伴有睡眠障碍帕金森病患者的睡眠特征及其影响因素

Clinical characteristics and influencing factors of sleep disorders in patients with Parkinson's disease

目的探讨伴有睡眠障碍帕金森病(PD)患者的睡眠特征及其影响因素。方法根据《国际睡眠疾病分类第3版》诊断标准、帕金森病睡眠量表(PDSS)、失眠严重程度指数量表(ISI)、Epworth嗜睡量表(ESS)得分及多导睡眠监测图(PSG)结果,选取PD伴睡眠障碍患者(PD-SD组)50例、不伴睡眠障碍患者(PD-NSD组)50例。对两组行Hoehn-Yahr(H-Y)分级评分,同时检测血清超敏C反应蛋白(hs-CRP)、血清铁(SI)、铁蛋白(SF)、转铁蛋白(TRF)的水平,分析两组之间各指标的差异和相关性。结果 PD-SD组PDSS得分、总睡眠时间、睡眠效率(SE)、REM期比例、N2期比例、N3期比例和SI的水平均低于PD-NSD组(P<0.05),ESS、ISI得分、病程、总觉醒时间,睡眠潜伏期(SL)、N1期比例、睡眠呼吸暂停低通气指数(AHI)、周期性肢体运动指数(PLMI)、hs-CRP和TRF的水平均高于PD-NSD组(P<0.05)。逐步多元线性回归方程结果示,SI的水平影响PDSS和ESS量表得分;hs-CRP水平影响ISI量表得分。结论伴有睡眠障碍PD患者睡眠特征表现为睡眠结构紊乱、睡眠质量下降、失眠严重和白天嗜睡,且伴有睡眠呼吸障碍及睡眠行为异常和异态睡眠。伴有睡眠障碍PD患者其睡眠障碍的发生可能与炎症反应和铁代谢异常有关。

Objective To investigate the characteristics and influencing factors of sleep disorders （SD） in patients with Parkinson＇s disease （PD）. Methods A total of 50 PD patients with SD （PD-SD group） and 50 PD patients without SD （ PD-NSD group） were included, according to the diagnostic criteria of The Third Edition of the International Clas- sification of Sleep Disorders, Parkinson Disease Sleep Scale （PDSS）, Insomnia Severity Index （ISI）, Epworth Sleepi- ness Scale （ESS） and polysomnography （PSG）. The Hoehn-Yahr （H-Y） score was graded. The levels of serum high- sensitivity C-reactive protein （hs-CRP）, serum iron （ SI）, serum ferritin （SF） and transferring （TRF） were detected and analyzed between the two groups. Results Comparied with PD-NSD group, the PDSS score, total sleep time, sleep efficiency （SE）, proportion of rapid eye movement （REM） stage, non-rapid eye movement （NREM） stage 2, NREM stage 3, and SI were shorter or lower in the PD-SD group （P〈0.05） ; the ESS score, ISI score, course of dis- ease, total arousal time, sleep latency （SL）, proportion of NREM stage 1, apnea-hypopnea index （AHI）, periodic limb movement index （PLMI）, hs-CRP and TRF were longer or higher in the PD-SD group （P〈0.05）. Multiple step- wise analysis showed that the IS level influenced the PDSS and ESS scores, and the hs-CRP level influenced the ISI score. Conclusion Sleep disturbances in PD-SD patients are characterized by disordered sleep structure, decreased sleep quality, severe insomnia, daytime sleepiness, respiratory disorder during sleep, abnormal sleep behaviors and pa- rasomnias. The sleep disorders of PD-SD patients may involve inflammatory reaction and iron metabolism disturbance.