帕金森病患者睡眠障碍相关因素分析及其对生活质量的影响

Relevant factors of sleep disorders and their influences on the quality of life in patients with Parkinson disease

目的探讨帕金森病(PD)患者伴发睡眠障碍(SD)的特点、影响因素、与运动症状(MS)及非运动症状(NMS)的相关性及其对患者生活质量的影响。方法收集2010年4月至2011年11月就诊于北京天坛医院神经内科的132例PD患者的人口学资料,采用匹兹堡睡眠指数量表(PSQI)、爱泼沃斯瞌睡量表(ESS)评估患者睡眠状况,完成相关MS、NMS及生活质量量表的评定。结果 (1)132例PD患者中86例(65.2%)伴发SD(PSQI评分≥5分),为SD组,PSQI平均分为(9.7±3.9)分;46例(34.8%)不伴发SD(PSQI评分<5分),为NSD组;同时完成ESS量表评定的114例患者中,15例(13.2%)有白天困倦(ESS评分≥10分),ESS平均分为(13.5±3.2)分,99例(86.8%)无白天困倦(ESS评分<10分)。(2)PD患者PSQI量表前三位因子及评测结果分别为白天功能紊乱(1.6±1.0)分,睡眠紊乱(1.3±0.5)分,主观睡眠质量(1.3±0.8)分。(3)SD组和NSD组除受教育水平(P=0.032)外,性别、年龄、起病年龄、病程、起病侧别及临床类型均无显著差异(P>0.05)。(4)SD组和NSD组除了统一帕金森病量表(UPDRS)Ⅲ评分外(P=0.007),H-Y分期、改良Webster评分、剂末现象个数、UPDRSⅣ评分均无显著差异(P>0.05)。(5)SD组NMS个数、运动症状期后NMS个数明显多于NSD组(P=0.000),而运动症状期前NMS无显著差异(P>0.05);SD组眩晕、噩梦、入睡困难、白天思睡、性生活障碍、性冷淡、焦虑、抑郁、淡漠、注意力下降、疼痛及梦游的发生率明显高于NSD组(P<0.05);SD组UPDRSⅠ、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、ESS、自主神经症状量表(SCOPA-AUT)、疲劳量表(FS-14)、疲劳严重度量表(FSS)及不宁腿综合征严重程度评定量表(RLSRS)评分均明显高于NSD组(P<0.05)。(6)SD组UPDRSⅡ、日常生活能力量表(ADL)评分明显高于NSD组(P<0.05);SD组39项帕金森病生活质量问卷(PDQL-39)量表评分明显低于NSD组(P<0.05)。(7)相关分析发现,焦虑、抑郁与PSQI评分的相关性最大(相关系数分别为0.625和0.670),其次是NMS个数、精神症状、不宁腿综合征及自主神经功能紊乱(相关系数分别为0.511、0.480、0.473和0.422);与PD患者ESS评分相关性较大的因素包括自主神经功能紊乱、剂末现象、NMS个数(相关系数分别为0.432、0.399和0.395)。(8)SD对PD生活质量(r=-0.411)及日常生活能力(与UPDRSⅡ及ADL评分的相关系数分别为0.285和0.210)均有显著影响;白天过度睡眠对患者生活质量(r=-0.205)及患者日常生活能力(UPDRSⅡ)(r=0.334)也有显著影响。结论 PD患者白天过度睡眠和SD的发生率高;躯体不适在白天过度睡眠中发挥更大作用,明显降低患者的日常生活能力;情绪障碍可能是导致患者整体睡眠质量不佳的主要因素,显著影响患者的生活质量。

Objective To explore clinical features of sleep disorders and their relationships with motor symptoms(MS),non-motor symptoms(NMS)and quality of life in patients with Parkinson disease(PD).Methods 132 PD patients were recruited and evaluated by Pittsburgh Sleep Quality Index(PSQI),Epworth Sleeping Scale(ESS) and other related scales for MS,NMS and quality of life.Results (1)86 of 132 PD patients(65.2%)were accompanied by sleep disorders(SD)(PSQI≥5),which mean score of PSQI was 9.7±3.9,46 PD patients(34.8%)were not accompanied by SD(NSD)(PSQI<5);among 114 PD patients who also finished the evaluation of ESS,15(13.2%)were accompanied by excessive daytime somnolence(EDS)(ESS≥10),which mean score of ESS was 13.5±3.2,99 patients(86.8%)were not accompanied by EDS(ESS<10);(2)Factors with the highest scores in PSQI were daytime dysfunction 1.6±1.0,which was followed by sleep disturbances 1.3±0.5 and subjective sleep quality 1.3±0.8;(3)SD and NSD groups were not different in gender,age,age at onset,disease duration,which side the disease started,clinical phenotypes except educational level(P=0.032);(4)There were no significant differences between SD and NSD groups in terms of Hohen-Yahr Staging,Modified Webster score,the numbers of wearing-off phenomena,UPDRS Ⅳ score(P>0.05)except The Unified Parkinson Disease Rating Scale(UPDRS)Ⅲ score (P=0.007);(5)The numbers of total NMS,NMS occurred after MS in SD group were significantly more than that in NSD group(P=0.000),the numbers of NMS occurred before MS in SD group were not significantly different from NSD group(P>0.05);the incidences of dizziness,nightmare,difficulty in falling sleep,daytime somnolence,sexual disorders,sexual apathy,anxiety,depression,apathy,attention deficit,pain and dream walking were all significantly higher in SD group than that in NSD group(P<0.05);the scores of UPDRSⅠ,Hamilton Depression Scale,Hamilton Anxiety Scale,ESS,The Scale For Outcomes in PD For Autonomic Symptoms,Fatigue Scale-14,Fatigue Severity Scale and Restless Leg Syndrome Rating Scale were all significantly higher in SD group than that in NSD group(P<0.05);(6)The scores of UPDRSⅡ,Activity of Daily Life were both significantly higher in SD group than that in NSD group(P<0.05);The score of Parkinson′s Disease Quality of Life Questionnaire was significantly lower in SD group than that in NSD group(P<0.05);(7)Correlation analysis showed that anxiety and depression had the closest relationship with the score of PSQI(the correlation coefficient were 0.625 and 0.670),respectively,followed by the numbers of NMS,psychiatric symptoms,restless leg syndrome and autonomic dysfunctions(the correlation coefficient were 0.511,0.480,0.473 and 0.422,respectively);the factors which had close relationships with the score of ESS were autonomic dysfunctions,wearing-off phenomena and the numbers of NMS(the correlation coefficient were 0.432,0.399 and 0.395,respectively);(8)SD group had significant influence on the quality of life(r=-0.411)and activity of daily life in PD patients(the correlation coefficient of UPDRSⅡand ADL were 0.285 and 0.210,respectively);EDS had significant influence on quality of life(r=-0.205)and activity of daily life(UPDRSⅡ)in PD patients(r=0.334).Conclusions PD patients have high incidences of SD and EDS;body discomforts play an important role in the occurrence of EDS and compromise the quality of life in PD patients;Mood disorders may be the main factor which induces the poor sleep quality and also significantly influence the quality of life for PD patients.