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针刺四神聪增加觉醒脑电活动并改善卒中后阻塞性睡眠呼吸暂停患者日间嗜睡的临床观察

作者:孙梦晓 来源:本站原创 点击:64次 更新:2018-08-10

宋 晶1,王东岩2,何 雷1,杨海永1

(1.黑龙江中医药大学,哈尔滨150040;2.黑龙江中医药大学附属第二医院,哈尔滨150001)

摘要:研究目的:通过观察卒中后OSA患者在针刺治疗前后对觉醒脑电生物标记物的影响,探究其潜在的改善神经认知作用的神经生物学依据。研究方法:我们招募了24例经PSG诊断的卒中后OSA患者(AHI>10)。将患者随机分为电针组和假针刺组各12例,采用随机单盲对照的试验方法。电针组采用电针四神聪穴进行治疗,采用断续波,频率为50Hz,断续比为1:1,强度以患者耐受为度,假针刺组电针非穴位点(四神聪旁开0.5cm的非穴点)治疗,余同电针组。每次20min,每日1次,治疗15天。两组患者分别在治疗前后进行卡罗林斯卡睡意测试(Karolinska Drowsiness Test ,KDT)(观察睁眼和闭眼状态下觉醒脑电测量,如图1,2)、整夜多到睡眠监测(PSG)、简明精神状态检查(MMSE)和蒙特利尔认知评估量表(MoCA)。KDT每两小时进行一次,从8点到14点(一天4次)。静息态觉醒脑电在卡罗林斯卡睡意测试(KDT)过程中记录,由重复的7.5min的脑电记录片段组成,每一个7.5分钟的片段从一段2.5min的睁眼时间开始,然后是2.5min的闭眼时间,接着又是一段2.5min的睁眼时间。每个2.5min段的前三十秒被从分析中丢弃,避免因患者接受改变行为的新任务所造成的假象。PSG 系统(Philip compumedics, E-Series, Australia)选用200Hz的采样率。脑电图记录通道包括C3-M2, C4-M1, F3-M2, F4-M1,O1-M2, O2-M1以及左右眼电图(EOG)还有卡罗林斯卡嗜睡量表。研究结果:电针组显著增加卒中后OSA患者觉醒脑电活动(脑电频率增快),α/δ比率增加(P < 0.05) ,快比率=(α+β)/(δ+θ)增加(P < 0.05)。α/δ比率与评价认知功能的MMSE和MoCA密切相关。电针组比假针刺组改善日间嗜睡显著,差异具有统计学意义(P < 0.05)。研究结论:电针治疗能够明显增加觉醒脑电活动,改善患者日间嗜睡。本研究为电针治疗卒中后OSA提供了神经生物学证据。

关键词:针灸学:睡眠呼吸暂停;电针;脑电图谱;脑电频率;日间嗜睡;神经认知功能

     


Electroacupuncture Increases Awake EEG Activation and Improves Daytime Sleepiness Performance in Obstructive Sleep Apnea after Stroke 

SONG Jing1, WANG Dongyan2, HE Lei1, YANG Haiyong1

(1.Department of Acupuncture and Moxibustion of Heilongjiang University of Chinese Medicine, Harbin150040, China;2.The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin150009, China)

Abstract: Objective: The study aimed to observe the waking electroencephalography(EEG) biomarkers before and after electroacupuncture on the treatment of patients with OSA after stroke , and to explore the potential neurobiological basis for the improvement of neurocognitive function .Methods: We recruited 24 patients with OSA after stroke who received a diagnosis using overnight polysomnography (PSG) with apneahypopnea index (AHI) > 10. Patients were randomly divided into two groups (randomized single blind controlled trial) : electroacupuncture group and sham acupuncture group (n=12). Electroacupuncture group was treated by acupuncturing Sishencong (EX-HN1) points. Discontinuous wave was chosen. The frequency of stimulation was 50 Hz (intermittent ratio 1:1). The strength of stimulation was within the patient tolerance. Sham acupuncture group received acupuncture non acupoint therapy which is besides Sishencong (EX-HN1) 0.5 cm, and the electrical stimulation was the same as the electroacupuncture group. Each time was 20 min and once a day. Patients were treated for 15 days. Observing the two groups Karolinska Drowsiness Test (KDT) (awake EEG measurement with eyes open and closed,as shown in figure 1,2)、Overnight polysomnography (PSG) 、Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) before and after the treatment. KDT tests were performed every 2 h from 08:00 to 14:00 (four sessions). Resting awake EEG was recorded during a KDT, which comprised repeated sessions of 7.5-min EEG recordings. Each 7.5-min session started with a 2.5-min eyes-open time, then 2.5-min eyes closed, then another 2.5-min of eyes open. Thirty seconds at the beginning of each 2.5-min segment were discarded from analysis to avoid the artefact caused by patients settling to the new task after being instructed to change behavior. The PSG system (Philip compumedics, E-Series, Australia) was used with a sampling rate of 200 Hz. EEG recording channels included C3-M2, C4-M1, F4-M1, F3-M2, O2-M1, O1-M2, left and right electrooculogram (EOG) and Karolinska Sleepiness Scale (KSS). Result:Compared to sham acupuncture group, electroacupuncture group increased awake EEG activation (faster EEG frequency) with increased alpha/delta (A/D) ratio (P < 0.05) and fast ratio = (alpha+beta)/(delta+theta) (P < 0.05) across the OSA patients after stroke. The A/D ratio signifcantly correlated with MMSE and MoCA. Compared with sham acupuncture group, daytime sleepiness was significantly improved in electroacupuncture group (P < 0.05).Conclusion: Electroacupuncture increases awake EEG activation, which can improve daytime sleepiness. This study provides supporting neurophysiological evidence that electroacupuncture is a potential treatment option on OSA after stroke.

Keyword:acupuncture, OSA, electroacupuncture, EEG spectra, EEG frequency, daytime sleepiness, neurocognitive function


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