帕金森病患者睡眠获益现象相关因素分析

Sleep benefit and its correlation factors in Parkinson＇s disease

目的分析帕金森病患者睡眠获益（sleep benefit）现象及相关影响因素。方法纳入2017年2—11月在山东大学齐鲁医院帕金森病与运动障碍诊疗中心门诊就诊的100例帕金森病患者，详细记录其临床资料，并进行临床亚型分组，使用匹兹堡睡眠质量指数量表、帕金森病睡眠量表、Epworth嗜睡量表和快速眼球运动期睡眠障碍筛查量表进行睡眠情况评估。对睡眠获益组和无睡眠获益组两组间一般资料、病程、用药情况、运动症状、睡眠情况及焦虑状况进行比较，应用非条件Logistic回归分析对相关因素进行分析。结果100例帕金森病患者中睡眠获益组51例（51%），无睡眠获益组49例（49%）。睡眠获益组应用左旋多巴等效剂量日总量[LEDD，（354.77±279.64） mg/d]、左旋多巴[（289.04±228.73） mg/d]及多巴胺受体激动剂[（41.13±51.48） mg/d]等效剂量显著低于无睡眠获益组[LEDD（510.76±266.26） mg/d，t＝－2.734, P＝0.006；左旋多巴（392.65±211.20） mg/d，t＝－2.366, P＝0.021；多巴胺受体激动剂（68.01±57.10） mg/d，t＝－1.950, P＝0.054]，应用多巴胺受体激动剂人数比例更低[23例（45.1%）和35例（71.4%），χ2＝7.112，P＝0.008]，夜间睡眠时长明显延长[（6.51±1.31） h和（5.89±1.29） h, t＝2.412, P＝0.018]，且震颤型患者中睡眠获益比例[19/27（70.4%）]高于姿势步态异常型[20/46（43.5%）, χ2＝4.855, P＝0.025]。Logistic回归分析表明，睡眠获益与夜间睡眠时长、震颤型运动亚型呈正相关，与LEDD、左旋多巴用量呈负相关。LEDD（OR＝0.998，95% CI 0.997～1.000，P〈0.05）及夜间睡眠时长（OR＝1.407，95% CI 1.004～1.972，P〈0.05）是睡眠获益的独立相关因素。结论睡眠获益的帕金森病患者左旋多巴服用剂量减少，夜间睡眠时间延长，推测与多巴胺神经元自身储备功能相对完善有关。

ObjectiveTo analyze the phenomenon of sleep benefit in Parkinson′s disease （PD） and its correlation factors. MethodsOne hundred PD patients in Department of Neurology, Qilu Hospital of Shandong University from February 2017 to November 2017 were included. They were recorded in detail the clinical information and clinical classification. Sleep conditions were assessed by Pittsburgh Sleep Quality Index, Parkinson Disease Sleep Scale, Epworth Sleepiness Disorder Scale and Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire. The general information, disease duration, medication, movement function, sleep condition and anxiety status were compared between sleep benefit group and without sleep benefit group. The correlation factors of sleep benefit was evaluated using unconditional Logistic regression analysis.ResultsFifty-one cases （51%） of sleep benefit were determined in our cohort of 100 PD patients. Sleep benefit group adminstered lower levodopa equivalent daily dose （LEDD, （354.77±279.64） mg/d） compared with patients without sleep benefit （（510.76±266.26） mg/d, t=-2.734, P=0.006）, including levodopa （（289.04±228.73） mg/d vs（392.65±211.20）mg/d, t=-2.366, P=0.021） and dopamine agonist dose （（41.13±51.48）mg/d vs（68.01±57.10）mg/d, t=-1.950, P=0.054）. Sleep benefit group had higher percentage of using dopamine agonist （23（45.1%） vs 35（71.4%）, χ2=7.112, P=0.008） and longer duration of nocturnal sleep episode（（6.51±1.31） h vs（5.89±1.29）h, t=2.412, P=0.018）. In addition, sleep benefit had a higher prevalence in tremor-dominant subtype of PD （19/27（70.4%）vs 20/46（43.5%）, χ2=4.855, P=0.025）. Logistic regression indicated that sleep benefit had a positive correlation with duration of nocturnal sleep episode and tremor-dominant subtype, as well as a negative correlation with LEDD and dose of levodopa. LEDD and duration of nocturnal sleep episode were the independent factors of sleep benefit （OR=0.998, 95%CI 0.997-1.000, P〈0.05; OR=1.407, 95%CI 1.004-1.972, P〈0.05）.ConclusionPD patients with sleep benefit administered low dose of dopamine and took long nocturnal sleep, which may relate to the relatively preserved dopamine storage function of dopaminergic neurons.