失眠障碍患者不同亚型间记忆和睡眠测定的差异及其相关性研究

发布时间：2018-03-07 05:30

本文选题：失眠障碍　切入点：记忆　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景:失眠是指尽管有适当的机会和环境睡眠,依然有睡眠起始、持续时间、巩固或质量的持续困难产生,并导致某种形式的日间损害。这些损害包括社交、职业、教育、学习、行为以及其他重要功能域,其中学习记忆能力的下降是失眠患者主观功能受损最为常见主诉。近年来的研究表明失眠患者也存在客观记忆损害,但这些损害是否具有亚型间的差异,以及是否涉及主/客观睡眠参数的改变均没有得到探索。目的:探索失眠障碍患者不同亚型(入睡困难、早醒、维持困难、混合型)间记忆和主/客观睡眠参数有无差异及其相关性。方法:收集失眠障碍(insomnia disorder,ID)患者,采集一般信息(性别、年龄、教育程度),进行情绪状态、主观睡眠质量和总体认知功能评价,包括:汉密尔顿抑郁量表17项版(HAMD-17)、匹兹堡睡眠质量指数(PSQI)和蒙特利尔认知评估量表(Mo CA,北京版)。当晚完成多导睡眠监测,次晨行睡眠自评,按自评结果将患者分为入睡困难型、早醒型、维持困难型和混合型4组。采用九盒迷宫试验检测客观记忆,包括参考、工作、物体、空间记忆。结果:①背景资料:各组间性别、年龄、病程、教育程度以及PSQI、HAMD-17和Mo CA分均无统计学差异(Ps0.05)。②记忆:4型患者的工作记忆和空间记忆错误数差异显著(Ps0.05),即早醒和混合组的空间记忆和工作记忆差于维持难组(Ps0.05);参考记忆和物体记忆错误数均无组间差异(Ps0.05)。③主观睡眠:4型患者PSQI分及其因子分均无组间差异(Ps0.05)。④客观睡眠参数:4型间睡眠效率和REM睡眠时间及REM%有显著差异(Ps0.05),即混合组睡眠效率低于早醒和维持困难组(Ps0.05),早醒和混合组REM时间及REM%低于维持难组(Ps0.05)。⑤记忆与主/客观睡眠参数的相关分析:控制性别、年龄和受教育年限后,记忆错误数与PSQI总分及各因子分Partial相关分析无显著相关性(Ps0.05);工作记忆和空间记忆错误数与REM时间(r=-0.387、-0.348,Ps0.05)和REM%(r=-0.350、-0.354,Ps0.05)负相关。结论:ID各亚型患者间空间和工作记忆能力不同(早醒型和混合型最差);各亚型间PSQI睡眠质量自评无明显差异,但多导睡眠图(PSG)客观睡眠参数有细微差异。REM睡眠减少可能涉及记忆的损害。
[Abstract]:Background: insomnia refers to persistent difficulties with sleep initiation, duration, consolidation or quality, despite appropriate opportunities and environments for sleep, and leading to some form of daytime damage. These include social, professional, educational, Learning, behavior, and other important functional domains, in which the decline of learning and memory ability is the most common complaints of insomnia patients with impaired subjective function. Recent studies have shown that insomnia patients also have objective memory impairment. But whether these lesions have subtype differences and whether they involve changes in subjective / objective sleep parameters have not been explored. Objective: to explore the different subtypes of insomnia patients (difficulty in falling asleep, early waking up, difficulty in maintaining sleep). Methods: the patients with insomnia disorder were collected and general information (sex, age, education level) was collected for emotional state. Subjective sleep quality and overall cognitive function were evaluated, including Hamilton Depression scale (Hamd 17), Pittsburgh Sleep quality Index (PSQI), Montreal Cognitive Assessment scale (Montreal Cognitive Assessment scale), Beijing version. Polysomnography was completed that night and sleep self-assessment was performed in the morning. According to the self-evaluation results, the patients were divided into 4 groups: difficult to fall asleep, early awake, difficult to maintain and mixed. Objective memory, including reference, work, object and spatial memory, was tested by nine boxes maze test. Age, course of disease, There was no significant difference in educational level and scores of PSQI HAMD-17 and Mo CA. There were significant differences in the number of working memory and spatial memory errors between Ps0.05- 2 and memory type 4, i.e., the spatial memory and working memory of early waking and mixed group were worse than those of difficult maintenance group. There was no significant difference in the number of memory errors between groups. There was no significant difference in PSQI scores and their factor scores in patients with subjective sleep: 4 type 4. There were significant differences in sleep efficiency, sleep time and REM% among objective sleep parameters of Ps0.054.There were significant differences in sleep efficiency, sleep time and REM% in patients with subjective sleep type 4, that is, sleep in mixed group. The sleeping efficiency was lower than that in the early waking and maintenance difficulty groups (P < 0.05), and the REM time and REM% in the early waking and mixed groups were lower than those in the difficult maintenance group. The correlation analysis between memory and subjective / objective sleep parameters: controlling sex, After age and years of schooling, There was no significant correlation between the number of memory errors and the total score of PSQI and the Partial correlation analysis of each factor score. There was no significant correlation between the number of memory errors in working memory and spatial memory, but the number of errors in working memory and spatial memory were negatively correlated with REM time and REM time. Conclusion the spatial and working memory abilities of the patients with different subtypes of PSQI are different (P < 0.05). There was no significant difference in PSQI sleep quality among the subtypes. But the objective sleep parameters of PSG were slightly different. REM sleep loss may involve memory impairment.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R740

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