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Abstract
Aim:To pilot study the therapeutic effect of dexmedetomidine-induced sleep balance treatment (DISBT) on the chronic refractory primary insomnia patients.
Methods:Forty-two patients with chronic refractory primary insomnia were randomly divided into two groups by random number table. Patients in DISBT group were given DISBT for 3 days, while patients in the control group were given conventional treatment for 3 day. Pittsburgh sleep quality index (PSQI), the hyperarousal scale (HAS), and Hamilton anxiety scale (HAMA) were evaluated and compared between the pre-treatment and post-1-week-treatment. Sleep architecture and electroencephalogram (EEG) spectrum were also recorded and compared pre-treatment and post-treatment.
Results:The scores of PSQI and HAMA in both groups after treatment were lower than those before treatment (P < 0.05), DISBT group-reduced degree were higher than those of the control group (P < 0.05). Sleep architecture of Stage 2 sleep proportion, EEG spectrum beta, and gamma relative power value in DISBT group were lower than those before treatment (P < 0.05), Stage 3 sleep proportion and delta relative power value were higher than those before treatment (P < 0.05); Sleep architecture of Stage 2 sleep proportion,beta, and gamma relative power value in control group were higher than those before treatment (P < 0.05); rapid eye movement sleep, Stage 3 sleep proportion, and delta relative power value were lower than those before treatment (P < 0.05). The total scores of the hyperarousal scale (HAS) in both groups after treatment were lower than those before treatment (P < 0.05), DISBT group-reduced degree were higher than those of the control group (P < 0.05), the extreme score, introspectiveness score, react score of HAS in control group after treatment had no statistical significance compared to those before treatment (P > 0.05), the extreme score, introspectiveness score, react score of HAS in DISBT group after treatment were lower than those before treatment (P < 0.05).
Conclusion:DISBT effectively reduced the insomnia patient cortex hyperarousal level, corrected disorder of sleep-awakening pathways and easedup insomnia symptom. It is an effective method for chronic refractory primary insomnia.
References
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Wang Y, Zhu GX. The clinical characteristics of chronic primary insomnia in China. Chinese J Clin Neurosci 2011; 19: 601-605.
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Berridge CW, Schmeichel BE, España RA. Noradrenergic modulation of wakefulness/arousal. Sleep Med Rev 2012; 16: 187-97. http://dx.doi.org/10.1016/j.smrv.2011.12.003
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Nelson LE, Jun L, Tianzhi G. The 2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiol 2003; 98: 428-36. http://dx.doi.org/10.1097/00000542-200302000-00024
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Insomnia definition, diagnosis and medication treatment consensus experts group. Insomnia definition, diagnosis and medication treatment consensus. Chinese J Neurol 2006; 39: 141-43.
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Mantz J, Josserand J, Hamada S. Dexmedetomidine: New insights. Eur J Anaesthesiol 2011; 28: 3-6. http://dx.doi.org/10.1097/EJA.0b013e32833e266d
Huupponen E, Maksimow A, Lapinlampi P, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep
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Venn RM, Bradshaw CJ, Spencer R. Preliminary UK experience of dexmedetormidine, a novel agent for postoperative sedation in the intensive care unit. Anesthesia 1999; 54: 1136-42. http://dx.doi.org/10.1046/j.1365-2044.1999.01114.x
Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: A review of the concept and its evidence. Sleep Med Rev 2010; 14: 19-31. http://dx.doi.org/10.1016/j.smrv.2009.04.002
Le’ger D, Bayon V. societal costs of insomnia. Sleep Med Rev 2010; 14: 379-89. http://dx.doi.org/10.1016/j.smrv.2010.01.003
Bonnet MH, Arand DL. Hyperarousal and insomnia: State of the science. Sleep Med Rev 2010; 14: 9-15. http://dx.doi.org/10.1016/j.smrv.2009.05.002
Wang Y, Zhu GX. The clinical characteristics of chronic primary insomnia in China. Chinese J Clin Neurosci 2011; 19: 601-605.
Zhang Y, Jiang XH, Hu Y. Analysis of psychological and physiological insomnia accompanied by emotional disorders and depressive insomnia PSG. Chinese J Clin Neurosci 2008; 16: 361-63.
Cortoos A, Verstraeten E, Cluydts R. Neurophysiological aspects of primary insomnia: Implications for its treatment. Sleep Med Rev 2006; 10: 255-66. http://dx.doi.org/10.1016/j.smrv.2006.01.002
Buysse DJ, Germain A, Hall M, et al. A neurobiological model of insomnia. Drug Discov Today Dis Models 2011; 8: 129-37. http://dx.doi.org/10.1016/j.ddmod.2011.07.002
Jiang XH, Xu ZQ, Liu J. The GABA changes of encephalofluetuograph in intrinsic insomnias. Chinese J Clin Neurosci 2005, 13: 236-38.
Saper CB, Scammell TE, Jun L. Hypothalamic regulation of sleep and circadian rhythms. Nature 2005; 437: 1257-63. http://dx.doi.org/10.1038/nature04284
Berridge CW, Schmeichel BE, España RA. Noradrenergic modulation of wakefulness/arousal. Sleep Med Rev 2012; 16: 187-97. http://dx.doi.org/10.1016/j.smrv.2011.12.003
Perlis ML, Smith MT, Andrews PJ, et al. Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep 2001; 24: 110-17.
Bastien CH. Insomnia: Neurophysiological and neuropsychological approaches. Neuropsychol Rev 2011; 21: 22-40. http://dx.doi.org/10.1007/s11065-011-9160-3
Pavlova M, Berg O, Gleason R, et al. Self-reported hyperarousal traits among insomnia patients. J Psychosom Res 2001; 51: 435-41. http://dx.doi.org/10.1016/S0022-3999(01)00189-1
Morin CM, Benca R. Chronic insomnia. Lancet 2012; 379: 1129-41. http://dx.doi.org/10.1016/S0140-6736(11)60750-2
Bastien CH, LeBlanc M, Carrier J. Sleep EEG power spectra, insomnia, and chronic use of benzodiazepines. Sleep 2003; 26: 313-17.
Nelson LE, Jun L, Tianzhi G. The 2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiol 2003; 98: 428-36. http://dx.doi.org/10.1097/00000542-200302000-00024
Gilsbach R, Albarrán-Juárez J, Hein L. Pre-versus postsynaptic signalling by 2-adrenoceptors. Curr Top Membr 2011; 67: 139-60. http://dx.doi.org/10.1016/B978-0-12-384921-2.00007-0
Roth T, Roehrs T, Pies R. Insomnia: Pathophysiology and implications for treatment. Sleep Med Rev 2007; 11: 71-79. http://dx.doi.org/10.1016/j.smrv.2006.06.002
Insomnia definition, diagnosis and medication treatment consensus experts group. Insomnia definition, diagnosis and medication treatment consensus. Chinese J Neurol 2006; 39: 141-43.
Backhaus J, Junghanns K, Broocks A, et al. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 2002; 53: 734-40. http://dx.doi.org/10.1016/S0022-3999(02)00330-6
Wang C, Chu YM, Zhang YL, et al. Factorial structure of HAMA in the Chinese patients with depressive disorder. J Clin Psychiatry 2011; 21: 299-301.
Iber C, Ancoli-Israel S, Andrew L, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester: Am Acad Sleep Med 2007; 24-30.
Mantz J, Josserand J, Hamada S. Dexmedetomidine: New insights. Eur J Anaesthesiol 2011; 28: 3-6. http://dx.doi.org/10.1097/EJA.0b013e32833e266d
Huupponen E, Maksimow A, Lapinlampi P, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep
[J]. Acta Anaesthesiol 2008; 52(2): 289-94. http://dx.doi.org/10.1111/j.1399-6576.2007.01537.x
Venn RM, Bradshaw CJ, Spencer R. Preliminary UK experience of dexmedetormidine, a novel agent for postoperative sedation in the intensive care unit. Anesthesia 1999; 54: 1136-42. http://dx.doi.org/10.1046/j.1365-2044.1999.01114.
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