不同亚型帕金森患者睡眠障碍的临床特征分析

Clinical characteristics of sleep disorders in different subtypes of patients with Parkinson disease

目的评价不同亚型的原发性帕金森病(PD)患者睡眠质量,分析PD睡眠障碍的临床特点及其相关影响因素。方法选取我院帕金森病专病门诊连续就诊和住院的原发性PD患者共107例,分为震颤为主型(47例)和姿势异常步态障碍(PIGD)为主型(60例),以直接会见方式采用帕金森睡眠量表(PDSS)、爱泼沃斯思睡量表(ESS)、统一帕金森评定量表-运动检查(UPDRSⅢ)、汉密尔顿抑郁量表(HAMD)、简明精神状态量表(MMSE),对其睡眠状况、运动功能、抑郁及认知功能进行评价和分析。结果 PIGD为主型PD患者帕金森睡眠量表总评分(115.72±19.28)显著低于震颤为主型PD患者(125.28±13.68)(P=0.003)。在各项的比较中,两组在夜间睡眠情况(PDSS-1)、入睡困难(PDSS-2)、睡眠维持(PDSS-3)、夜尿情况(PDSS-8)、肢体疼痛(PDSS-12)组间比较差异有统计学意义(P<0.05),其余项无统计学意义(P>0.05)。另外,两组快速动眼睡眠期行为障碍(RBD)比较有显著差异(P=0.014),而两组白天过度嗜睡(EDS)状况比较无统计学意义。多因素Logistic回归显示PIGD为主型PD患者睡眠障碍与UPDRSⅢ、抑郁及左旋多巴日剂量相关,而与H-Y分期、EDS、MMSE、不宁腿综合征(RLS)及病程等无显著相关;震颤为主型PD患者睡眠总质量与H-Y分期及MMSE总分相关,而与其他因素均无明显相关。结论 PIGD为主型较震颤为主型PD患者更易出现睡眠障碍,主要表现为快速动眼睡眠行为障碍、入睡困难、片段睡眠、夜尿症、夜间肢体疼痛等,可能与PD不同亚型的临床异质性相关。

Objective To evaluate the quality of sleep of patients with Parkinson disease (PD) in different subtypes and analyse their clinical characteristics and related factors. Methods 107 consecutive patients with idiopathic PD in our patient-clinic, including 47 patients of tremor-dominant PD subtype and 60 patients of postural instability and gait difficulty-dominant (PIGD) subtype,were participated in subjective evaluation. Face-to-face interview assessments were performed by using Parkinson disease sleep scale (PDSS) & Epworth sleepiness scale (ESS), unified Parkinson disease rating scale (UPDRS), Hamilton Depression Rating Scale (HAMD), and mino-mental state examination (MMSE) to respectively evaluate the sleep quality, movement function,depression and cognition state. Results The total PDSS score in PIGD-dominant subtype was significantly lower than tremor-dominant subtype[(115.72±19.28) vs. (125.28±13.68),P=0.003]. Among these items, there were differences between two subtypes for nighttime sleep state (PDSS-1), difficulties in falling asleep (PDSS-2), fragmented sleep (PDSS-3), incontinence of urine (PDSS-8), pain of limbs (PDSS-12)(P<0.05). Mult-factor logistic showed that sleep disorder of PIGD-dominant PD subtype was related to UPDRSⅢ, HAMD score and daily dose of L-dopa, but not related to duration of disease, EDS, RLS or MMSE score. Tremor-dominant PD subtype was related to H-Y stage and MMSE score, but not related to other factors. Conclusions Sleep disorders are more common in PIGD-dominant PD than tremor-dominant PD, and the main type of sleep disorders was difficulties in falling asleep, fragmented sleep, nocturia and pain of limbs. This may be related to the clinical heterogeneity of different subtypes of PD.