帕金森病日间嗜睡与冻结步态的相关性分析

Association of excessive daytime sleepiness and freezing of gait in Parkinson′s disease

目的探讨帕金森病患者日间嗜睡与发生冻结步态之间的相关性。方法收集2017年8月至2018年1月上海交通大学医学院附属新华医院神经内科门诊或住院部的帕金森病患者136例,其中有冻结步态患者50例,无冻结步态患者86例,将86例非冻结步态患者根据其有无日间嗜睡分为日间嗜睡组(14例)及非日间嗜睡组(72例),并进行18个月的随访,采用Cox回归分析方法分析日间嗜睡与冻结步态之间的相关性。结果与非冻结步态帕金森病患者相比,有冻结步态患者的睡眠更差,其中伴有日间嗜睡的患者的比例更高[40%(20/50)比16%(14/86),x^(2)=9.49,P=0.002],差异具有统计学意义。在完成随访的46例患者中,日间嗜睡组冻结步态的发生率显著高于非日间嗜睡组[6/7比21%(8/39),x^(2)=9.04,P=0.003]。Cox回归分析结果提示日间嗜睡(HR=8.03,95%CI 2.58~24.99,P<0.01)和高每日左旋多巴等效剂量(HR=5.92,95%CI 1.95~17.93,P=0.002)与冻结步态的发生显著相关。结论日间嗜睡及高每日左旋多巴等效剂量可能是帕金森病患者未来发生冻结步态的危险因素。

Objective To investigate the relationship between excessive daytime sleepiness and freezing of gait in Parkinson′s disease(PD).Methods A total of 136 participants with PD were consecutively recruited between August 2017 and January 2018 at the Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.The patients were divided into freezers with 50 patients and nonfreezers with 86 patients.The clinical characteristics of freezers and nonfreezers in PD patients were assessed.In the longitudinal study,a cohort of nonfreezers with 86 patients at baseline clinical visit for a maximum of 18 months were prospectively followed.The patients were divided into the excessive daytime sleepiness group(n=14)and the non-excessive daytime sleepiness group(n=72).Then a Cox regression analysis was performed to further investigate the relationship between excessive daytime sleepiness and freezing of gait in PD,and explore risk factors for freezing of gait.Results The freezers had significantly worse sleep compared with the nonfreezers.The proportion of patients with excessive daytime sleepiness in freezers was higher than nonfreezers[40%(20/50)vs 16%(14/86),x^(2)=9.49,P=0.002].The proportion of freezers in the patients with excessive daytime sleepiness was significantly higher than that in the patients without excessive daytime sleepiness[59%(20/34)vs 29%(30/102),x^(2)=9.49,P=0.002].During a maximum of 18-month follow-up,freezing of gait incidence(6/7)in the excessive daytime sleepiness group was significantly higher than that in the non-excessive daytime sleepiness group[21%(8/39),x^(2)=9.04,P=0.003].Excessive daytime sleepiness(HR=8.03,95%CI 2.58-24.99,P<0.01)and high L-dopa equivalent daily dose(HR=5.92,95%CI 1.95-17.93,P=0.002)were significantly associated with an increased hazard of freezing of gait.Conclusion Excessive daytime sleepiness and high L-dopa equivalent daily dose may be risk factors for the development of freezing of gait in PD in the future.