BACKGROUND:The global coronavirus disease 2019 (COVID-19) pandemic seriously affected people's lives. We evaluated anxiety and depression among patients with insomnia in northeast China during the first wave and release of COVID-19, providing a basis for the clinical diagnosis and treatment of insomnia. METHODS:We enrolled 4211 patients with insomnia from January 2016 to February 2020, August 2020 to February 2022, August 2022 to December 2022, and January 2023 to February 2023, from our institution. Sleep quality was evaluated using the Athens Insomnia Scale, Insomnia Severity Index (ISI), and Pittsburgh sleep quality index (PSQI), while mood disorder and fatigue were evaluated using the Hhospital anxiety and depression scale (HAD), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Fatigue Scale-14 (FS-14). RESULTS:Insomnia with depression increased in prevalence after COVID-19 compared with before (12.8 % vs. 15.3 %, P < 0.05), while the age of patients decreased [(50.2 ± 15.2) vs. (47.5 ± 16.8), P < 0.05]. The number of patients with insomnia and severe depression increased compared with before COVID-19 (20.3 % vs. 25.3 %, P < 0.05). A higher proportion of patients with insomnia for >2 years had depression (P < 0.05). As the epidemic subsided, insomnia increased among young and male patients (young patients: 55.2 % vs. 37.0 %; male patients: 41 % vs. 27.4 %, respectively; P < 0.05). The proportion of patients with insomnia with anxiety and depression increased (53.8 % vs. 51.8 %，P < 0.05), the proportion with moderate to severe anxiety increased (7.6 % vs. 13.5 %, P < 0.05), and moderate and severe depression decreased (moderate: 25.6 % vs. 19.1 %, severe: 25.8 % vs. 20.3 %, P < 0.05, respectively). Middle-aged and elderly patients had higher PQSI scores in sleep latency, habitual sleep efficiency, subjective sleep quality, and use of sleep medications than young patients (P < 0.05). The PSQI score was positively correlated with the PHQ-9 score (r = 0.526), GAD-7 score (r = 0.563), and FS-14 score (r = 0.316) (P < 0.05). LIMITATIONS:The study was single-center, the sample size was small, and assessment data were lacking from early in the epidemic. The scale is subjective, which may affect the accuracy. CONCLUSION:Insomnia with depression increased during COVID-19. The patients were younger than before the epidemic, and a higher proportion with insomnia for >2 years had depression. The proportion of patients with insomnia with anxiety and depression was higher after the epidemic period, and the degree worsened. The proportion of insomnia with depression decreased after the epidemic period, and the degree alleviated. The proportion of young male patients with insomnia increased. Middle aged and elderly patients with insomnia had poor sleep quality, which was positively correlated with anxiety, depression, and fatigue.

Background: Restless legs syndrome (RLS) is a prevalent sensorimotor nervous system disorder in patients accompanied with insomnia, blood pressure fluctuation, and sympathetic dysfunction. These symptoms may disrupt cerebral hemodynamics. Dynamic cerebral autoregulation (dCA) describes the temporary response of cerebrovascular system to abrupt fluctuations in blood pressure, which keep cerebral blood flow stable and serve as a marker of cerebrovascular system ability. Objective: This research aimed to assess dCA in RLS patients. Methods: In this study, RLS patients were recruited and subsequently classified into four groups (mild, moderate, severe, and very severe) based on the International RLS Rating Scale (IRLS). Healthy controls matched for age and sex were enrolled. All participants were evaluated dCA by assessing phase difference (PD). A portion of patients with RLS was reassessed for dCA after one month of medication therapy (pramipexole [0.125 mg/day] and gabapentin [300 mg/day]). Results: There were altogether 120 patients with RLS and 30 controls completed the polysomnography and dCA assessment. PD was lower in the moderate, severe, and very severe RLS groups than that in the controls and mild RLS groups. Periodic limb movement index (PLMI), arousal index, and IRLS all showed a linear correlation with PD in RLS patients. Additionally, PD increased in RLS patients after therapy. Conclusion: The dCA was compromised in moderate, severe, and very severe RLS patients and was negatively correlated with the IRLS, arousal index, and PLMI. After 1 month of therapy, dCA improved in RLS patients.

失眠是一种常见的睡眠障碍,其指尽管有适当的睡眠机会和睡眠环境,依然对于睡眠时间和睡眠质量感到不满足,并且影响日间社会功能的一种主观体验 [1].伴随着社会发展,生活节奏加快,竞争压力增大,以失眠为主的睡眠障碍的发生率逐年升高,已成为严重的公共卫生问题[2].失眠障碍与人类心身疾病的发生密切相关,与经济社会重大事故的发生有紧密联系,日益引起人们的高度关注.目前中医药作为治疗失眠障碍的替代方法,已取得了一定的成果,良好的治疗效果逐渐引起临床医生的重视[3].本文就酸枣仁汤在失眠障碍中的应用研究进展综述如下.

Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a recently discovered autoimmune inflammatory disease of the central nervous system. It presents with a variety of clinical symptoms, including fever, seizures, psychiatric symptoms, limber weakness, and sensory symptoms. However, the symptoms of sleep disorders have not been sufficiently addressed. Here, we report a case of GFAP-A in which the patient complained of excessive daytime sleepiness and an excessive need for sleep. Our patient was a 58-year-old male who experienced excessive daytime sleepiness for 50 days following SARS-CoV-2 infection. He was diagnosed with coronavirus disease 2019 on June 1st. On the 7th of June, he experienced excessive daytime sleepiness, nausea, reduced food intake, lower limb weakness, and dysuria. Subsequently, his sleepiness significantly deteriorated on July 21st. Five months prior, the patient underwent laparoscopic partial right nephrectomy for clear-cell renal cell carcinoma. Brain MRI revealed abnormal hyperintense lesions in the pontine brain and around the mesencephalic aqueduct on T2 and T2-fluid attenuated inversion recovery (T2-FLAIR) sequences However, these lesions did not exhibit any pathological enhancement. Spinal cord MRI revealed lesions in the C6–C7 and T2–T3 segments on the T2 sequence. His Epworth Sleepiness Scale (ESS) score was 16 (reference range, <10), and 24-hour polysomnography supported the diagnosis of rapid-eye-movement sleep disorder and severe sleep apnea-hypopnea syndrome. Glial fibrillary acidic protein IgG antibodies were detected in the cerebrospinal fluid (1:32, cell-based assay) but not in the serum. The level of hypocretin in the cerebrospinal fluid was 29.92 pg/mL (reference range ≥110 pg/mL), suggesting narcolepsy type 1. After treatment with corticosteroids for approximately 1 month, the patient showed considerable clinical and radiological improvement, as well as an increase in hypocretin levels. Although repeated polysomnography and multiple sleep latency tests suggested narcolepsy, his ESS score decreased to 8. Our findings broaden the range of clinical manifestations associated with GFAP-A, thereby enhancing diagnostic and therapeutic strategies for this disease. Additionally, our results indicate a potential common autoimmune mechanism involving GFAP-A and orexin system dysregulation, warranting further investigation.

Narcolepsy type 1 is a kind of sleep disorder characterized by a specific loss of hypocretin neurons in the lateral hypothalamus and reduced levels of hypocretin-1 in the cerebrospinal fluid. Hypocretin deficiency is associated with autonomic disorders. This article summarizes the autonomic disorders and possible mechanisms associated with narcolepsy type 1. Patients with narcolepsy type 1 often have various systemic autonomic symptoms, including non-dipping blood pressure, reduced heart rate variability, dynamic cerebral autoregulation impairment, reduced gastric motility and emptying, sleep-related erectile dysfunction, skin temperature abnormalities, and blunted pupillary light reflex. Similar findings should strengthen the recognition and intervention of these disturbances in clinical practice. In addition to hypocretin deficiency, current evidence also indicates that pharmacological therapy (including psychostimulants and anti-cataplectic drugs) and comorbidities may contribute to the alterations of autonomic system observed in narcolepsy type 1.

失眠是一种常见的疾病,是以频繁而持续的入睡困难或睡眠维持困难并导致睡眠满意度降低为特征的睡眠障碍.患者的睡眠时间不足或睡眠质量差,难以开始或维持睡眠,夜间频繁觉醒或过早醒来,醒来后难以再入睡,并伴有醒时烦躁或疲劳等症状.Meta分析显示中国普通人群失眠患病率为15％,疫情期间失眠的患病率高达29. 1％ [1] ,《健康中国行动(2019-2030 年)》将降低失眠的患病率作为心理健康促进的行动目标之一[2].在过去的十年里,人们逐渐认识到睡眠的重要性.研究发现,睡眠对认知、情绪和身体机能有广泛的影响.失眠往往与其他疾病共病,包括其他睡眠障碍(如睡眠呼吸暂停、中枢性过度睡眠和睡眠-觉醒昼夜节律障碍)、身体疾病(如慢性疼痛和癌症)以及心理和精神疾病(如药物滥用、焦虑和抑郁)等,影响人们的身体健康.因此,探究失眠的治疗方法,改善失眠非常有必要.

Restless legs syndrome (RLS) is a sensorimotor disorder with a obvious circadian rhythm, as its symptoms often occur or worsen only in the evening or at night. The mechanisms behind the rhythms of RLS have not yet been fully elucidated. This review explores possible causes for the circadian fluctuations of the symptomatology, including the levels of iron, dopamine, melatonin, melanocortin, and thyroid-stimulating hormone in the brain, as well as conditions such as peripheral hypoxia and microvascular function disorders. The metabolic disturbances of the substances above can create a pathological imbalance, which is further aggravated by physiological fluctuations of circadian rhythms, and results in the worsening of RLS symptoms at night. The review concludes with the suggestions for RLS treatment and research directions in the future.

Arginine vasopressin(AVP),also known as antidiuretic hormone,is a highly conserved neuropeptide se-creted by the supraoptic or paraventricular nucleus of the hypothalamus and has complex physiological functions.This ar-ticle reviews the physiological properties of AVP and elaborates on the possible involvement of AVP in sleep-arousal regula-tion via the hypothalamic orexinergic and noradrenergic systems and the role of AVP in maintaining circadian homeostasis by facilitating intercellular coupling of suprachiasmatic nucleus neurons,as well as the potential role of AVP in the regula-tion of anxiety and depression.

失眠是一种常见的睡眠障碍.伴随社会发展,生活节奏加快,竞争压力增大,以失眠为主的睡眠障碍的发生率逐年升高,已成为严重的公共卫生问题.目前中医药作为治疗失眠障碍的替代方法,良好的治疗效果逐渐引起临床医生的重视.酸枣仁汤是一种常见的中药方剂,可通过多种机制来发挥治疗失眠的作用,包括调节中枢神经递质和免疫细胞因子水平、调节下丘脑-垂体-肾上腺轴功能、调控昼夜节律相关的基因、参与星形胶质细胞的调节以及影响营养物质的代谢等.本文就酸枣仁汤治疗失眠障碍的相关机制进行综述.

睡眠是机体维持健康必不可少的生理过程,目前脑电图( electroencephalography,EEG)可以快速且准确的识别睡眠的神经电生理现象,如纺锤波、K复合波及慢波睡眠等,已广泛应用于研究睡眠分期[1]及异常睡眠模式[2] ,但其空间分辨率较低,无法识别特定区域的大脑活动.相比之下,功能磁共振( functional magnetic resonance imaging,fMRI)的空间分辨率高且可检测大脑深层活动,已广泛应用于研究睡眠与觉醒,但其时间分辨率较差,只能通过血流及血氧水平依赖( Blood Oxygenation Level Dependent,BOLD)信号间接检测神经元活动.因此,目前多采用同步脑电图联合功能磁共振技术( EEG-fMRI)灵敏而精确的监测大脑睡眠与觉醒活动[3].本文就EEG-fMRI在睡眠与觉醒中的应用研究进展综述如下.

虚拟现实( virtual reality,VR)技术是一种以计算机技术为核心,并融合了人工智能技术、多媒体技术、传感器技术、人机交互技术、行为学等多方面知识,以交互性、沉浸性、想象性为特征的环境仿真技术.其通过相应的辅助设备可以实现有效的人机交互,从视觉、听觉、触觉等方面创造逼真的虚拟情境,让患者体验身临其境的效果[1,2].随着计算机算法、显示设备等的不断进步, VR技术正日趋成熟,并已经与多个学科形成了交叉,在很多领域发挥着自己的作用.在神经内科领域,VR技术在睡眠调节、神经心理、神经康复等方面发挥作用,并且随着"互联网+"及远程医疗模式的兴起,可以预见VR未来将发挥更大作用.本文对VR在神经内科学中的应用现状及进展进行总结和展望.