帕金森病患者睡眠障碍的研究

Study of sleep disorder in patients with Parkinson disease

目的研究帕金森病(PD)患者睡眠障碍的临床特点、睡眠结构及影响因素。方法应用PD睡眠量表(PDSS)和多导睡眠图记录仪(PSG)对40例PD患者(PD组)和42名健康对照者(正常对照组)的睡眠质量进行评估,并分析PD组睡眠结构紊乱与年龄、病程、Hoehn-Yahr(H-Y,修正)分级及美多芭剂量的关系。结果 PD组睡眠障碍共27例(67.5%),明显多于正常对照组(12例,28.6%)(P<0.05)。PD组睡眠障碍的主要类型为入睡困难、早醒、片断睡眠、不宁腿综合征、日间打盹、梦魇等;睡眠障碍的主要形式为非快动眼睡眠期(NREM)1期睡眠与3+4期睡眠减少。PD组中H-Y分级3～5级的患者睡眠障碍的发生率(87.5%)明显高于H-Y分级0～2级的患者(37.5%)(P<0.01)。与正常对照组比较,PD组患者总睡眠时间(TST)、睡眠效率(SE)、快动眼睡眠时间(REMS)明显降低,而睡眠潜伏期(SL)、觉醒指数(AI)、REM期睡眠潜伏期(RL)明显增高(P<0.05～0.001)。PD组患者以上各睡眠指标均与年龄不相关,而均与病程、H-Y分级、美多芭剂量不同程度相关(P<0.05～0.01)。结论多数PD患者存在睡眠结构异常,表现为SE下降、SL延长、TST减少及觉醒次数增加等,其与病程、H-Y分级和美多芭剂量相关。

Objective To study the clinical features,sleep structures and influential factors of sleep disorder in patients with Parkinson disease （PD） . Methods The sleep quality of 40 PD patients （PD group） and 42 healthy controls （normal control group） were detected by PD sleep scale （PDSS） and polysomnography （PSG） . And the relationships between the disorder of sleep structure and age,course of disease,Hoehn-Yahr （H-Y,revised ） grading,dose of Madopar were analyzed. Results There were 27 patients （67. 5% ） with sleep disorder in PD group,which was significantly more than normal control group （12 cases,28. 6% ） （P 0. 05） . In the PD group, there were several kinds of sleep disorder including difficulty falling sleep,early awake,partly sleep,restless legs syndrome,nap at day,nightmare,et al. The main form of sleep disorder in PD group was the decrease of 1sleep period and 3 ＋ 4 sleep period of non-rapid eye movement （NREM） . And in the PD group,the incidence of sleep disorder in patients with H-Y grading 3 - 5 （87. 5% ） was significantly higher than in patients with H-Y grading 0 - 2 （37. 5% ） （P 0. 01） . Compared with normal control group,the total sleep time （TST） ,sleep efficiency （SE） and rapid eye movement sleep time （REMS） were obviously decreased,and the sleep latency,awakening index （AI） and REM sleep latency （RL） were obviously increased （P 0. 05 - 0. 001） . All the above sleep indexes were not correlated with patients’age,but correlated with their course of disease,H-Y （revised） grading and dose of Madopar in PD group （P 0. 05 - 0. 01） . Conclusions Most PD patients get abnormal sleep structure,which shows decreased SE,prolonged SL,less TST and increased awakening times. And it is correlated with course of disease, H-Y （revised） grading and dose of Madopar.