帕金森病患者睡眠障碍与认知功能障碍的相关性分析

Correlation analysis of sleep disorder and cognitive dysfunction in patients with Parkinson disease

目的探讨帕金森病(PD)患者睡眠障碍的特点、与认知功能障碍的相关性以及明确睡眠障碍在预测评估PD发生认知功能障碍方面的价值。方法采用帕金森睡眠量表(PDSS)、爱泼沃斯思睡量表(ESS)、匹兹堡睡眠质量指数量表(PSQI)和蒙特利尔量表(Mo CA)分别评估110例早中期原发性PD患者的睡眠状况和认知功能,并详细记录人口学资料和PD患者运动功能的评估状况,同时配合多项神经心理学测试对PD患者的注意和工作记忆、执行能力、语言能力、记忆力以及视空间能力等5大认知领域进行全面系统评价。结果 (1)110例PD患者中98例(89.1%)伴发睡眠障碍,12例(11.9%)睡眠正常。PD睡眠障碍组Mo CA评分和各个分项认知评分均低于PD睡眠正常组,除数字正背和语义流畅性外,余测试结果两组间差异均具有统计学意义(P<0.05);PD睡眠障碍组认知功能障碍的发生率为75.5%,睡眠正常组认知功能障碍的发生率为33.3%,两组认知功能障碍的发生率存在差异,伴有睡眠障碍的PD患者更易出现认知功能障碍(χ2=7.28,P=0.007)。(2)睡眠障碍的Logistic回归分析显示:年龄(OR=1.117,P=0.012)和汉密顿抑郁量表(HAMD)总分(OR=1.304,P=0.006)是PD睡眠障碍发生的危险因素;夜间睡眠时间缩短和性别是日间过度思睡(EDS)发生的危险因素,并且男性比女性出现EDS的危险性大。(3)PD患者中存在认知功能障碍者(Mo CA评分<26分)78例,认知功能正常者评分(Mo CA评分≥26分)32例,认知障碍的发生率为71%。PD认知功能障碍组和PD认知功能正常组的睡眠状况存在差异,PD认知功能障碍组PDSS 3、PDSS 6和PDSS 9的分数明显低于PD认知功能正常组,两组间差异具有统计学意义(均P<0.05);PD认知功能障碍组的RBD的发生率为41%,明显高于PD认知功能正常组(18.8%),组间差异具有统计学意义(P<0.05),对于RLS和EDS的发生率两组间差异无统计学意义(P>0.05)。(4)睡眠紊乱(标准系数-0.340,P值0.001)和睡眠效率(标准系数-0.234,P值0.019)与PD认知功能呈线性负相关。睡眠紊乱和睡眠效率下降能够直接影响PD认知功能。(5)Spearman相关分析显示:PSQI总分及主观睡眠质量、睡眠潜伏期、睡眠效率和睡眠紊乱等睡眠因子分数与各项认知功能评分具有普遍相关性(P<0.05),差异有显著统计学意义;服用睡眠药物与BVMT-R测试呈负相关(P<0.01);白天功能紊乱与霍普金斯词语学习测试有关(P<0.05)。结论 PD患者睡眠障碍与认知功能障碍显著相关,伴有睡眠障碍和RBD的PD患者更易出现认知功能障碍,伴或不伴有认知功能障碍的患者睡眠状况存在差异;睡眠质量差对PD认知功能的各个领域均有影响,而服用睡眠药物和白天功能紊乱则有针对性的影响PD患者的记忆力;夜间睡眠紊乱和睡眠效率下降均能够直接影响PD认知功能。

Objective To explore the characteristics of Parkinson disease(PD) patients with sleep disorders, and the correlation of cognitive dysfunction and definite whether sleep disorder is a new predictor for PD cognitive dysfunction. Methods Using Parkinson Sleep Scale(PDSS), Epworth Sleeping Scale(ESS), Pittsburgh Sleep Quality Index Scale(PSQI) and Montreal Scale respectively to evaluate the sleep status and cognitive functions of 110 primary PD patients. And then detail record the demographic data and motor function's assessment in PD patients. At the same time cooperated with several neuropsychological tests about attention and working memory, executive ability, language ability, memory and visual spatial ability and so on, in order to evaluate the five cognitive areas comprehensively and systematically. Results(1) 98 cases(89.1%) in 110 PD patients were with sleep disorders, 12 cases(11.9%) were normal sleep. The Mo CA score and each test of cognitive scores in PD sleep disorder group were lower than PD sleep normal group, in addition to the numbers front recitation and semantic fluency, the rest tests' results were statistically significantly different between the two groups(P<0.05); In PD sleep disorder group, the incidence of cognitive dysfunction was 75.5%, in sleep normal group, the incidence of cognitive dysfunction was 33.3%, the incidence of cognitive dysfunction between the two groups were different, PD patients with sleep disorders were more likely to appear cognitive dysfunction(χ2=7.28, P=0.007).(2) Logistic regression analysis shew: age(OR 1.117, P=0.012) and HAMD scores(OR 1.304, P=0.006) were risk factors for PD sleep disorders(P<0.05); short sleep time at night and gender were risk factors for EDS, and the men had higher risk than women in EDS.(3) In PD patients 78 cases were with cognitive impairment(Mo CA score<26 points), 32 cases were normal, the incidence of cognitive impairment was 71%. The scores of PDSS 3 keep sleep disorders, PDSS 6 suffer dreams and PDSS 9 urinary incontinence caused by limited mobility in PD cognitive dysfunction group were obvious lower than PD normal cognitive function group, the difference between the two groups was statistically significant. The incidence of RBD in the PD cognitive dysfunction group was 41% that higher than cognitive function normal group, P<0.05, the difference between the two groups was statistically significant, and the incidences of RLS and EDS had no difference between the two groups.(4) The sleep disorders(coefficient-0.340, P=0.001) and sleep efficiency(coefficient-0.234, P=0.019) were linear negative correlation with PD cognitive function. Sleep disorders and sleep inefficiency can affect PD cognitive impairment.(5) The Spearman correlation analysis showed that PSQI total scores and other sleep disorders cores in PD patients had universal correlation with each cognitive function test scores(P<0.05), the differences had obvious statistical significance; Sleep medications had negatively correlated with BVMT-R test(P<0.01); Daytime dysfunction related to Hopkins words learning test(P<0.05). Conclusions Sleep disorders are significantly associated with cognitive dysfunction in PD patients, the PD patients who with sleep disorders are more likely to suffering cognitive dysfunction. There are some differences in manifestations of sleep disorders between PD patients with and without cognitive dysfunction. Poor sleep quality has impacted on all the areas of cognitive function, while sleep medications and daytime dysfunction targeted effect the memory of PD patients; sleep disorders and sleep inefficiency can affect PD cognitive dysfunction.