帕金森病伴发睡眠障碍的临床特点 、相关r因素及视频多导睡眠图的变化

摘要

Objective To investigate the clinical characteristics , related factors , changes of video-polysomnography (v-PSG) and its influence on the quality of life in Parkinson disease (PD) patients accompanied with sleep disturbances (SD).Methods Ninety-four patients with PD were enrolled in Beijing Tiantan Hospital from June 2014 to June 2016 , and we recorded the demographic data. The Pittsburgh sleep quality index scale (PSQI) was used to assess the patients' sleep status , according to the evaluation results , patients were divided into PD with SD group (PSQI≥5 , PD-SD group) and PD without SD group (PSQI<5 , PD-NSD group) . PD patients were assessed with unified Parkinson's disease rating scale (UPDRS) Ⅲ ,mini-mental state examination (MMSE) ,Montreal cognitive assessment (MoCA) , Hamilton depression scale (HAMD) , Hamilton anxiety scale (HAMA) ,Epworth Sleeping Scale (ESS) ,fatigue severity scale (FSS) ,UPDRS Ⅱ ,ADL scale ,39 PD quality of life questionnaire and PSQI.We compared the two groups of patients' motor and non-motor symptoms ,quality of life and sleep quality changes.Results (1) Fifty-seven of the 94 PD patients (60.64％ ) were accompanied by SD. (2) There was no significant difference in gender ,age ,education level ,age of onset and course of disease between the PD-SD group and the PD-NSD group (P>0.05) . (3) The PD-SD group and the PD-NSD group were significantly different in subjective sleep quality , sleep latency , sleep time , sleep efficiency ,sleep disorders and daytime dysfunction (all P< 0.01) . (4) The scores of UPDRS Ⅰ and FSS scores were significantly higher in the PD-SD group than those in the PD-NSD group (P< 0.01);HAMD , HAMA and ESS were significantly higher in the PD-SD group than the PD-NSD group (P<0.05) .The scores of UPDRS Ⅱ ,activity of daily life were both significantly higher in the PD-SD group than the PD-NSD group (P<0.05) .The score of Parkinson's Disease Quality of Life Questionnaire was significantly higher in the PD-SD group than the PD-NSD group (P<0.05) . (5) There were 21 SD patients and 11 PD-NSD patients completed v-PSG.Compared with the PD-NSD group ,the total sleep time was significantly decreased (P<0.05) ,the sleep efficiency and the lowest oxygen saturation was significantly lower (P<0.05) in the PD-SD group.Conclusions The incidence of SD was higher in patients with PD ;PD-SD group has more serious sleep disorders and the overall quality of sleep was worse than PD-NSD group. SD could affect other non-motor symptoms in PD patients.%目的 探讨帕金森病(PD)患者伴发睡眠障碍(SD)的临床特点、相关因素、视频多导睡眠图(v-PSG)变化及其对患者生活质量的影响.方法 收集2014-06—2016-06就诊于北京天坛医院老年病科的94例PD患者,记录患者的人口学资料.采用匹茨堡睡眠质量指数量表(PSQI)评估患者的睡眠状况,根据评测结果将患者分为PD伴发SD组(PSQI≥5分,PD-SD组)及未伴发SD组(PSQI<5分,PD-NSD组).对PD患者进行统一帕金森病评分量表第三部分(UPDRS-Ⅲ)、蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、爱泼沃斯思睡量表(ESS)、疲劳严重度量表(FSS)、UPDRSⅡ量表、日常生活能力量表(ADL)、39项PD生活质量问卷(PDQL-39)及PSQI评分检测,比较两组患者运动症状、非运动症状、生活质量以及睡眠质量等变化.结果 (1)94例PD患者中57例(60.64％)存在SD.(2)PD-SD组和PD-NSD组在性别构成、年龄、起病年龄、受教育水平及病程方面比较均无统计学差异(P>0.05).(3)PSQI量表评分结果显示,PD-SD组睡眠质量、睡眠潜伏期、睡眠时间、睡眠效率、SD、使用睡眠药及日间功能障碍评分均较PD-NSD组高(均P<0.01).(4)PD-SD组患者UPDRSⅠ评分、FSS评分、HAMD评分、HAMA评分和ESS评分、UPDRSⅡ评分、ADL评分、PDQL-39评分明显高于PD-NSD组(P<0.05或P<0.01).(5)32例PD患者行v-PSG监测,与PD-NSD组比较,PD-SD组总睡眠时间减少(P<0.05),睡眠效率及最低血氧饱和度降低(均P<0.05).结论 PD患者SD的发生率较高;PD-SD患者SD更严重,整体睡眠质量更差;SD明显影响PD患者其他非运动症状.