老年帕金森病病人呼吸暂停低通气与认知损伤的相关性

Study on sleep apnea hypopnea and cognitive injury in elderly patients with Parkinson’s disease

目的探究老年PD病人认知障碍与夜间睡眠及呼吸暂停低通气的关系。方法共纳入425例≥60岁的老年PD病人。采用UPDRS第三部分(UPDRS-Ⅲ)、Hoehn-Yahr分期(H-Y分期)、非运动症状量表(NMS)、帕金森病睡眠量表(PDSS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、MoCA等评估病人的PD相关病情。同时采用多导睡眠监测(PSG)评估病人睡眠情况。采用多因素Logistic回归分析认知障碍与夜间睡眠及呼吸暂停低通气的关系。结果共182例PD病人存在认知损伤(42.8%)。伴认知损伤病人HAMA、NMS评分、HAMD评分及焦虑/躯体化、体质量改变、认知损伤、迟缓症状分项评分均较高,PDSS评分较低,提示伴认知损伤病人存在较重的非运动症状(P均<0.05)。同时发现伴认知损伤病人睡眠效率下降,睡眠潜伏期延迟,一期睡眠比例升高,深睡眠比例下降,并且睡眠呼吸暂停低通气指数(AHI)明显增高,微觉醒指数明显增高,睡眠期平均血氧明显下降(P均<0.05)。Logistic回归分析提示,AHI指数为认知损伤独立的危险因素,较高的PDSS评分、睡眠效率及睡眠中平均血氧饱和度为认知功能的保护因素。结论老年PD病人认知损伤与夜间睡眠及呼吸暂停低通气有关。

Objective To explore the relationship between the cognitive impairment and sleep apnea hypopnea syndrome in the elderly patients with Parkinson’s disease(PD).Methods This study evaluated 425 elderly patients with PD using Unified PD Rating Scale(UPDRS)partⅢ,Hoehn and Yahr(H&Y)staging,Non-Motor Symptoms Questionnaire(NMS-Quest),PD Sleep Scale(PDSS),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and Montreal Cognitive Assessment(MoCA).At the same time,polysomnography(PSG)was used to assess the sleep conditions.The relationship between cognitive impairment and sleep apnea hypopnea was analyzed.Results Cognitive damage was found in 182 PD patients(42.8%)with higher scores of HAMA,NMS,HAMD and anxiety/somatosis,body quality change and the awareness damage,with lower score of PDSS(P<0.05).The patients with cognitive injury presented with lower sleep efficiency,delayed sleep latency and average oxygen,with higher rate of NREM sleep stage 1 time(N1 time)and higher level of sleep-related apnea hypopnea index(AHI)and micro-wake index(all P<0.05).Logistic regression analysis indicated that AHI index was a risk factor of cognitive injury,while higher PDSS score,sleep efficiency,and average blood oxygen saturation in sleep were protective factors(P<0.05).Conclusions The cognitive damage in the elderly PD patients is closely related to sleep apnea hypopnea.