帕金森病睡眠障碍及影响因素研究

Analysis of Sleep Disorder in Patients with Parkinson's Disease

目的:观察帕金森病(PD)睡眠障碍发生情况,分析其影响因素和可能的原因。方法:采用帕金森睡眠评分量表(Parkinson’sdiseasesleepscale,PDSS)、改良Weber、Hoehn-Yahr(H-Y)分期、UPDRSⅢ和Hamilton抑郁量表、日常生活能力(ADL)量表以及简明精神状态量表(MMSE)分别对PD患者的睡眠、病情严重程度、运动功能和抑郁程度、生活能力以及认知功能进行评定,并计算每日服用左旋多巴及吡贝地尔的剂量。结果:50例PD患者中48例(96%)发生睡眠障碍,其中白天过度困倦72·9%,失眠62·5%,多恶梦58·3%,睡眠破碎58·3%,早醒50·0%,幻觉18·8%。经分析PD患者睡眠总质量与UPDRSⅢ“关”期评分、H-Y分期、改良Weber、ADL评分,HAMILTON抑郁量表评分、MMSE评分以及患者年龄、左旋多巴和吡贝地尔每日剂量相关,与病程长短无关。结论:PD患者睡眠障碍较为常见,主要表现为白天过度困倦、失眠、多恶梦、睡眠破碎和早醒等;其程度与年龄、抑郁、病情严重度及多巴胺能药物剂量有关,与病程长短无关。

Aim： To observe the occurrence and the characteristic of sleep disorder in Parkinson＇ s disease, and investigate the influential factors related to it. Methods：Sleep disorder was evaluated by Parkinson＇ s Disease Sleep Scale （PDSS）, disease severity by Hoehn-Yahr stages and improved Weber scores, the movement functions by UPDRS, the level of depression by Hamilton rating scales（24 items）, the capability of life by ADL（activity daily life）, the cognition by MMSE, both the daily dosage of L-dopa and Piribedil were calculated. Results： Sleep disorder were seen in 48 （96%） PD patients; these were： excessive day time sleepiness in 72.9%, insomnia in 62.5%, nightmares in 58.3%, sleep early in 50.0% and hallucination in 18.8% of PD patients. Using stepwise liner regression fragmentation in 58.3 %, waking and partial correlation, we found that the level of sleep disorder negatively correlated with Hamilton rating scales, the daily dosage of Piribediland L-dopa, ADL, improved Weber scores, the off period scores of UPDRS Ⅲ and Hoehn-Yahr, age and MMSE, independent of the course of disease. Conclusion： Sleep disorder is very common in Parkinson＇ s disease and the main type is excessive daytime sleepiness （EDS）, insomnia in the second place. The level of sleep disorder was associated with the age, disease severity, depression and the dosage of dopamine, but independent of the course of disease.