Clinical Research Of Regulation Hyperarousal To Correct Sleep Debt

Background and Objective:Insomnia is a disease complaint of difficulty falling asleep,maintaining sleepdysfunction and non-restorative sleep, that accompanied by daytime dysfunction.Insomniais a major public health problem. About a quarter of people in his life are affected by theinsomnia symptom.Insomnia is dangerous that can reduce the quality of life, increase theonset risk of somatic and mental illness, which can lead to absenteeism, traffic accidents,etc. so that increase the consumption of medical resources. Effective treatments of insomniacontains drug treatment and non-drug treatment. Drug treatment has characteristics ofdefinite clinical curative effect,work fast and good short-term application effect. Drugtreatment can’t cure insomnia.Long-term use can produce tolerance and dependence,Andcan also produce rebound insomnia symptoms and withdrawal effects when the substance isdiscontinued.Non-drug treatment has part of effective support in clinical practice, but theevidence is still limited.So there is no consistent conclusion about non-drugtreatment.Cognitive behavioral therapy (CBT) confirmed by evidence-based medicine hasnot yet been Widely used due to domestic existing medical environment factors. Therefore,new treatments need to be urgently developed.Current studies suggest that the hyperarousalis an important mechanismof insomnia,which is expressed in terms of cortical, cognitiveand physiologic activation. In view of hyperarousal theory, direct interference onhyperarousal will improve insomnia symptom and daytime dysfunction. Dexmedetomidine(Dex) can completely agonism α2acceptor with characteristics of High selective, work fastand short half-life.Therefore it has sedative and analgesic and sympathetic blockade effectin clinical practice.Dexmedetomidine can impact on the LC-neurons throughadreno-autoreceptors or other adrenoceptors to regulate sleep-wake pathway,therebydecrease arousal level and improve sleep quality.The study employed Dexmedetomidine tocure insomnia patients and survey its clinical effects，in order to a new reliable approach for insomnia.Subjects and Methods:Fifty insomnias admitted to our hospital between February2012and July2013wererandomly divided into two groups,25patients as Dex group while another25patients asconventional group. All insomnias meet the diagnostic criteria and the exclusion criteria ofDiagnostic and Statistical Manual of Mental Disorders (DSM-IV) for primary insomnia.Inaddition,25normal sleepers admitted to the physical examination center were randomlyrecruited as the normal sleep group.Normal sleep group admission criteria including:(1) Donot conform to the diagnostic criteria for primary insomnia DSM-IV;(2)There was noserious disease about systematic review;(3) no history of drinking,or no interest o f tea orcoffee;(4)Aged30-65years old. All subjects knew the related process prior to admissionand signed the informed consent.MethodsAll subjects accepted common physical and auxiliary examinations.They needcomplete sleep related scale,such as the Pittsburgh sleep quality index (PSQI), Insomniaseverity index scale (ISI).The hyperarousal scale under the guidance of specialist.Allsubjects accepted assessment,such as Hamilton anxiety scale(HAMA), Hamilton depressionscale(HAMD).All subjects accepted monitoring of ET, serum5-HT and NE.In addition,allinsomnias accepted polysomnography (PSG).The difference of neurotransmitter in the brainhad been contrasted between insomnias and normal sleepers. Dex group accepted Sleepinduction therapy by Dex. Conventional group accepted general treatment. brainneurotransmitter and clinical efficacy were mainly observed.Results:1.The ISI，PSQI，HAS score were significantly higher in insomnias compared withnormal sleepers(P<0.05).ET results show that the S4series(5-HT) is significantly lower ininsomnias compared with normal sleepers(P<0.05),while the S7series(NE) is significantlyhigher in insomnias compared with normal sleepers(P<0.05). There was not significantdifferences between insomnias and normal sleepers on S1series(GABA),S2series(Glu),S5series(Ach),S11series(DA)(P>0.05).2.Dex group:After treatment, the PSQI total score, sleep quality, sleep time, sleepefficiency factor score decreased comparing to that before treatment (P<0.05).The HAS total score, React score,Extreme score,Introspectiveness score decreased comparing to thatbefore treatment (P<0.05).PSG show that the sleep latency and waking hours decreasedcomparing to that before treatment(P<0.05),while total sleep time and sleep efficiencysignificantly increased comparing to that before treatment (P<0.05).There was notsignificant differences between insomnias and normal sleepers on number of awakeningcomparing to that before treatment (P>0.05). ET results show that the S4series(5-HT)increased comparing to that before treatment (P<0.05),while the S7series(NE) decreasedcomparing to that before treatment (P<0.05). There was not significant differences betweenpre-treatment and post-treatment on S1series(GABA),S2series(Glu),S5series(Ach),S11series(DA)(P>0.05).Serum5-HT and NE results show that the5-HT increased comparingto that before treatment (P<0.05),while NE decreased comparing to that before treatment(P<0.05).3.Regular group：After treatment，the PSQI total score, sleep quality, sleep time, sleepefficiency factor score decreased comparing to that before treatment (P<0.05). The HAStotal score, React score decreased comparing to that before treatment (P<0.05).There wasnot significant differences between pre-treatment and post-treatment on PSG parameter，ETresult，Serum5-HT and NE results show that the5-HT increased comparing to that beforetreatment (P<0.05),while NE decreased comparing to that before treatment (P<0.05).4.After treatment，the PSQI total score, sleep quality, sleep latency,sleep time, sleepefficiency,Sleep disorders factor score were significantly lower in Dex group comparedwith conventional group(P<0.05).The HAS total score, React score,Extremescore,Introspectiveness score were significantly lower in Dex group compared with Regulargroup(P<0.05). PSG show that the sleep latency were significantly lower in Dex groupcompared with conventional group(P<0.05),while total sleep time and sleep efficiency weresignificantly higher in Dex group compared with conventional group(P<0.05).There wasn’tmrked differences between two groups on number of awakening,waking hours ofPSG(P>0.05). ET results show that the S4series(5-HT) were significantly higher in Dexgroup compared with conventional group(P<0.05),while the S7series(NE) weresignificantly lower in Dex group compared with conventional group(P<0.05).There wasn’tmarked differences between two groups on S1series(GABA),S2series(Glu),S5series(Ach),S11series(DA)(P>0.05). Serum5-HT and NE results show that5-HT were significantly higher in Dex group compared with conventional group(P<0.05),while NEwere significantly lower in Dex group compared with conventional group(P<0.05).Conclutions:1.Studies show that there is significantly awakening level and neurotransmitter ofbrain in insomnia compared with normal sleepers.2.Dex is thought to be directly aimed at hyperarousal mechanisms, adjust the levels ofthe neurotransmitter in the brain,improve sleep quality.It can be a new treatment option forinsomnia.3.Neurotransmitter in the brain can be used to assess hyperarousal level.