帕金森病患者睡眠障碍情况3年半随访研究

Sleep disorders in a three and a half years survey of Parkinson's disease patients

目的随访观察帕金森病(PD)患者睡眠障碍情况的发生、发展及变化及相关因素。方法应用PD睡眠量表(PDSS)、统一PD评定量表第Ⅱ、Ⅲ部分(UPDRSⅡ、Ⅲ)、PD非运动症状(NMS)筛查问卷(NMSQ)、汉密尔顿抑郁及焦虑量表(HAMD及HAMA)、MMSE和蒙特利尔认知测验(Mo CA)等量表,在基线和3年半随访末对106例原发性PD患者的睡眠情况、日常生活能力、运动症状、抑郁、焦虑情绪及认知能力等方面进行评估,同时计算患者每日左旋多巴等效剂量(LED)。结果与基线(124.18±14.31)比较,患者PDSS总分在随访末(113.90±23.98)时明显下降(P<0.001),其中梦境困扰、夜尿及白天过度嗜睡均明显降低(均P<0.01)。随着疾病进展,PD患者睡眠障碍发生率在随访末时(77.08%)较基线时(53.77%)明显上升(P=0.001),失眠(包括入睡困难及保持睡眠困难)、肢体不安及不宁腿、梦境困扰、夜尿、白天过度嗜睡、震颤、肌肉痛性痉挛在随访中均明显升高(均P<0.05)。多元线性回归分析显示,PD患者睡眠障碍与其年龄、UPDRSⅡ及Ⅲ、NMS、HAMD及HAMA评分和每日LED相关,而与MMSE、MOCA评分及病程长短等无关。结论PD患者睡眠障碍发生率高、表现类型多样,随着年龄增长、疾病进展逐渐加重,合并较多NMS、日常生活能力及运动症状严重及伴有抑郁、焦虑情绪的患者多存在睡眠障碍。

Objective To explore the development,progression and change of sleep disorders in Parkinson＇s disease（ PD） patients and its related factors. Methods One hundred and six consecutive patients with idiopathic PD were involved in this survey at baseline and 3. 5 years follow-up. Parkinson＇s disease sleep scale（ PDSS）,unified Parkinson＇s Disease Rating Scale（ UPDRS） part Ⅱ Ⅲ,non-motor Symptoms Questionnaire scale（ NMSQ）,Hamilton Depression Anxiety Rating Scales（ HAMD HAMA）,MMSE and Montreal cognitive assessment（ MOCA） were used to assess the sleep quality,activity of daily life,motor symptoms,depression,anxiety and cognitive function of PD patients,and levodopa equivalent dose（ LED） was calculated as well. Results Compared with baseline（ 124. 18 ± 14. 31）,the PDSS total score at 3. 5 years follow-up（ 113. 90 ± 23. 98） was significantly reduced（ P〈0. 001）,and there were also significant reduced in nightmares,nocturia and excessive daytime sleepiness among the fifteen items（ all P〈0. 01）. The incidence of sleep dysfunction at follow-up in PD patients（ 77. 08%） was significantly higher than that at baseline（ 53. 77%）（ P = 0. 001）. The prevalence of insomnia（ including difficulty in initiating and maintaining sleep）,periodic limb movement disorder and restless legs syndrome,nightmares nocturia,excessive daytime sleepiness,tremor and painful muscle cramps significantly increased during the follow-up（ all P〈0. 05）. The multiple stepwise linear regression analyses showed that the sleep disorders of PD patients were correlated with the scores of UPDRS Ⅱ Ⅲ,NMS,HAMD,HAMA,age,and LED per day,independent of scores of MMSE and MOCA and the course of disease. Conclusions Sleep disorders in PD patients are of high incidence and have various types of manifestions,and also aggravate over time with age growing. Those PD patients with more NMS,serious activities of daily life and motor symptoms,and with moods of depression and anxiety may have more possibilities to suffer from sleep dysfunction.