51.00±24.70,12.00±4.90),NREMⅡ期(66.70±35.30,18.00±14.00),睡眠潜伏期(52.00±25.00,14.00±5.00),睡眠效率(67.10±21.00,118.00±64.40),清醒期睡眠(165.00±107.00,36.30±24.20),Ⅱ期时间(24.70±15.10,23.00±17.40),Ⅲ期时间(68.91±15.29,65.51±5.47),REM时间(17.07±9.50,19.66±5.58),自发微觉醒次数(38.62±18.90,21.50±13.90),PSQI:入睡时间(0.46±58.00,0.78±0.73),睡眠效率(0.30±0.10,0.78±0.19),总分.(2.90±1.78,6.80±4.70)上述各差异均具有显著性(P<0.01)。(5)服利培酮同时不服镇静催眠药与利培酮合并服用苯二氮卓类药物比较:PSG潜伏期Ⅰ期(40.60±26.00,89.90±73.60),睡眠潜伏期(39.86±30.89,90.60±73.90),PSQI总分(4.18±3.70,9.55±5.54);服利培酮同时不服镇静催眠药与利培酮合并服用佐匹克隆类药物比较:PSG潜伏期Ⅰ期(40.60±26.00,16.93±9.60),NREMⅡ期(199.86±68.23,273.75±80.00),PSQI总分(4.20±3.70,7.62±3.02);利培酮合并服用苯二氮卓类药物与利培酮合并服用佐匹克隆类药物比较:PSG潜伏期Ⅰ期(89.90±73.60,16.93±9.60)。【结论】(1)正常人与精神分裂症患者睡眠的生理、心理指标明显不同,精神分裂症患者总睡眠时间减少,睡眠效率减低,NREMⅠ期、Ⅱ期明显延长,快动眼睡眠REM时间减少。(2)临床症状对精神分裂症患者睡眠的心理改变及睡眠各阶段有一定程度的影响,表现在某些症状群,可影响精神分裂症患者的睡眠心理主观感受,同时更多影响NREMⅢ期、Ⅳ期潜伏期和时间。(3)精神分裂症睡眠与药物及副作用关系密切。药物副作用可加重睡眠的主观心理感受,不服用镇静催眠药物及服用不同种类镇静催眠药物对睡眠生理影响明显不同。佐匹克隆类药物可以缩短NREMⅠ期,服用苯二氮卓类药物可使NREMⅠ期明显延长。(4)精神分裂症睡眠主观心理感受与睡眠生理变化明显相关,其中与是否使用镇静催眠药物的关系最为密切。更多还原

【Abstract】 [Object]To study the polysomnographic feature of Schizophrenia and the relationship with clinical symptoms and drugs. [Methods]104 schizophrenics were given the assessment of PSQI,PANSS,NOSIE,QOL and TESS.34 patients taking risperidone received two consecutive nights of PSG test and among them 10 patients were administered zopiclone,12 ones were given benzodiazepine drugs and the rest were given no such drugs.30 control subjects were given the examination of PSG and PSQI. [Results](1) The total score of PANSS has certain correlation to that of PSQI(0.26,P<0.05). There is significant correlation between the thinking disorder factor of PANSS and Sleep Latency of PSQI(0.264,P<0.05),besides activating factor of PANSS and Habitual Sleep Efficiency of PSQI(0.28, P<0.05).And the significant correlation also shows between psychiatric factor of NOSIE and Sleep Latency of PSQI(0.23,P<0.05),delaying factor of NOSIE and Sleep Latency of PSQI(0.246,P<0.05), besides delaying factor of NOSIE and Sleep Duration of PSQI(0.253,P<0.05).The total score of TESS is significantly correlated to Sleep Disturbance(0.386,P<0.05),to Daytime Dysfunction(0.319,P<0.05) and total score of PSQI(0.324,P<0.05).(2) There is significant correlation between PANSS score and Sleep Latency of PSQI(-0.43,P<0.05),PANSS additional factor and Sleep Duration of PSG(0.40, P<0.05).And the activating factor has positive correlation with the third stage of NREM(0.41,P<0.05), the fourth stage of NREM,and the time of fourth stage of NREM.The depression scale of PANSS is correlated to the time of third stage of NREM(0.56,P<0.05).(3) The Sleep Disturbance of PSQI has correlation to the first stage of NREM(0.56,P<0.05),to the second stage of NREM(0.52,P<0.05),to the percentage of awake time(0.45,P<0.05),to sleep latency(0.45,P<0.05),sleep efficiency(-0.39, P<0.05).The factor of Used Sleep Medication of PSG shows significant correlation with the third stage of NREM(-0.43,P<0.05),with the fourth stage of NREM(0.56,P<0.05),the time of third stage of NREM(-0.46,P<0.05),with the percentage of the second stage(0.64,P<0.05),with the percentage of the third stage(-0.38,P<0.05),with the percentage of the fourth stage(0.47,P<0.05),and the time of fourth stage of NREM(0.52,P<0.05).(4) The comparison of PSG and PSQI between the patients and control group is following.PSG:total sleep time(338.00±117.00,422.00±60.00),the first stage of NREM(51.00±24.70,12.00±4.90),the second stage of NREM(66.70±35.30,18.00±14.00), sleep latency(52.00±25.00,14.00±5.00),sleep efficiency(67.10±21.00,118.00±64.40),wake time (165.00±107.00,36.30±24.20),the time of second stage of NREM(24.70±15.10,23.00±17.40), the time of third stage(68.91±15.29,65.51±5.47),REM duration(17.07±9.50,19.66±5.58), arousal times(38.62±18.90,21.50±13.90).PSQI:Sleep Latency(0.46I±117.00,422.00±60.00), Sleep Efficiency(0.30±0.10,0.78±0.19)and total score(2.90±1.78,6.80±4.70).The difference is significant for all the compared items above.The comparison between patients taking risperidone with no sedative hypnotics and those with benzodiazepine drugs:the first stage of latency of PSG(40.60±26.00, 89.90±73.60),sleep latency(39.86±30.89,90.60±73.90),total score of PSQI(4.18±3.70, 9.55±5.54),The comparison between patients with no sedative hypnotic and those with zopiclone.:the first stage of latency of PSG(40.60±26.00,16.93±9.60),the second stage of NREM(199.86±68.23, 273.75±80.00),total score of PSQI(4.20±3.70,7.62±3.02).The comparison between patients with no sedative hypnotic and those with zopiclone:the first stage of latency of PSG(89.90±73.60, 16.93±9.60). [Conclusion](1) There is significant difference of physiological and psychological features between the healthy subjects and schizophrenics.For the patients,the total sleep time,sleep efficiency and REM time is all reduced while the first and second stages of NREM are prolonged.(2) The clinical symptoms have certain influence for the patients on psychological change and all stages of sleep.Some symptoms might affect the subjective sleep feeling besides the third stage of NREM,latency of the fourth stage and time of the fourth stage.(3) The sleep of schizophrenics has a close relation to the drugs and side effect.The side effect might aggravate subjective sleep feeling.No sedative hypnotics or different kinds of sedative hypnotics might bring obviously different influence on sleep physiology.Zopiclone can shorten the first stage of NREM while benzodiazepine drugs might prolong the first stage of NREM.(4) For the schizophrenics,the subjective sleep feeling is significantly concordant with sleep psychological change,especially correlated with sedative hypnotics.更多还原