早期帕金森病患者多巴胺能药物与夜间睡眠的相关性探讨

Clinical study of correlation between dopaminergic medications and nocturnal sleep in patients with early-stage Parkinson's disease

目的探索帕金森病(PD)患者多巴胺能药物与夜间主观和客观睡眠之间的关系。方法收集本院2010年10月至2013年6月门诊诊疗的帕金森病患者的人口学特征和疾病信息,所有患者行整夜视频多导睡眠图、完成PD睡眠量表(SCOPA-SLEEP),采集用药信息,包括服药与就寝时间,转化为左旋多巴当量。结果共有41例男性、20例女性患者纳入研究,中位年龄63.6岁,中位病程5年。经过年龄、性别、疾病严重程度和病程校正,更高的左旋多巴等效剂量(LED4H)与更高的SCOPA-NS(P<0.05)及入睡后觉醒时间(P<0.05)相关。更高剂量就寝前多巴胺能药物摄入与快速动眼(REM)睡眠时间百分比减少相关(P<0.05)。结论就寝前服用更高剂量多巴胺能药物与更少的REM睡眠及更差的睡眠质量相关。尽管PD患者睡眠质量不佳由多种因素引起,但仍建议将睡前服药剂量和时间纳入帕金森病患者管理当中。

Objective To explore the correlation between dopaminergic medications and subjective and objective nocturnal sleep in patients with Parkinson＇s disease （PD）. Methods Patients with PD were reernited from the outpatient clinic in our hospital from September 2010 to June 2013, whose demographic characteristics and disease information were collected. All patients underwent one-night polysonmography and responded to SCOPA-SLEEP. Medication intake information including medication time and bedtime were obtained and converted to levodopa equiva- lents. Results 41 males patients and 20 females patients were enrolled in this study, whose median age was 63.6 years and the median duration of disease was 5 years. After the adjusting for age, sex, disease severity and disease du- ration, greater total levodopa equivalent intake within 411 was correlated to higher total SCOPA-nighttime score （P〈 0.05） and greater wake time after sleep onset （P〈0.05）. Greater dopaminergic medication intake prior to sleep was also correlated to less percentage of rapid eye movement （REM） sleep in total sleep time （P〈0.05）. Conclusion Higher doses of dopaminergie medications intake prior to sleep were correlated to worse sleep quality and less REM sleep. Although poor nocturnal sleep in patients with PD is multi-factorial in etiology, our findings suggest that timing and dos- es of medications prior to sleep need to be considered in the management of patients with PD.