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Douleur et Analgésie

, Volume 16, Issue 2, pp 71–78 | Cite as

Fragmentation du sommeil chez le patient éprouvant de la douleur

  • L. Parrino
  • M. Zucconi
  • M. G. Terzano
Article

Résumé

La douleur est une cause majeure de l'insomnie chez les malades et plus de 70% des patients en douleur se plaignent de troubles du sommeil. Des études polysomnographiques ont démontré que les patients éprouvant de la douleur chronique affichent une perturbation marquée de la structure et de la continuité du sommeil. Les constatations les plus courantes sont: changements fréquents de phases de sommeil, augmentation des réveils nocturnes, diminution du sommeil à ondes lentes et du sommeil à mouvements oculaires rapides, augmentation du sommeil superficiel et des mouvements du corps, intrusion électroencéphalographique (EEG) de sommeil alpha-delta, augmentation du nombre d'éveils et du taux de pattern d'activation cyclique (PAC). Le PAC est un marqueur physiologique du sommeil instable qui amplifie les réactions aux événements perturbateurs de la consolidation du sommeil. Ainsi, la qualité du sommeil dépend de mécanismes cérébraux qui évaluent les événements externes afin de protéger l'intégrité vitale. Ces mécanismes, situés au niveau thalamique, commande le maintien du sommeil, l'éveil bref ou le réveil comportemental, selon le risque que représente l'événement en cause. Pendant le sommeil, le système neurovégétatif demeure réceptif aux stimuli externes et opère en synchronie avec le processus PAC. Chez les sujets sains, la stimulation thermique nociceptive provoque une accélération du rythme cardiaque peu importe la phase du sommeil, avec un gradient décroissant de la phase 2 au sommeil à ondes lentes et au sommeil MOR. Les réponses autonomiques peuvent varier chez les patients fibromyalgiques n'affichant pas la diminution normale de l'activité sympathique pendant le sommeil et chez les patients éprouvant de la douleur chronique qui sont déjà aux prises avec la fragmentation du sommeil ou l'insomnie. Les modifications spécifiques du sommeil découlant d'un syndrome unique de douleur ou de parasomnies associées à la douleur pendant le sommeil (par ex. le bruxisme, les crampes nocturnes dans les jambes et le reflux gastro-œsophagien) sont également décrites.

Mots-clés

Sommeil douleur micro-éveils patron cyclique alternant fragmentation du sommeil polysomnographie 

Summary

Pain is reported as a leading cause of insomnia in medical illness and more than 70% of patients with painful syndromes complain of sleep problems. Polysomnographic investigation has demostrated that patients with chronic pain have a marked alteration of sleep structure and continuity. The most common findings are: frequent stage shifts, increase of nocturnal awakenings, decreased amounts of slow wave sleep and REM sleep, increase of superficial sleep and body movements, intrusion of alpha-delta sleep, increased arousals and CAP rate. CAP (cyclic alternating pattern) is the EEG marker of unstable sleep and is enhanced by any factor or event that interferes with sleep consolidation. The maintenance of sleep relies on cerebral mechanisms that evaluate sensorial inputs, prevent awakening for non-meaningful information and protect vital integrity allowing relevant inputs to trigger arousals or other behavioural responses. These safeguarding processes require a gate for sensory inputs. Gating is exerted at the thalamic level, leading the cortex to be awakened, aroused or maintain sleep continuity in relation to the intensity and risk of the stimulus and to the ongoing condition of sleep depth and stability. During sleep, the neurovegetative system remains active to external stimuli and proceeds in synchrony with the CAP process. In healthy subjects, a significant cardiac acceleration provoked by nociceptive thermal stimulation occurs during all sleep stages with a decreasing gradient from stage 2, slow wave sleep and REM sleep. Autonomic responses may vary in fibromyalgic patients without the normal decrease in sympathetic activity during sleep and in chronic pain patients already affected by sleep fragmentation or insomnia. The specific alterations of sleep in single painful syndromes and in parasomnias associated with pain during sleep (such as bruxism, nocturnal leg cramps and gastrœsophageal reflux) are described.

Key-words

Sleep pain arousals cyclic alternating pattern sleep fragmentation polysomnography 

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Centre des troubles du sommeil, Département de neurologieUniversité de ParmeParma
  2. 2.Centre des troubles du sommeil, Départment de neurologieInstitut/Hôpital San RaffaeleMilanItalie

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