Observation Of One Patient With Suspected Narcolepsy By Multiple 24-hour Continuous Polysomnography In Natural State

Objective: 1.To learn the characteristics of sleep-wake structure in one patient with narcolepsy in natural state;2.To compare the characteristics between each 24-hour continuous polysomnography of daytime naps’ sleep-structure in one patient with narcolepsy;3.To place a value on multiple 24-hour continuous polysomnography in the diagnosis of narcolepsy.Methods: A patient with suspected narcolepsy was collected by medical history and physical examination.His cognitive level,mental state,and daytime sleepiness were assessed by mental,cognitive,emotional and somnolence scales including the Mini-Mental State Examination(MMSE),the Montreal Cognitive Assessment(Mo CA),the Hamilton Anxiety Scale(HAMA),the Hamilton Depression Scale(HAMD)and the Epworth Sleepiness Scale(ESS).24-hour ambulatory electroencephalogram(24h-AEEG)was used to check for the presence of seizures.Portable polysomnography(p-PSG)was used to monitor the patient in 24 hours for 5 days.Comparing the patient’s life log within 5 days,analyze the characteristics of sleep-wake structure between each 24-hour.Results: The main clinical manifestation of the patient was excessive daytime sleepiness,who was in normal cognitive function and good mental and psychological state.These clinical manifestations and the result of 24-hour ambulatory electroencephalogram helped the patient exclude seizures and psychotic disorders.He was also not combined with other types of sleep disorders.The continuous polysomnography showed the patient’s daytime naps had a high correlation with environmental and behavioral factors.Most of the daytime naps occurred at 13:00-17:00.The depth of these naps was usually stage Non-rapid eye movement(NREM,N)2 sleep.There were typical sleep onset rapid eye movement periods(SOREMPs),which REM sleep was transferred from the stage Wake(W)/N1.The nocturnal sleep had features of shortening sleep latency and REM sleep latency,increased N1 sleep,decreased N3 sleep and high micro-arousal index.Conclusions: By means of p-PSG continuous monitoring,the natural characteristics of sleep-wake structure and onset patterns in this case were presented:1.The number of daytime naps detected by p-PSG in natural state was more than that recorded in his life log;2.During the continuous monitoring by p-PSG in natural state,the percentage of typical REM-onset naps was 33.3%,and the atypical none-REM naps was 66.7%.p-PSG continuous monitoring has enriched the clues of the nocturnal polysomnography combined with multiple sleep latency test,which is more practical to guide the individualized accurate diagnosis and treatment of diseases.