RBD患者的睡眠结构及其号隋绪状态、自主神经功能症状、睡眠质量的相关性

Sleep structure of rapid eye movement sleep disorder patients and its correlations with emotional state, autonomic nerve symptom and sleep quality

目的探讨快速眼动期睡眠障碍（RBD）患者的睡眠结构，并进一步分析其与患者情绪状态、自主神经功能症状、睡眠质量的相关性。方法选取自2014年10月至2016年5月于天津医科大学总医院神经内科门诊就诊、主诉存在睡眠行为异常并经视频-多导睡眠图（v-PSG）检查确诊的22例RBD患者为病例组．募集性别、年龄、文化水平相匹配并经v-PSG检查排除RBD诊断的23例健康成人为对照组。对2组研究对象进行v-PSG监测，并应用流调用抑郁自评量表（CES—D）及淡漠症状评定量表（AES）、帕金森病患者自主神经功能症状评定量表（SCOPA-AUT）、帕金森病患者睡眠状况评定量表（SCOPA-SLEEP）进行情绪状态、自主神经功能症状、睡眠质量评估。采用统计学方法，分析病例组与对照组间睡眠结构及周期性腿动指数（PLMI）、呼吸暂停-低通气指数（AHI）、觉醒指数等相关参数的差异，分析病例组与对照组间情绪状态、自主神经功能症状、睡眠质量等量表评分的差异，分析病例组情绪状态、自主神经功能症状、睡眠质量等量表评分与睡眠结构的相关性。结果与对照组相比，病例组非快速眼动期（NREM）-Ⅰ期睡眠增多，NREM-Ⅱ、NREM-Ⅲ期睡眠减少，PLMI增高，CES-D评分增高，SCOPA-AUT量表中消化系统、泌尿系统症状评分及总分增高，差异均有统计学意义（P〈0．05）。病例组CES—D评分与NREM—Ⅰ期睡眠所占睡眠结构的百分比呈显著正相关关系（r=0.520，P=-0．000），SCOPA-SLEEP量表中夜间失眠（SLEEP-N）评分及总分（SLEEP-T）与PLMI呈显著正相关关系（r=0．465，P=-0．029；r=0．444，P=0．039），SCOPA-SLEEP量表中日间嗜睡（SLEEP-D）评分与NREM-Ⅲ期睡眠所占睡眠结构的百分比呈显著负相关关系（r=-0．480，P=0．041），SCOPA-AUT量表中心血管系统症状评分与PLMI呈显著正相关关系（r=0．439，p=-0．041）。结论RBD患者客观存在睡眠结构紊乱，PLMI增加，及容易合并抑郁情绪，以及存在消化、泌尿系统等自主神经功能受损症状。RBD患者的心血管系统症状、夜间睡眠问题的发生与PLMI有关。抑郁情绪的出现或与NREM—Ⅰ期睡眠延长造成的神经递质紊乱尤其是5-羟色胺减少有关。日间嗜睡与NREM-Ⅲ期睡眠缩短相关。

Objective To evaluate the sleep structure of rapid eye movement sleep disorder （RBD） patients and its correlations with emotional state, autonomic nerve system function symptoms, and sleep quality. Methods Twenty-two RBD patients examined in our hospital from October 2014 to May 2016 who complained of behavior disorders and conformed diagnosis by video-polysomnography （v-PSG） were chosen as RBD group; 23 healthy gender, age and education-level matched subjects confirmed without RBD by v-PSG were selected as control group. Their emotional state, autonomic nerve function and sleep quality were assessed by center for epidemiological survey depression scale （CES-D）, apathy evaluation scale （AES）, scale for outcomes in PD for autonomic symptoms （SCOPA-AUT）, and scale for outcomes in PD for sleep （SCOPA-SLEEP）. The differences in sleep structures, periodic leg movement index （PLMI）, apnea hypopnea index （AHI） and arousal index between RBD group and control group were compared. The differences of scores of emotional state, autonomic nerve system function symptoms were compared between the two groups. The correlations of sleep structure with emotional state, autonomic nerve system function symptom, and sleep quality in RBD group were analyzed. Results As compared with those of the control group, the proportion of non-rapid eye movement （NREM）-I sleep of RBD group was significantly increased, proportions of NREM-II sleep and NREM-II/ sleep were statistically reduced, PLMI, CES-D scores, urinary and digestive system questionnaire and overall scores in the RBD group were significantly increased （P〈0.05）. In patients from RBD group, CES-D scores were positively correlated with proportion of NREM-I sleep （r=0.520, P=-0.000）; nighttime sleepiness questionnaire and overall scores were positively correlated with PLMI （r=0.465, P=0.029; r=0.444, P=-0.039）; daytime sleepiness scores were negatively correlated with proportion of NREM-III sleep （r=-0.480, P=-0.041）; cardiovascular system symptom was correlated with PLMI （r=0.439, P=0.041）. Conclusion RBD patients suffer sleep structure disturbance, depression tendency, digestive and urinary system of autonomic nerve symptoms; sleep quality scores and total scores, cardiovascular system symptoms scores are positively correlated with LMI; daytime sleepiness is negatively correlated with reducing phase III sleep, CES-D scores are correlated with increasing NREM-I sleep and unbalanced neurotransmitter, especially, 5-TH level.