The Study On Effect Of Propofol Induce Sleep Treatment On The Chronic Insomnia Patients

BackgroundIt is indecated by the epidemiological evidence that about 10∽13 percent adults suffered anguish with chronic insomnia, and 25∽30 percent adults had been transient or occasional hyposomnia. The chronic insomnia patients were usually in sleep deprivation, caused agitaion,warelessness,lassitude and the failure function with the stress,respiration,immunifaction and endocrine secretion, that influence the patients studying,working and living seriously. At present, the treatment on chronic insomnia was by sedative hypnotics, subsidiary traditional chinese medicine and physical treatment. The cognitive behavior therapy was developed raerely in the forthcoming condition, but the patients submiting drug compliance were cut down by the dose dependent sedative hypnotics and the patients and partial doctors uncorrected recognition. The recent study manifest that general anesthesia by propofol and natural sleep were similarity in ethology and interaction each other in generated mechanism, which indicated that general anesthesia would recover the neurotransmitters system balance by activating the entocerebrum regulating sleep neurolattice, thus reverse sleep debt. The general anesthesia by propofol are many graces, such as short demiperiod,fast effect,easy contral concentration and few adverse effect and so on. At present, it is not reported that anesthesia by propofol treat on chronic insomnia in domestic documents. The rats were anesthetized by propofol after sleep deprivation, the concentrate of exciability neurotransmitters was significantly decreased,such as NE,DA, while the rejection capability neurotransmitters was increased,such as GABA. According to this theory, we designed that propofol anesthetize sleeping balance treatment on the chronic insomnia patients, the effective power was 97%.Of course, all these measures were carried out under the agreement of hospital Ethics Committee and the patients permission in writing. Objective:1. It is established the animal model of REM sleep deprivation by modified multiple platform method in the study and investigated the effects of rapid eye movement (REM) sleep deprivation on cognitive function and the content of 5-HT in the rat frontal cortex, and approached the possible mechanism. And then, investigated the cognitive function and the level of 5-HT in frontal cortex after general anesthesia by propofol after sleep deprivation.2. The chronic insomnia patients were selected among the clinic inpatients,who would been treated by propofol anesthesia inducing sleep after the agreement of hospital Ethics Committee and the patients permission in writing, the short and long term curative effect were sdutied.Materials and Methods:1. Animals and groups: The health adult Sprague-Dawley rats were adopted and divided into groups randomly,such as blank contral group(n=10),big platform contral group(n=40),sleep deprivation group(n=40),propofol anesthesia group(n=40),fat milk contral group(n=40), each group was subdivided into 24h,48h,72h and 96h four phase point except blank contral group.2. Animal model prepare: Experimental model of sleep deprivation (SD) was established by use of modified multiple platform method.3. Learning and memory measure The variation of learning and memory was detected by Morris water maze at pre and post sleep deprivation.4. The level of 5-HT detect : High performance liquid chromatography- electrochemical detection( HPLC-ECD) techniques were used to analyze the levels of 5-HT.5. Chronic insomnia patients selected: Twenty-five chronic insomnia inpatients were selected who were in hospital and had no other disease.6. Treatment method: The neurology department carried out the anesthetize duse sleeping balance treatment on chronic insomnia combining with the department of anethesiology. The insomnia inpatients were excepted serious disease by routine examination, fasting diet before treatment, the propofol was micro-injecting 2 hours with the electrocardio-monitoring, after the patient waked , withdrawed the monitoring. 7. Curative effect assessment: Compare the record of ET and score of LSEQ between before and after therapy. Polysomnography (PSG) recordings were conducted and scores of Pittsburgh sleep quality index(PSQI) were measured pre and post therapy.Results1. As compared with blank control group, the content of 5-HT in frontal cortex increasing accompanied with the REM sleep deprivation time prolonging, while the learning ability was decreasing.2. The content of 5-HT in the front cortex was increasing with the time of REM sleep deprivation prolonging, it was significant statistic difference at 72 hour and 96 hour that compared with the big platform group or the blank contral group.3. After 96 hours sleep deprivation, the latency phase time of the propofol anesthesia group rats was more decreased than the fat milk contral group rats', while the content of 5-HT in front cortex was decreased, the difference was statistical significance.4. The activity of excitable neurotransmitters was more obviously activity and inhibitory neurotransmitters was more obviously weaken than the normal score (P<0.01). The activity of excitable neurotransmitters was more obviously decrease after therapy than before therapy (P<0.05). The patients were associated with a significantly higher response to anesthetize sleeping balance therapy in ease of getting to sleep,quality of sleep,alertness and behavioral integrity the following morning and gross score(p<0.05).;5. The score of PSQI suggested that there were 90% (27 cases)decrease more than 25%, The patients were associated with a significantly higher responses to anesthetize duse sleeping therapy in ease of getting to sleep,quality of sleep,altering and behavioral integrity the following morning and gross score. Increased total sleep duration, decreased awake frequency and decreased awake duration was found after therapy with PSG while changed sleep architecture such as decreased S1%, increased S3%, S4% and the percentage of REM time was found.Conclusion1.The dysfunction of learning ability of sleep deprivation may be associated with the content of 5-HT in the rat frontal cortex;2.The treatment of chronic insomnia by anesthetize sleeping balance was effective and safety, and was a effective method to recover sleep debt; 3.The treatment by anesthetize induce sleeping may improve the sleep architecture of partial chronic insomnia patients especially effectively recover the sleep debt of the patient with in a short duration.