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正常睡眠的分期和结构

Author
Mark R Pressman, PhD
Section Editors
Robert C Basner, MD
Ruth Benca, MD, PhD
Deputy Editor
April F Eichler, MD, MPH

引言

正常睡眠的目的尚不明确，但似乎是一个活动的过程，睡眠过程中大脑参与如在清醒期发生的各种复杂活动。1968年[1]和2007年[2]出版了睡眠分析标准。美国睡眠医学学会(American Academy of Sleep Medicine, AASM)认证的睡眠实验室被要求采用2007年标准进行睡眠分析，而由其他机构认证的睡眠实验室可能继续采用1968年标准进行睡眠分析。在本综述中，我们根据最近公布的标准描述睡眠分期和结构。对正常睡眠的潜在功能也进行了综述。

睡眠分期

睡眠以每30秒一帧进行分析，每帧可被归类为快速眼动(rapid eye movement, REM)睡眠期或非快速眼动(non-rapid eye movement, NREM)睡眠期[2]。

REM睡眠 — 在正常情况下，REM睡眠是每90-120分钟重复出现的睡眠时相。REM睡眠占总睡眠时间的20%-25%，并且每晚出现4-5次[3]。REM睡眠具有如下3个主要特征[4]：

  • 脑电模式类似于活动、觉醒的脑电图(electroencephalogram, EEG)模式，呈低电压高频模式。由于这种相似性，有时将REM睡眠称为异相睡眠。
  • 快速眼球运动。
  • 张力缺失肌电图(electromyogram, EMG)提示除眼外肌外，所有的横纹肌都处于松弛状态。肌张力缺失是α运动神经元直接抑制的结果。

REM睡眠可以分为位相性REM睡眠和强直性REM睡眠(tonic REM sleep)。位相性REM睡眠是在REM睡眠期间快速眼球运动的位相性阵发(phasic bursts)部分，这可能与肌电图活动的短暂阵发(有时称作抽搐)和/或交感神经活动骤增有关。强直性REM睡眠是存在于位相性REM睡眠阵发之间的部分。

       

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-16.
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References
Top
  1. Rechtshaffen A, Kales A (Eds). A manual of standardized terminology and scoring system for sleep stages of human subjects. 204, United States Government Printing Office; National Institutes of Health, Washington, DC 1968.
  2. Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specification, 1st ed, American Academy of Sleep Medicine, Westchester, IL 2007.
  3. Carskadon, MA, Dement, WC. Normal Human Sleep: An Overview. In: Principles and Practices of Sleep Medicine, Fifth, Kryger, MH, Roth, et al. (Eds), Elsevier Saunders, St. Louis, MO 2011. p.16.
  4. ASERINSKY E, KLEITMAN N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science 1953; 118:273.
  5. Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med 1993; 328:303.
  6. Hornyak M, Cejnar M, Elam M, et al. Sympathetic muscle nerve activity during sleep in man. Brain 1991; 114 ( Pt 3):1281.
  7. Kawana F, Kasai T, Maeno K, et al. Atrioventricular block during the phasic events of REM sleep in a patient with severe obstructive sleep apnea syndrome. J Clin Sleep Med 2008; 4:257.
  8. Osuna E, Patiño G. REM sleep-related complete heart block: is it a specific sleep-related disorder? Sleep Med 2006; 7:387.
  9. Guilleminault C, Pool P, Motta J, Gillis AM. Sinus arrest during REM sleep in young adults. N Engl J Med 1984; 311:1006.
  10. Findley LJ, Wilhoit SC, Suratt PM. Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest 1985; 87:432.
  11. Weitzenblum E, Chaouat A. Sleep and chronic obstructive pulmonary disease. Sleep Med Rev 2004; 8:281.
  12. Hendricks JC, Morrison AR, Mann GL. Different behaviors during paradoxical sleep without atonia depend on pontine lesion site. Brain Res 1982; 239:81.
  13. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9:293.
  14. Hirshkowitz, M, Wilcox Rose, et al. Neurotransmitters, Neurochemistry, and the Clinical Pharmacology of Sleep. In: Sleep Disorders Medicine, 3rd ed, 2009. p.67-79.
  15. Pressman, MR. Primer of Polysomnogram Interpretation, Butterworth-Heinemann, Boston 2002.
  16. Physiology in Sleep, Orem, J, Barnes, CD (Eds), Academic Press, New York 1980.
  17. Hirshkowitz, M, Moore, CA, Hamilton, CR, et al. Polysomnography of adults and elderly: Sleep architecture, respiration and leg movements. J Clin Neurophysiol 1992; 9:56.
  18. Adam K, Oswald I. Sleep is for tissue restoration. J R Coll Physicians Lond 1977; 11:376.
  19. Horne, J. Why We Sleep, Oxford University Press, Oxford 1988.
  20. Hobson JA. REM sleep and dreaming: towards a theory of protoconsciousness. Nat Rev Neurosci 2009; 10:803.
  21. Rechtschaffen A, Bergmann BM, Everson CA, et al. Sleep deprivation in the rat: X. Integration and discussion of the findings. Sleep 1989; 12:68.
  22. Endo T, Roth C, Landolt HP, et al. Selective REM sleep deprivation in humans: effects on sleep and sleep EEG. Am J Physiol 1998; 274:R1186.
  23. Shapiro CM, Bortz R, Mitchell D, et al. Slow-wave sleep: a recovery period after exercise. Science 1981; 214:1253.