快眼动睡眠行为障碍与早期帕金森病患者运动及非运动症状特征

Characteristics of motor and non-motor symptoms in patients with rapid eye movement sleep behavior disorder and early Parkinson disease

目的探讨快眼动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)、早期帕金森病(Parkinson disease,PD)伴与不伴RBD患者的运动、非运动症状及多导睡眠图特征。方法收集2020年8月至2021年5月就诊于四川大学华西医院睡眠门诊的特发性RBD(idiopathic RBD,IRBD)患者及神经内科门诊的早期PD患者,分为IRBD组(67例)、PD伴RBD组(PD+RBD,19例)、PD不伴RBD组(PD-RBD,22例)。选用统一帕金森病评定量表第3部分(united Parkinson's disease rating scale part 3,UPDRS Ⅲ)、Hoehn-Yahr(H-Y)分级、Epworth嗜睡量表(Epworth sleepiness scale,ESS)、香港中文大学快眼动睡眠期行为障碍量表(REM sleep behavior disorder questionnaire-Hong Kong,RBDQ-HK)、汉密尔顿抑郁量表17项(17-item Hamilton depression scale,HAMD-17)、简易精神状态检查量表(mini-mental state examination,MMSE)、Sniffin' Sticks嗅觉功能检测、视觉模拟评分法(visual analogue scale,VAS)、帕金森病自主神经功能评定量表(scale for outcomes in Parkinson's disease-AUT,SCOPA-AUT)评估患者的运动症状以及非运动症状包括日间嗜睡、RBD症状、抑郁、认知功能、嗅觉功能、疼痛程度及自主神经功能;患者均接受整夜多导睡眠监测。对3组患者的运动、非运动症状及睡眠参数进行单因素方差分析、非参数Krukal Wallis检验、χ^(2)检验、Fisher精确检验等统计学处理。结果 3组患者的运动功能比较差异有统计学意义(F=57.009,P<0.05),PD+/-RBD的UPDRS Ⅲ及H-Y评分均较IRBD组增高(均P<0.05),但PD+/-RBD两组间运动功能差异无统计学意义(P>0.05)。3组患者的非运动症状ESS、MMSE、嗅觉功能、VAS评分均差异无统计学意义(均P>0.05);但与IRBD组[0(0,3)分]比较,PD+RBD组的HAMD评分[2(1,9)分]更高(P<0.05);3组患者自主神经功能SCOPA-AUT评分差异有统计学意义(P<0.05),主要在消化系统、泌尿系统及性功能方面,其中,IRBD组[8(4,14)分]、PD+RBD组[11(7,14)分]的SCOPA-AUT总分均较PD-RBD组[4(5,5.75)分]高(均P<0.05),尤其是消化系统评分(均P<0.05);PD+RBD组[(3.47±1.17)分]性功能评分较IRBD组[(1.78±0.60)分]高(P<0.05),泌尿系统评分也较PD-RBD组高(P<0.05)。3组患者的睡眠参数除REM氧减指数以外,均差异无统计学意义,PD-RBD组的REM氧减指数[21.30(6.10,34.00)/h]显著高于IRBD组[5.90(2.70,16.73)/h],差异有统计学意义(P<0.05)。结论早期PD伴RBD存在更严重的非运动症状,尤其是抑郁及自主神经功能障碍,RBD可能与更早期和更广泛的自主神经功能损害有关。

Objective To investigate the motor and non-motor symptoms and polysomnographic features in patients with rapid eye movement sleep behavior disorder(RBD),early Parkinson's disease(PD)with and without RBD.Methods Patients with idiopathic RBD(IRBD)and early PD were collected from the clinics in West China Hospital of Sichuan University from August 2020 to May 2021.All the patients were divided into 3 groups including IRBD group(67 cases),PD with RBD(PD+RBD)group(19 cases),and PD without RBD(PD-RBD)group(22 cases).Unified Parkinson's disease rating scale part 3(UPDRS-Ⅲ),Hoehn-Yahr(H-Y)stage,Epworth sleepiness scale(ESS),REM sleep behavior disorder questionnaire-Hong Kong(RBDQ-HK),17-item Hamilton depression scale(HAMD-17),mini-mental state examination(MMSE),Sniffin’Sticks olfactory function test,visual analogue scale(VAS),and scale for outcomes in Parkinson's disease-AUT(SCOPA-AUT)were used to assess the motor and non-motor symptoms including sleepiness,RBD,depression,cognitive function,olfactory function,pain and autonomic function respectively.All patients were performed to the polysomnography(PSG)examination.One-way ANOVA,Krukal-Wallis test,χ^(2) test and Fisher accurate test were used to analyze the data of motor and non-motor symptoms and sleep parameters among the 3 groups accordingly.Results There were statistically significant differences in motor symptoms among the three groups(F=57.009,P<0.05),and the scores of UPDRSⅢand H-Y stage were higher in the PD+/-RBD group than those in the IRBD group(both P<0.05).However,there was no significant difference in motor symptoms between PD+RBD group and PD-RBD group(P>0.05).There were no significant differences in the scores of ESS,MMSE,olfactory function test and VAS(all P>0.05).But the HAMD-17 score was significantly higher in the PD+RBD group(2(1,9))than that in the IRBD group(0(0,3)(P<0.05).The SCOPA-AUT scores of autonomic function were significant differences in the three groups,mainly in the digestive system,urinary system,and sexual function(P<0.05).Notably,the IRBD group(8(4,14))and PD+RBD group(11(7,14))had higher scores of SCOPA-AUT compared with PD-RBD group(4(4,5.75)(all P<0.05),especially in the digestive dysfunction(all P<0.05).The PD+RBD group(3.47±1.17)had higher scores of sexual function compared with IRBP group(1.78±0.60)(P<0.05),and the urinary system scores also higher than PD-RBD group(P<0.05).The PD-RBD group(21.30(6.10,34.00)/h)had a significantly higher oxygen desaturation index in REM sleep compared with that of IRBD group(5.90(2.70,16.73)/h)(P<0.05).Conclusions Early PD with RBD has more severe non-motor symptoms,especially depression and autonomic dysfunction.RBD can be related with the earlier and more widely autonomic dysfunction.