初诊帕金森病患者快速眼动期睡眠行为障碍相关危险因素分析

Analysis of risk factors associated with sleep behavior disorders during rapid eye movement in de novo Parkinson’s disease patients

目的筛查初诊未服药的帕金森病患者快速眼动睡眠行为障碍(RBD)的危险因素。方法纳入2018-12—2022-07南京医科大学附属脑科医院帕金森病专病门诊收治的101例初诊帕金森病患者,根据快速眼动睡眠期行为障碍量表-香港版(Rapid-eye-movement Sleep Behavior Disorder Questionnaire HongKong,RBDQ-HK)分为伴RBD组(PD-RBD组)(评分≥18,30例)和不伴RBD组(PD-nRBD组)(评分≤17,71例),比较2组患者汉密尔顿抑郁量表24项(HAMD-24)、汉密尔顿焦虑量表(HAMA)、简易精神状态检查量表(MMSE)、校正蒙特利尔认知评价量表(校正MoCA)、帕金森病睡眠量表(PDSS)、帕金森病非运动症状问卷量表(NMSQ)、统一帕金森病评价量表第二部分(UPDRSⅡ)、统一帕金森病评价量表第三部分(UPDRSⅢ)、Hoehn-Yahr分期改良版差异。Logistic回归筛查分析帕金森病患者快速眼动期睡眠行为障碍的危险因素。结果101例患者中共30例(29.70%)伴RBD。与不伴RBD患者(71例)相比,伴RBD患者PDSS评分(Z=—2.019,P=0.044)较低;HAMD-24评分(Z=—2.086,P=0.037),NMSQ评分(Z=—2.554,P=0.011)较高。Logistic回归分析显示,NMS得分高(OR=1.130,95%CI:1.017~1.256,P=0.023)是帕金森病患者快速眼动期睡眠行为障碍的独立危险因素。结论初诊帕金森病患者RBD发生率较高,非运动症状是帕金森病患者发生RBD的主要危险因素,要重视PD患者RBD症状的筛查。

Objective To screen the risk factors for rapid eye movement sleep behavior disorder(RBD)in de novo Parkinson’s disease patients.Methods 101 de novo Parkinson’s disease patients who were admitted to the Parkinson’s Disease Specialized Outpatient Clinic of the Affiliated Brain Hospital of Nanjing Medical University from December 2018 to July 2022 were included,and according to the Rapid-eye-movement Sleep Behavior Disorder Questionnaire HongKong(RBDQ-HK)into a group with RBD(PD-RBD group)(score≥18,30 patients)and a group without RBD(PD-nRBD group)(score≤17,71 patients),comparing the 24-item Hamil⁃ton Depression Scale(HAMD-24),Hamilton Anxiety Scale(HAMA),Mini-Mental State Examination(MMSE),the corrected Montreal Cognitive Assessment(corrected MoCA),the Parkinson’s disease sleep scale(PDSS),the Parkinson’s Disease Non-Motor Symptom Questionnaire(NMSQ),the Unified Parkinson’s Disease Rating Scale PartⅡ(UPDRSⅡ),the Unified Parkinson’s Disease Rating Scale PartⅢ(UPDRSⅢ),and the Hoehn-Yahr Staging Modified differences between the two groups.Logistic regression screening was used to analyze risk factors for sleep behavior disorders during the rapid eye movement phase in patients with Parkinson’s disease.Results A total of 30 of 101 patients(29.70%)had RBD,compared to patients without RBD(71),patients with RBD had lower PDSS scores(Z=—2.019,P=0.044);higher HAMD-24 scores(Z=—2.086,P=0.037),higher NMSQ scores(Z=—2.554,P=0.011).Logistic regression analysis showed that a high NMS score(OR=1.130,95%CI:1.017-1.256,P=0.023)was an independent risk factor for REM sleep behaviour disorders in patients with Parkin⁃son’s disease.Conclusions The incidence of RBD is high in de novo Parkinson’s disease patients,non-motor symptoms are a major risk factor for the development of RBD in patients with Parkinson’s disease,and screening for symptoms of RBD in patients with PD should be emphasized.