The Study Of Dynamic Cerebral Autoregulation In Patients With Central Disorders Of Hypersomia

Objective: The purpose of this study was to observe the changes of the dynamic cerebral autoregulation in patients with central disorders of hypersomia,and to discuss the possible pathophysiological mechanisms so that we can provide more evidence for the clinical treatment of central hypersomia.Method: In this study,patients with excessive daytime sleepiness during the period from February 2016 to February 2017 were enrolled as experimental group in the Department of Neurology,No.1 Hospital of Jilin University,21 cases were followed up and 7 cases were enrolled as healthy control group.According to the results of the PSG and MLST,it was divided into hypersomia group?narcolepsy without RBD group?narcolepsy with RBD group,each group has 7 cases.Non-invasive continuous cerebral blood flow velocity(CBFV)and arterial blood pressure were recorded simultaneously using a transcranial Doppler device and a servo-controlled plethysmograph,respectively.Transfer function analysis was used to derive the autoregulatory parameters including phase difference(PD),gain,to evaluate the d CA function.In the patients with narcolepsy,7 patients were treated with cerebral blood flow regulation after standardized treatment for 1 months,and compared with before treatment.Result:(1)Compared with the ESS score(2.1 ± 1.3)of control group,hypersomia group,narcolepsy without RBD group narcolepsy with RBD group ESS score(14.6±3.8,16.4±4,18±2.9)were significantly increased,the differences were statistically significant(p< 0.05).(2)The left phase difference of hypersomia group,narcolepsy without RBD group narcolepsy with RBD group(33.97±8.71?35.49±11.72?32.00±13.09)were lower than that of the control group(53.15 ± 7.91),the right phase difference of hypersomia group,narcolepsy without RBD group narcolepsy with RBD group(33.95±9.21?36.58±13.30?31.85±8.77)were lower than that of the control group(53.54±10.87),left and right phase research object of different groups had significant difference(p < 0.05).But there were no significant differences in the left and right gains between subjects in different groups(p>0.05).There was no significant difference between the corresponding hemisphere PD(p > 0.05)of the narcolepsy without RBD group and with RDB group;and there was no significant difference in the corresponding hemisphere gain(p> 0.05).(2)Compared the ESS of Narcolepsy patients before and after treatment,the ESS score after treatment(11.3 ± 2)was decreased than before treatment ESS(15.6 ± 2.7),the difference was significant(p< 0.05);Compared with left PD(24.79±10.13°)before the treatment,the after treatment of narcolepsy patients left PD(43.9 ± 12.54 °)increased significantly,the difference was significant(p < 0.05);After treatment,the right PD(43.05±14.89°)was significantly increased compared with that of the left PD(25.39±5.50°)before treatment,and the difference was significant(p < 0.05).There was no significant difference in the gain of the cerebral hemisphere in patients with narcolepsy before and after treatment(p> 0.05).Conclusion:(1)The d CA dysfuntion was happened in patients with central disorders of hypersomnia.(2)There is no difference in the degree of dynamic cerebral blood flow in the patients of narcolepsy with RBD and without RBD,which may have the same pathophysiological mechanism.(3)The d CA was improved in patients with narcolepsy after drug(Metylphenidate /Fluoxetine/Venlafaxine)treatment.