临床异质性的早期帕金森病患者睡眠障碍分析

Assessmenof sleep disturbance based on the clinical heterogeneity of early-stage idiopathiParkinson＇sdisease

目的评估不同临床亚型的早期帕金森病（PD）患者的睡眠状况。方法基于PD患者一系列的运动及非运动临床表现，包括震颤、强直、少动、姿势步态异常、淡漠、抑郁、认知障碍等，以及基本人口学资料，如年龄、性别、发病年龄、病程等，采用聚类分析的统计学方法对486例早期原发性PD患者进行分型。亚型1（各种临床表现均轻，且运动表现以震颤为主）；亚型2（各种运动及非运动症状均最重）；亚型3（临床症状严重程度介于亚型1和2之间）；亚型4（病程短、疾病进展速度快为特征）。进一步应用匹兹堡睡眠质量指数（PSQI）对不同亚型的PD患者进行睡眠质量评测。结果48．6％（PSQI评分≥7分患者236例）的早期PD患者存在睡眠障碍，其中女性PD患者睡眠障碍发生率为55．1％（130／236），男性发生率为44．9％（106／236），早期PD患者中女性比男性更易发生睡眠障碍。不同亚型间患者PSQl分值[（亚型1（6．09±3．72）分、亚型2（9．36±4．24）分、亚型3（7．82±4．35）分、亚型4（9．09±4．73）分]差异有统计学意义（F=14．503，P=0．000）。结论睡眠障碍是早期PD患者常见的非运动症状，睡眠障碍存在临床异质性。

Objective To assesthe sleep disturbance in patientwith early-stage idiopathiParkinson＇ disease of differenclinical subgroups. MethodFouhundred and eighty-six Chinese PD patientwere selected aousubjects. Theiclinical datincluding demographics, broad spectrum of motovariableand non motofeatures, including tremor, rigidity, hypokinesia, PIGD, motophenotypcs, disease progression, fatigue, constipation, apathy, depression, global cognitive function and L-dopcomplicationwere collected and analyzed by clusteanalysis. The PD subtypewere classified by using k-meanclusteanalysiaccording to the clinical data. The clusteanalysiindicated foumain subtype： subtype 1 wamildly affected in all domain; subtype 2 waseverely affected on all motoand non motosymptoms;subtype 3 showed intermediate severity in mosdomains;subtype 4 characterized by shordisease duration and rapid disease progression. Then compared the sleep disturbance among differensubtypewith Pittsburgh Sleep Quality Index （PSQI）. ResultTwo hundred and thirty-six cases（48. 6% ） were identified asuffering from sleep disturbance. Of which,female PD with sleep disturbance rate wa55. 1% （130/236） and male wa44. 9% （106/236）. Female waprone to develop sleep disturbance aearly stage than male. PSQI scorein subtype 1,2,3 and 4 were （6. 09 ± 3.72）, （9. 36 ±4. 24）, （7. 82 ±4. 35） and （ 9. 09 ± 4. 73 ） respectively and the difference wasignifican（ F = 14. 503, P = 0. 000） Conclusion Sleep disturbance occurfrequently in patientwith early-stage Parkinson＇disease and exisclinical heterogeneity.