老年痴呆与睡眠障碍的相关性研究

Correlative study about sleep disorders of elderly patients with dementia

目的探讨不同程度老年痴呆与睡眠障碍的相关性。方法回顾性分析2014年1月~2015年12月在南京医科大学第二附属医院睡眠障碍门诊就诊的176例老年患者临床资料,依据就诊时MMSE痴呆量表评分分为对照1组(≥27分,45例)、轻度1组(19~26分,42例)、中度1组(10~18分,44例)和重度1组(≤9分,45例)。为消除老年常见病对痴呆的影响,将其中无老年常见病的87例患者另分为4组:对照2组(≥27分,22例)、轻度2组(19~26分,21例)、中度2组(10~18分,23例)、重度2组(≤9分,21例)。采用整夜多导睡眠图(PSG)监测分析不同程度痴呆以及有无老年常见疾病与睡眠结构之间的关系。结果轻度1组的快速动眼睡眠(REM)、睡眠效率(SE)高低于对照1组,差异有统计学意义(P<0.05);中度1组的睡眠潜伏期(SL)高于对照1组,REM、SE低于对照1组,SL高于轻度1组,SE低于轻度1组,差异有统计学意义(P<0.05);重度1组的SL高于对照1组和轻度1组,REM、SE低于对照1组、轻度1组和中度1组,REM、SE低于中度1组,差异有统计学意义(P<0.05)。轻度2组的REM、SE低于对照2组,差异有统计学意义(P<0.05);中度2组的SL高于对照2组,REM、总睡眠时间(TST)、SE均低于对照2组,SL高于轻度2组,TST、SE低于轻度2组,差异有统计学意义(P<0.05);重度2组的SL高于对照2组和轻度2组,REM、TST、SE均低于对照2组和轻度2组,REM、SE低于中度2组,差异均有统计学意义(P<0.05)。结论老年痴呆患者存在明显的睡眠质量下降,痴呆越严重,睡眠质量越差,PSG可作为常规评定痴呆进程及发展的辅助指标。

Objective To explore the correlation between sleep disorders of elderly patients and different levels of dementia. Methods From January 2014 to December 2015, a total of 176 elderly patients were selected in the sleep disorder clinic, the Second Affiliated Hospital of Nanjing Medical University as research objects and divided into the group 1 control（scores≥27, n = 45）, group 1 mild（scores 19-26, n = 42）, group 1 moderate（scores 10-18, n = 44）and group 1 severe（scores≤9, n = 45） according to the mini-mental state examination（MMSE）. To eliminate the effect of elderly common diseases to dementia, the patients without the elderly common diseases were also divided into 4 groups：group 2 control（scores ≥27, n = 22）, group 2 mild（scores 19-26, n = 21）, group 2 moderate（scores ≥10-18,n = 23） and group 2 severe（scores ≤9, n = 21）. The relationship between different levels of dementia and sleep structure was analyzed by overnight polysomnography（PSG） monitoring. Results rapid eye movement（REM）, sleep efficiency（SE）of the group 1 mild were lower than those of the group 1 control,with statistically significant difference（P〈0.05）;SL（sleep latency） in the group 1 moderate was higher than those of the group 1 control, REM, SE in the group 1 moderate were lower than those of group 1 control,while SL was higher and SE was lower in the group 1 moderate than those of group1 mild,with statistically significant differences（P〈0.05）; SL in group 1 severe was higher than those in group 1 control and group 1 mild, REM and SE in group 1 severe were significantly lower than those in group 1 control, group 1 mild and group 1 moderate, with statistically significant differences（P〈0.05）. REM and SE in group 2 mild were lower than those of group 2 control, with statistically significant differences（P〈0.05）; SL in group 2 moderate was higher than that in group 2 control, REM, total sleep time（TST） and SE in group 2 moderate were lower than those in group 2 control,SL was higher than that in group 2 mild, TST, SE were lower than those i n group 2 mild, with statistically significant differences（P〈0.05）; SL in group 2 severe was higher than those in group 2 control and group 2 mild, REM, TST and SE in group 2 severe were signi-ficantly lower than those in group 2 control and group 2 mild, REM, SE were lower than group 2 moderate, with statistically significant differences（P〈0.05）. Conclusion The elderly patients with dementia have a significant decline in sleep quality. The more severe the dementia was, the worse the quality of sleep was. PSG monitoring is useful for patients no matter whether they have common diseases of the elderly or not. Therefore, PSG can be used as a supplementary indicator to assess the process and development of dementia.