Abstract: Background　Sleep-wake disorders are most likely to occur in patients after cerebral hemorrhage，which can delay the recovery process.But long-term pharmaceutical treatment can cause low response.Tomatis listening therapy can stimulate and improve the interconnections between human ears and the nervous system，thereby regulating the sleep structure via listening to the music consisting of sounds with the sudden transition from low-to-high frequencies and vice versa.Objective　To explore the effect of Tomatis listening therapy on sleep structure in patients with acute cerebral hemorrhage.Methods　138 patients with sleep disorders after acute cerebral hemorrhage were recruited from Neurosurgery Department，North China University of Science and Technology Affiliated Hospital，from July 2017 to July 2018.By use of a table of random numbers，they were equally divided into control group，music therapy group，and listening therapy group，receiving conventional nursing，conventional nursing and common music therapy，conventional nursing in combination with Tomatis listening therapy （listening to the music consisting of sounds with the sudden transition from low-to-high frequencies and vice versa），respectively.The intervention lasted for consecutive 14 days for all participants.Sleep quality data were collected by overnight PSG monitoring.Sleep structure was compared between the groups before and after intervention.Results　There were significant differences in non-REM latency，REM latency，ratios of non-REM latency to total sleep time， stage 3 non-REM sleep time to total sleep time，stage 4 non-REM sleep time to total sleep time，and REM sleep time to total sleep time after intervention among three groups （P<0.05）．Self-controlled comparisons showed that，compared with baseline，after intervention，sleep quality changed insignificantly in the control group （P>0.05）；ratio of stage 4 non-REM sleep time to total sleep time increased in music therapy group （P<0.05）；ratios of total sleep time to total recording time，stage 3 non-REM sleep time to total sleep time，stage 4 non-REM sleep time to total sleep time，and REM sleep time to total sleep time increased while non-REM latency，and ratios of non-REM latency to total sleep time decreased in listening therapy group （P<0.05）．Intergroup comparisons found that three groups showed significant differences in post-intervention ratios of non-REM latency to total sleep time，and REM latency to total sleep time，non-REM sleep time to total sleep time，stage 3 non-REM sleep time to total sleep time，stage 4 non-REM sleep time to total sleep time，and REM sleep time to total sleep time （P<0.05）．Moreover，pre- and post-intervention differences in ratios of non-REM latency to total sleep time，and non-REM sleep time to total sleep time，“slow wave” （stages 3 and 4 non-REM） sleep time to total sleep time，and REM sleep time to total sleep time differed significantly between the groups （P<0.05）．To be specific，music therapy group had a greater pre- and post-intervention difference in ratio of stage 4 non-REM sleep time to total sleep time than the control group ，compared with listening therapy group，pre- and post-intervention differences in ratios of non-REM sleep time to total sleep time，“slow wave” sleep time to total sleep time，and REM sleep time to total sleep time，and pre- and post-intervention difference in non-REM latency were all less in the control group，and they were also less in music therapy group except the latter aspect （P<0.017）．Conclusion　Tomatis listening therapy in combination with conventional nursing can effectively improve the sleep structure and sleep quality in patients with acute cerebral hemorrhage.

Key words: Cerebral hemorrhage, Tomatis auditory training, Sleep structure, Polysomnography, Sleep time

摘要： 背景　脑出血后患者极易发生睡眠-醒觉行为紊乱，延缓预后进程，长期应用药物容易产生耐受性。经Tomatis高-低频转换处理的音乐训练可刺激、丰富人耳和神经系统之间的互联，进而调节睡眠结构。目的　探讨Tomatis高-低频转换听觉训练对急性期脑出血患者睡眠结构的影响。方法　选取2017年7月—2018年7月在华北理工大学附属医院神经外科治疗的138例急性期脑出血睡眠障碍患者为研究对象，并将其按随机数字表法分为对照组、音乐组、听觉训练组，每组46例，对照组实施日常护理，音乐组在日常护理的基础上进行常规音乐训练，听觉训练组在日常护理的基础上进行经处理的Tomatis高-低频转换听觉训练，连续干预14 d，采用多导睡眠监测（PSG）记录数据，比较三组患者干预前后睡眠结构的差异。结果　三组患者干预后非快速动眼睡眠（NREM）潜伏期、快速动眼睡眠（REM）潜伏期、NREM持续时间占总睡眠时间比例、3期睡眠时间占总睡眠时间比例、4期睡眠时间占总睡眠时间比例、REM时间占总睡眠时间比例比较，差异均有统计学意义（P<0.05）。对照组在各个方面与干预前比较，差异均无统计学意义（P>0.05）；音乐组干预后4期睡眠时间占总睡眠时间比例较干预前延长（P<0.05）；听觉训练组干预后总睡眠时间占总记录时间比例、3期睡眠时间占总睡眠时间比例、4期睡眠时间占总睡眠时间比例、REM时间占总睡眠时间比例较干预前延长，NREM潜伏期、NREM持续时间占总睡眠时间比例较干预前减少（P<0.05）。三组患者在NREM潜伏期、NREM持续时间占总睡眠时间比例、慢波睡眠（3期和4期睡眠）时间占总睡眠时间比例、REM时间占总睡眠时间比例差值比较，差异均有统计学意义（P<0.05）。其中音乐组在4期睡眠时间占总睡眠时间比例差值的绝对值高于对照组，听觉训练组在NREM持续时间占总睡眠时间比例、慢波睡眠（3期和4期睡眠）时间占总睡眠时间比例、REM时间占总睡眠时间比例差值的绝对值高于音乐组及对照组，NREM潜伏期差值高于对照组（P<0.017）。结论　Tomatis高-低频转换听觉训练可有效改善脑出血急性期患者的睡眠结构，提高其睡眠质量。

关键词: 脑出血, Tomatis听觉训练, 睡眠结构, 多导睡眠监测, 睡眠时间