调控睡眠-觉醒的分子细胞和脑网络机制探讨

睡眠是影响人体健康的重要因素,睡眠失调易引起多种生理和心理疾病。睡眠稳态既受外界因素(昼夜变化、饮食和温度)影响,亦受内在系统(分子钟和促睡眠/觉醒神经元)调控。细胞内有CLOCK、PER、CRY、NPAS2和BMAL1等分子周期性变化控制生物节律;脑内有基底前脑、丘脑、下丘脑、脑桥和延髓等神经元群体特异性地抑制或促进睡眠与觉醒,各核团之间通过突触连接形成神经网络启动和维持觉醒、非快速眼动睡眠和快速眼动睡眠。睡眠障碍普遍存在,本综述将针对调控生物体睡眠-觉醒的分子、细胞和脑网络机制展开讨论,为防治睡眠障碍类疾病提供新的思路。     

快速眼动睡眠产生的神经机制:蓝斑核神经元停止发放是一个必要的条件

两种类型的神经元参与了快速眼动（rapid eye movement,REM）睡眠的调节：快速眼动一发放（REM-ON）神经元和快速眼动-沉寂神经元（REM-OFF）。快速眼动-沉寂神经元属去甲肾上腺素能神经元,正如名字表示的那样——在快速眼动睡眠期间停止发放。已有研究表明,这些神经元放电活动的停止是导致快速眼动睡眠的前提条件,γ-氨基丁酸（γ-aminobutyric acid,GABA）可使它们停止发放。如果这嗤神经元不停止发放,脑中的去甲肾上腺素水平将升高,不出现快速眼动睡眠。剥夺快速眼动睡眠所引起的去甲肾上腺素增加,至少是快速眼动睡眠丧失引起Na^＋-K^＋ATP酶活性增加的原因,而这可能是导致快速眼动睡眠剥夺所引发的各种效应的主要因素。     

大鼠发育期睡眠/觉醒周期的神经调节

幼年期大鼠的睡眠/觉醒周期和成年期的有显著差异,最为显著的特点是快眼动(REM) 睡眠在24 小时内的百分比远多于其他任何年龄阶段,随着脑发育成熟而逐渐减少.与此同时,非快眼动(NREM) 睡眠和觉醒的百分比逐渐增加.后者与参与NREM睡眠和觉醒调节的神经元在发育早期的成熟程度较为一致.鉴于大鼠发育早期REM睡眠每日的百分比由最高开始逐渐降低,而触发和促进REM睡眠的胆碱能神经元各生化成分的活性则是由最低开始逐渐升高,此期的REM睡眠应该还有胆碱能以外的动力驱动.新近的资料表明,促肾上腺皮质激素释放因子(CRF)可能是幼年期REM睡眠的另一主要驱动力量.     

睡眠过程中内膝体神经元的听反应后抑制

内侧膝状体神经元接受来自离皮层系统的兴奋和抑制两种神经调节．听觉刺激诱发的内膝体神经元起始反应后会伴随着一段长时抑制．在可自由活动的大鼠上研究了内膝体神经元的听反应后抑制现象．利用植入电极阵列技术,记录了大鼠在睡眠过程中的脑电、肌电以及内膝体神经元胞外放电活动,发现在睡眠的快速眼动时期和非快速眼动时期内膝体神经元存在着听反应后抑制现象,并发现这种抑制更多地出现在非快速眼动睡眠期．在睡眠过程中,丘脑网状核听觉分区的失活会导致内膝体神经元的听反应后抑制消失或减弱．因此,我们推测丘脑网状核神经元参与了内膝体神经元在睡眠中的听反应后抑制,它在非快速眼动睡眠中对内膝体施加了更强的抑制作用．     

五羟色胺在睡眠-觉醒中作用

五羟色胺(5-hydroxytryptamine,5-HT)又称为血清素(serotonin)广泛存在于机体多种组织。神经系统内的五羟色胺属于单胺类神经递质,与很多生理功能有关,参与对摄食、性行为、神经内分泌、疼痛感知、学习记忆和情绪、睡眠-觉醒等生理过程的调控。新近基于电生理、神经化学、分子生物学和神经药理学研究方法发现,五羟色胺和睡眠觉醒过程特别是觉醒过程密切相关,在促进觉醒、抑制快动眼睡眠方面有重要作用。本文介绍了五羟色胺在睡眠-觉醒周期中作用研究的最新进展。     

快速眼动睡眠期行为障碍(RBD)的帕金森病临床特征分析

目的:探究合并不同发作形式的快速眼动睡眠期行为障碍(RBD)与帕金森病的临床特点及自主神经功能障碍变化。方法:采用快速眼动期睡眠行为障碍筛查量表及帕金森综合评分量表(Unified Parkinson's disease rating scale),对20例合并简单型(RBD)的帕金森病患者(RBD-简单组)与20例合并复杂型(RBD)的帕金森病患者(RBD-复杂组)进行研究。结果:两组帕金森病患者的一般情况、左旋多巴药物日剂量、疾病病程等无统计学差异(P>0.05)。合并复杂型(RBD)的帕金森病患者运动部分评分高于合并简单型(RBD)的帕金森病患者(P<0.05)。两组患者之间在非震颤、强直、运动减少症状均存在统计学差异(P<0.05),(RBD)复杂组评分均高于(RBD)简单组。多因素logistics回归显示,复杂型(RBD)的存在与UPDRS-Ш部分评分相关,而与年龄、病程、教育年限、左旋多巴药物日剂量等无显著相关,与运动减少症状最为相关,与震颤、非震颤、强直症状无相关性。两组患者运动障碍类型与(RBD)发作形式无明显相关性(P=0.108)。结论:合并复杂型(RBD)的帕金森病患者运动症状更重,并且累及运动障碍的诸多方面。帕金森病患者存在复杂型(RBD)症状主要与UPDRS-Ш评分相关,其中与运动减少方面显著相关。     

90例原发性癫痫患者睡眠呼吸障碍及其相关事件分析

目的:探讨原发性癫痫患者夜间睡眠呼吸障碍及相关事件的特点.方法:对90例原发性癫痫患者进行夜间多导睡眠图(PSG)检查.分析夜间睡眠呼吸暂停低通气指数、睡眠各期SPO2值及相关腿动事件.结果:本组病人的PSG检测结果表现为SPO2监测显示有26.67%的患者合并有睡眠呼吸暂停低通气综合症(SAHS),合并SAHS组与不合并SAHS组在年龄、体重指数、是否合并高血压病方面进行比较P均<0.05,其差异有统计学意义.两组在病程、性别、发作形式、有无痫样放电、有无周期性腿动方面比较P值均>0.05,其差异无统计学意义.SPO2仪显示癫痫患者夜间存在不同程度低氧事件,其中SPO2最低值均发生在REM期.肌电显示孤立性腿动指数增加人数为27例(占30%),周期性腿动指数增加人数为15人(占16.67%),其中因激醒事件及呼吸事件因素而导致腿动指数增加分别占一定比例,且腿动事件主要集中在NREM期.结论:原发性癫痫患者常伴有睡眠呼吸障碍及夜间低氧事件.     

视频脑电图鉴别诊断癫痫患者睡眠障碍、认知障碍的临床价值研究

目的:探讨视频脑电图诊断癫痫患者睡眠障碍、认知障碍的临床价值。方法:选取2014年1月~2016年12月在我院神经内科进行诊治的癫痫患者236例作为癫痫组,另选取同期的健康患者家属或者其他健康体检者236例作为正常对照组,对两组进行视频脑电图联合睡眠参数分析;并对癫痫组视频脑电图联合认知参数进行分析。结果:癫痫组睡眠Ⅰ~Ⅱ期时间显著长于正常对照组且具有统计学差异(P=0.000),睡眠Ⅲ~Ⅳ期时间显著短于正常对照组且具有统计学差异(P=0.000),睡眠时相转换频率、觉醒指数均显著高于正常对照组且均具有统计学差异(P=0.000);清醒期、睡眠期不同痫样放电指数(IED)的WAIS-RC IQ和WMS-RC MQ均具有统计学差异(P0.05),10%IED≤50%者的WAIS-RC IQ和WMS-RC MQ均显著低于1%IED≤10%者且均具有统计学差异(P0.05),IED 10%可能是痫样放电影响患者认知功能的最低阈值。结论:视频脑电图在癫痫患者睡眠障碍、认知障碍识别中具有重要的临床价值。     

月经周期对女性睡眠-觉醒和静息-活动的影响

目前有关月经周期对睡眠影响的研究结果并不一致,而对月经周期中昼夜睡眠-觉醒及静息-活动节律尚缺乏系统性的研究.本研究旨在观察正常育龄期女性月经周期中睡眠-觉醒及静息-活动昼夜节律的变化.我们采用静息-活动监测仪(actigraphy)和睡眠日志,调查了12个自然生活状态下健康育龄期妇女在月经周期不同阶段,即行经期、围排卵期、黄体早期及黄体晚期中睡眠与活动节律的变化.结果显示,睡眠-觉醒节律参数在四期之间无统计学显著差异;而静息-活动节律方面,所有受试女性静息-活动节律的平均日周期长度为(24.01±0.29)h,并且四期之间无显著性差异.行经期日间稳定系数(interdaily stability,IS)比黄体早期显著增加(P＜0.05).黄体早期日间活动开始时间明显较黄体晚期提前(P＜0.05);黄体早期的活动峰值时相比围排卵期显著提前(P＜0.05).月经周期可以影响静息-活动昼夜节律时相.而总体静息-活动数量与质量未发生显著变化;健康育龄期妇女在月经周期的各阶段中睡眠-觉醒节律亦无明显变异.     

6-OHDA 帕金森病大鼠快动眼睡眠状态下 皮层脑电及基底节场电位的异常变化

目的:了解帕金森病(PD)模型大鼠在快动眼睡眠状态下皮层脑电和基底节场电位的异常变化。方法:用6-羟基多巴胺(6-OHDA)脑内两点注射法建立PD大鼠模型,并经阿扑吗啡注射诱发旋转对模型进行评价。通过多导宏电极在体电生理记录技术结合视频录像,对正常大鼠和6-OHDA大鼠PD模型进行苍白球场电位和皮层M1、M2区脑电的多部位24小时同时记录。功率谱分析和相干分析用于揭示快动眼睡眠状态下各记录位点信号的频率成分以及不同记录位点神经元集群之间的变化。结果:与正常大鼠相比,6-OHDA帕金森病模型大鼠在REM期间的皮层脑电在θ和γ频段上都有变化:初级运动皮质M1区的θ频段成分消失,辅助运动区M2的θ频段成分略有增加,患侧苍白球的θ频段成分增大显著;M1区的γ频段成分增大,而γ频段成分在苍白球基本没有变化。结论:6-OHDA对中脑多巴胺能神经元的损害可造成大鼠双侧皮层M1区θ节律的消失和γ节律的增强,以及对侧M1-M2区之间在γ节律上的同步被显著增强,而γ节律在苍白球没有变化。这些异常电活动可能是由于VTA受损引起从而与帕金森病的快动眼睡眠行为障碍有关。     

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Summary The sedative-hypnotic medications, including benzodiazepines and non-benzodiazepines, are the most common treatments for insomnia. However, concerns regarding patterns of inappropriate use, dependence and adverse effects have led to caution in prescribing those sedative-hypnotic medications. On the other hand, a traditional Chinese herb remedy, suanzaorentang, has been efficiently and widely used in clinic for insomnia relief without severe side effects in Asia. Although suanzaorentang has been reported to improve sleep disruption in insomniac patients, its mechanism is still unclear. The present study was designed to elucidate the effects of oral administration of suanzaorentang on physiological sleep-wake architectures and its underlying mechanism in rats. We found that oral administration of suanzaorentang at the beginning of the dark onset dose-dependently increased non-rapid eye movement sleep (NREMS) during the dark period, but had no significant effect on rapid eye movement sleep (REMS). Our results also indicated that intracerebroventricular (ICV) administration of γ-aminobutyric acid (GABA) receptor type A antagonist, bicuculline, significantly blocked suanzaorentang-induced enhancement in NREMS during the dark period, but GABA_B receptor antagonist, 2-hydroxysaclofen had no effect. These results implicated that this traditional Chinese herb remedy, suanzaorentang increases spontaneous sleep activity and its effects may be mediated through the GABA_A receptors, but not GABA_B receptors.     

The involvement of serotonin receptors in suanzaorentang-induced sleep alteration

Summary Sedative-hypnotic medications, including benzodiazepines and non-benzodiazepines, are usually prescribed for the insomniac patients; however, the addiction, dependence and adverse effects of those medications have drawn much attention. In contrast, suanzaorentang, a traditional Chinese herb remedy, has been efficiently used for insomnia relief in China, although its mechanism remains unclear. This study was designed to further elucidate the underlying mechanism of suanzaorentang on sleep regulation. One ingredient of suanzaorentang, zizyphi spinosi semen, exhibits binding affinity for serotonin (5-hydroxytryptamine, 5-HT) receptors, 5-HT_1A and 5-HT₂, and for GABA receptors. Our previous results have implicated that GABA_A receptors, but not GABA_B, mediate suanzaorentang-induced sleep alteration. In current study we further elucidated the involvement of serotonin. We found that high dose of suanzaorentang (4 g/kg/2 ml) significantly increased non-rapid eye movement sleep (NREMS) when comparing to that obtained after administering starch placebo, although placebo at dose of 4 g/kg also enhanced NREMS comparing with that obtained from baseline recording. Rapid eye movement sleep (REMS) was not altered. Administration of either 5-HT_1A antagonist (NAN-190), 5-HT₂ antagonist (ketanserin) or 5-HT₃ antagonist (3-(4-Allylpiperazin-1-yl)-2-quinoxalinecarbonitrile) blocked suanzaorentang-induced NREMS increase. These results implicate the hypnotic effect of suanzaorentang and its effects may be mediated through serotonergic activation, in addition to GABAergic system.     

Sleeping outside the box: electroencephalographic measures of sleep in sloths inhabiting a rainforest

The functions of sleep remain an unresolved question in biology. One approach to revealing sleep's purpose is to identify traits that explain why some species sleep more than others. Recent comparative studies of sleep have identified relationships between various physiological, neuroanatomical and ecological traits, and the time mammals spend in rapid eye movement (REM) and non-REM sleep. However, owing to technological constraints, these studies were based exclusively on animals in captivity. Consequently, it is unclear to what extent the unnatural laboratory environment affected time spent sleeping, and thereby the identification and interpretation of informative clues to the functions of sleep. We performed the first electroencephalogram (EEG) recordings of sleep on unrestricted animals in the wild using a recently developed miniaturized EEG recorder, and found that brown-throated three-toed sloths (Bradypus variegatus) inhabiting the canopy of a tropical rainforest only sleep 9.63 h d(-1), over 6 h less than previously reported in captivity. Although the influence of factors such as the age of the animals studied cannot be ruled out, our results suggest that sleep in the wild may be markedly different from that in captivity. Additional studies of various species are thus needed to determine whether the relationships between sleep duration and various traits identified in captivity are fundamentally different in the wild. Our initial study of sloths demonstrates the feasibility of this endeavour, and thereby opens the door to comparative studies of sleep occurring within the ecological context within which it evolved.     

Altered NMDA receptor trafficking contributes to sleep deprivation-induced hippocampal synaptic and cognitive impairments

Recent evidence indicates that continuous wakefulness (sleep deprivation, SD) causes impairments in behavioral performance and hippocampal long-term potentiation (LTP) in animals. However, the mechanisms by which SD impairs long-term synaptic plasticity and cognitive function are not clear. Here, we report that 24-h SD in mice results in impaired hippocampus-dependent contextual memory and LTP and, unexpectedly, in reductions of the surface expression of NMDA receptor (NMDAR) subunit NR1 and NMDAR-mediated excitatory post-synaptic currents at hippocampal perforant path-dentate granule cell synapses. The results suggest that the reduction of functional NMDAR in hippocampal neurons may underlie the SD-induced deficits in hippocampus-dependent contextual memory and long-term synaptic plasticity.     

NONLINEAR BEHAVIOR OF HUMAN RESPIRATORY MOVEMENT DURING DIFFERENT SLEEP STAGES

To investigate the nonlinear properties of respiratory movement during different sleep stages, we applied an algorithm proposed by Grassberger and Procaccia to calculate the correlation dimension in rapid eye movement and non-rapid eye movement sleep. We also tested for nonlinearity in respiratory movement by comparing the correlation dimension for the original data with that for surrogate data. The study population included eight healthy volunteers. We recorded respiratory movement and the sleep electroencephalogram for 8 h. The correlation dimension for respiratory movement was 3.28 ± 0.19 (mean ± SD) during rapid eye movement sleep, 2.31 ± 0.21 during light sleep (stage I) and 1.64 ± 0.25 during deep slow-wave sleep (stage IV). Thus, the correlation dimension differed significantly by sleep stage (p < 0.001): it was least during stage IV sleep and greatest during REM. The correlation dimension for the original data also differed from that for surrogate data, confirming nonlinearity in original data. The results suggest that the nonlinear dynamics of respiratory movement in sleep changes with sleep stage, presumably due to the information processing by the cerebral cortex. The increased correlation dimension for respiratory movement in REM sleep may be related to increased cortical information processing associated with dreaming. (Chronobiology International, 18(1), 71–83, 2001)     

帕金森病伴快速眼动睡眠期行为障碍

快速眼动(REM)睡眠期行为障碍(RBD)是REM睡眠期出现肌张力缺失并伴有与噩梦相关的复杂运动为特征的发作性疾病,RBD与帕金森病(PD)密切相关,在PD患者中的发生率高。伴RBD的PD患者临床上多表现为强直型,病程更长,运动症状、非运动症状更重,生活能力及生活质量的损害更突出。RBD的病理生理机制可能主要涉及脑桥被盖部、蓝斑/蓝斑下区复合体及其投射通路功能的紊乱。诊断RBD主要依据特征性临床表现及视频多导睡眠图(v-PSG)的监测结果。治疗上除了积极干预PD外,应对患者及其床伴采取保护措施;当患者的异常睡眠行为对其造成严重的困扰并具有危险性时,需给予药物治疗。     

Melanin concentrating hormone induces hippocampal acetylcholine release via the medial septum in rats

Among various actions of melanin concentrating hormone (MCH), its memory function has been focused in animal studies. Although MCH neurons project to various areas in the brain, one main target site of MCH is hippocampal formation for memory consolidation. Recent immunohistochemical study shows that MCH neurons directly project to the hippocampal formation and may indirectly affect the hippocampus through the medial septum nucleus (MS). It has been reported that sleep is necessary for memory and that hippocampal acetylcholine (ACh) release is indispensable for memory consolidation. However, there is no report how MCH actually influences the hippocampal ACh effluxes in accordance with the sleep–wake cycle changes. Thus, we investigated the modulatory function of intracerebroventricular (icv) injection of MCH on the sleep–wake cycle and ACh release using microdialysis techniques. Icv injection of MCH significantly increased the rapid eye movement (REM) and non-REM episode time and the hippocampal, not cortical, ACh effluxes. There was a significant correlation between REM episode time and hippocampal ACh effluxes, but not between REM episode time and cortical ACh effluxes. Microinjection of MCH into the MS increased the hippocampal ACh effluxes with no influence on the REM episode time. It appears that the effect sites of icv MCH for prolongation of REM episode time may be other neuronal areas than the cholinergic neurons in the MS. We conclude that MCH actually increases the hippocampal ACh release at least in part through the MS in rats.     

6-OHDA帕金森病大鼠快动眼睡眠状态下皮层脑电及基底节场电位的异常变化

目的：了解帕金森病（PD）模型大鼠在快动眼睡眠状态下皮层脑电和基底节场电位的异常变化。方法：用6-羟基多巴胺（6-OHDA）脑内两点注射法建立PD大鼠模型,并经阿扑吗啡注射诱发旋转对模型进行评价。通过多导宏电极在体电生理记录技术结合视频录像,对正常大鼠和6-OHDA大鼠PD模型进行苍白球场电位和皮层M1、M2区脑电的多部位24小时同时记录。功率谱分析和相干分析用于揭示快动眼睡眠状态下各记录位点信号的频率成分以及不N记录位点神经元集群之间的变化。结果：与正常大鼠相比,6-OHDA帕金森病模型大鼠在REM期间的皮层脑电在臼和y频段上都有变化：初级运动皮质M1区的θ频段成分消失,辅助运动区M2的θ频段成分略有增加,患侧苍白球的θ频段成分增大显著;M1区的γ频段成分增大,而γ频段成分在苍白球基本没有变化。结论：6-OHDA对中脑多巴胺能神经元的损害可造成大鼠双侧皮层M1区θ节律的消失和γ节律的增强,以及对侧M1-M2区之间在γ节律上的同步被显著增强,而γ节律在苍白球没有变化。这些异常电活动可能是由于VTA受损引起从而与帕金森病的快动眼睡眠行为障碍有关。     

Light-Dark Difference in Arterial Pressure Variability During REM Sleep in the Rat

We have observed mean arterial pressure (MAP) variability during rapid eye movement (REM) sleep and brain temperature (Tb) in the rat during both light and dark periods over 24 h. MAP was measured using a telemetric device with a computer data capture and analysis system. As markers of MAP variability, the maximum and coefficient of variation (CV%) of MAP during REM sleep were determined. The following results were obtained: (a) there was a light-dark difference in MAP during non-REM (NREM) sleep and Tb during both NREM and REM sleep; (b) the increase of MAP in going from NREM to REM sleep in the light period was greater than that in the dark period, whereas the increase of Tb in the light period was not different from that in the dark period; (c) the maximum and CV% for MAP during REM sleep in the light period were greater than those in the dark period; (d) there was a negative correlation between the average Tb and MAP CV% during REM sleep. We suggest that phasic fluctuation of MAP during REM sleep may be influenced, in part, by a factor independent of sleep mechanisms.