基于量表的帕金森病睡眠障碍的发生率及临床特点分析

Analysis of the incidence and clinical features of sleep disorders in patients with Parkinson’s disease

目的探讨PD病人睡眠障碍(SD)的发生率、临床特点及相关因素。方法收集南京医科大学附属脑科医院253例在门诊就诊的PD病人基本信息和临床资料,以匹兹堡睡眠质量指数(PSQI)7分为界将病人分为睡眠障碍(SD)组和非睡眠障碍(NSD)组。采用多种PD相关量表对病人临床特点、相关因素进行评估。结果(1)PD病人SD发生率为65.22%。(2)SD组病人的病程、统一帕金森病评分量表第三部分(UPDRS-Ⅲ)、Hoehn-Yahr(H-Y)分级、左旋多巴等效剂量(LED)、汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、39项生活质量调查问卷(PDQ39)评分显著高于NSD组,MMSE评分、MoCA评分显著低于NSD组(均P<0.05)。SD组病人更易出现疼痛、兴趣减退、情绪低落、焦虑、注意力下降、头晕乏力、夜尿增多症状(P<0.05)。(3)PD病人PSQI评分与年龄、病程、临床表型、LED、H-Y分级、UPDRS-Ⅲ评分、HAMD评分、HAMA评分、PDQ39评分呈正相关(r=0.164、0.171、0.177、0.191、0.336、0.310、0.470、0.359、0.429,P<0.05),与MMSE评分、MoCA评分呈负相关(r=-0.271、-0.225,P<0.05)。结论PD病人SD发生率较高,存在SD的PD病人可能伴有更多的非运动症状和更严重的情绪障碍及认知功能损害,生活质量更差。

Objective To analyze the incidence,clinical characteristics and related factors of sleep disorders(SD)in the patients with Parkinson’s disease(PD).Methods A total of 253 cases of PD outpatients from the Affiliated Brain Hospital of Nanjing Medical University were collected as the research subjects.The basic information and clinical data of the patients were collected.According to the evaluation results of Pittsburgh sleep quality index(PSQI),the patients were classified into sleep disorder group(SD)and non-sleep disorder group(NSD).The third part of the unified Parkinson’s disease rating scale(UPDRSⅢ),Hoehn-Yahr(H-Y)classification,Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),Mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),Parkinson’s disease non-sports questionnaire(NMS-Quest)and 39 PD quality of life questionnaire(PDQ39)were used to evaluate patients’situation.Results The incidence rate of SD in the PD patients was 65.22%.The course of disease,H-Y classification,the level of LED,and the scores of UPDRSⅢ,HAMD,HAMA and PDQ39 of SD group were significantly higher than those of NSD group(P<0.05),while the scores of MMSE and MoCA were significantly lower than those of NSD group(P<0.05).The patients in SD group were more likely to have pain,decreased interest,depression,anxiety,decreased attention,dizziness and nocturia compared to NSD group(P<0.05).PSQI score was positively correlated with age,disease duration,clinical phenotype,LED,H-Y stage,and the scores of UPDRSⅢ,HAMD,HAMA and PDQ 39(r=0.164,0.171,0.177,0.191,0.336,0.310,0.470,0.359,0.429,P<0.05),and negatively correlated with the scores of MMSE and MoCA(r=-0.271,-0.225,P<0.05).Conclusions The incidence of SD is high in the PD patients.The PD patients with SD may have more non-motor symptoms,more severe mood disorders and cognitive impairment,and worse quality of life.