不同类型头晕患者的睡眠特征

文献信息

中文摘要

目的： 睡眠障碍与头晕常共存，但不同前庭疾病的具体睡眠特征仍缺乏充分描述。本研究旨在探讨良性阵发性位置性眩晕（BPPV）、前庭性偏头痛（VM）和持续性姿势-知觉性头晕（PPPD）患者与健康对照相比的独特睡眠特征。
方法： 我们开展了一项横断面研究，共纳入90名参与者：24名健康对照、21例BPPV、23例PPPD和22例VM。睡眠采用多模式方法评估：14天活动记录仪、单夜家庭睡眠呼吸暂停检测（Watch-PAT）以及经验证的问卷，包括匹兹堡睡眠质量指数（PSQI）、头晕残障量表（DHI）和贝克焦虑/抑郁量表。
结果： 所有头晕组均报告主观睡眠质量显著差于对照，且心理负担更高。然而，每种疾病呈现出独特的客观特征：BPPV：以客观睡眠碎片化和显著更高的呼吸暂停-低通气指数（AHI：31.5）及氧减饱和度指数（ODI：16）为特征。这些患者还表现出夜间不安增加（L5）。PPPD：表现出“睡眠悖论”，即客观睡眠效率最高但主观感知最差（PSQI：11.0）。患者日间活动减少（M10），睡眠作息僵化，周末与工作日起床时间几乎无差异。VM：以总睡眠时间最短和明显（虽无统计学显著性）的“社交时差”为特点，表现为周末与工作日起床时间相差120分钟。
结论： 头晕在睡眠方面并非同质实体。所发现的独特特征提示临床管理应个体化：在BPPV中筛查睡眠呼吸暂停，在PPPD中通过认知行为方法处理客观-主观分离，在VM中管理睡眠剥夺和昼夜节律规律性。

英文摘要

OBJECTIVE: Sleep disturbances and dizziness are frequently comorbid, yet the specific sleep profiles across different vestibular disorders remain poorly characterized. This study aimed to investigate distinct sleep signatures in patients with benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), and persistent postural-perceptual dizziness (PPPD) compared to healthy controls.
METHODS: We conducted a cross-sectional study with 90 participants: 24 healthy controls, 21 with BPPV, 23 with PPPD, and 22 with VM. Sleep was assessed using a multimodal approach: 14-day actigraphy, a single-night home sleep apnea test (Watch-PAT), and validated questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Dizziness Handicap Inventory (DHI), and Beck Anxiety/Depression Inventories.
RESULTS: All dizziness groups reported significantly worse subjective sleep quality and higher psychological burden than controls. However, each disorder presented a unique objective signature: BPPV: Characterized by objective sleep fragmentation and a markedly higher Apnea-Hypopnea Index (AHI: 31.5) and Oxygen Desaturation Index (ODI: 16). These patients also showed increased nocturnal restlessness (L5). PPPD: Demonstrated a "sleep paradox" with the highest objective sleep efficiency but the poorest subjective perception (PSQI: 11.0). Patients showed reduced daytime activity (M10) and rigid sleep routines with virtually no weekend-weekday get-up time difference. VM: Distinguished by the shortest total sleep time and pronounced, though not statistically significant, "social jetlag", reflected by a 120-min discrepancy between weekend and weekday get-up times.
CONCLUSION: Dizziness is not a homogeneous entity regarding sleep. The distinct signatures found suggest that clinical management should be tailored: screening for sleep apnea in BPPV, addressing the objective-subjective disconnect in PPPD via cognitive-behavioral approaches, and managing sleep deprivation and circadian regularity in VM.