慢性肾脏病对帕金森病患者白天过度嗜睡的影响

Effect of chronic kidney disease on excessive daytime sleepiness of patients with Parkinson's disease

目的探讨帕金森病(PD)合并慢性肾脏病(CKD)患者出现白天过度嗜睡(EDS)的临床特征,并评估肾功能对PD患者EDS的影响。方法将60例PD合并CKD患者作为研究对象。根据CKD分期,利用相关量表[爱波沃斯嗜睡量表(ESS)评分等]评估不同肾功能状态PD患者临床特征,探讨肾功能对PD患者EDS的影响。以多元线性回归分析影响PD患者EDS的相关因素,以确定影响EDS的预测因素。结果 PD合并CKD患者白天过度嗜睡各组的人口学资料间差异无统计学意义。合并CKD的PD患者发生EDS率为51.7%。随着患者肾功能下降,ESS评分(F=4.578,P=0.001)、匹茨堡睡眠质量指数(PSQI)评分(F=3.399,P=0.025)、统一PD评定量表Ⅲ(UPDRSⅢ)评分(F=3.745,P=0.015)、统一PD评定量表II(UPDRSII)评分(F=3.244,P=0.030)逐渐升高;多次睡眠潜伏期试验(MSLT)时间逐渐缩短(F=5.672,P=0.001)、每日服用左旋多巴等效剂量(LED)用量逐渐减少(F=5.785,P=0.001),患者的夜间睡眠质量、运动功能、日常生活能力、生活质量均变差。LED剂量与EDS呈正相关,肾功能与EDS呈负相关。结论合并CKD的PD患者伴发EDS常见,其原因不仅与疾病本身的病理改变、睡眠中枢调节机制紊乱有关,也与夜间睡眠质量差和抗帕金森病药物的应用有关。CKD可能是PD患者发生EDS的危险因素。

Objective To study the clinical features of excessive daytime sleepiness （EDS） in patients with Parkinson＇s disease （PD） complicated with chronic kidney disease （CKD）, and assess the effect of renal function on EDS of patients with PD. Methods 60 patients with PD complicated with CKD were enrolled as the subjects. According to the CKD stage, Epworth sleepiness scale （ESS） and other relevant scales were used to assess the clinical features of PD patients in order to evaluate the influence of renal function on EDS of the PD patients. Multiple-variables linear regression was also applied for analyzing factors involved in EDS of PD patients so as to determine the predictive factors influencing EDS. Results Between the groups of PD patients who had EDS complicated with CKD, the differences in demographic data were not statistically significant. The incidence rate of EDS was 51.7% in the PD patients complicated with CKD. With decline of renal function of patients, the ESS score （ F = 4. 578, P = 0. 001 ）, Pittsburgh sleep quaiity index （PSQI） （ F = 3. 399, P = 0. 025 ）, unified Parkinson disease rating scale m （ UPDRS Ⅲ ） score （F=3.745, P=0.015）, and UPDRS Ⅱ score （F=3.244, P=0.030） all increased, while Parkinson disease quality of life questionnaire-39 （PDQL-39） score （ F = 0. 792, P = 0.279）, the multiple sleep latency test （MSLT） time （ F = 5. 672, P = 0. 001 ） , and levodopa equivalents （LDE） （ F = 5. 785, P =0.001 ） gradually reduced; and the patients＇ quality of sleep at night, motor function, ability of daily life, and quality of life were also reduced accordingly. Conclusion EDS was common in PD patients complicated with CKD, which was not only related with pathological changes of the disease itself and disorders of the sleep centre regulation, but also with the poor quality of sleep at night as well as application of the anti-PD drugs. CKD may be a risk factor for EDS of PD patients.