伴快速眼动期睡眠行为障碍帕金森病患者的睡眠结构及其与认知功能、抑郁状态、运动功能的相关性

Sleep structure of Parkinson's disease patients with rapid eye movement sleep behavior disorder and its correlations with cognitive function,depressive state and motor function

目的探讨伴快速眼动期睡眠行为障碍(RBD)的帕金森病(PD)患者的睡眠结构及其与认知功能、抑郁状态、运动功能的相关性。方法选取120例PD患者为研究对象,根据是否合并RBD分为PD+RBD组(n=45)和PD组(n=75)。记录2组睡眠结构情况;比较2组的蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、统一帕金森病评价量表第3部分(UPDRS-Ⅲ)以及自主神经症状量表(SCOPA-AUT)评分。分析PD+RBD组患者睡眠结构与MoCA、HAMA、HAMD、UPDRS-Ⅲ、SCOPA-AUT评分的相关性。结果PD+RBD组的非快速眼动(NREM)1期占比、睡眠觉醒指数、睡眠中周期性肢体运动(PLMS)和呼吸暂停低通气指数(AHI)高于PD组,NREM 3期占比、快速眼动(REM)期睡眠占比、睡眠效率和最低血氧低于PD组,差异有统计学意义(P<0.05)。PD+RBD组的HAMA、HAMD、UPDRS-Ⅲ、SCOPA-AUT评分高于PD组,MoCA评分低于PD组,差异有统计学意义(P<0.05)。PD+RBD组NREM 1期睡眠占比、睡眠觉醒指数、PLMS、AHI与HAMA、HAMD、UPDRS-Ⅲ、SCOPA-AUT评分呈正相关,而与MoCA评分呈负相关(P<0.05);NREM 3期睡眠占比、REM期睡眠占比、睡眠效率、最低血氧与HAMA、HAMD、UPDRS-Ⅲ、SCOPA-AUT评分呈负相关,而与MoCA评分呈正相关(P<0.05)。结论伴有RBD的PD患者存在睡眠结构紊乱,并与认知功能、抑郁状态、运动功能及自主神经功能密切相关。

Objective To investigate the sleep structure of Parkinson's disease(PD)patients with rapid eye movement sleep behavior disorder(RBD)and its correlations with cognitive function,depressive state and motor function.Methods A total of 120 PD patients were enrolled in this study,and divided into PD+RBD group(n=45)and PD group(n=75)based on the presence or absence of RBD.Sleep structure was recorded for both groups.The scores of the Montreal Cognitive Assessment(MoCA),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Unified Parkinson's Disease Rating Scale PartⅢ(UPDRS-Ⅲ)and Scales for Outcomes in Parkinson's Disease-Autonomic(SCOPA-AUT)were compared between the two groups.The correlations of MoCA,HAMA,HAMD,UPDRS-Ⅲand SCOPA-AUT scores with sleep structure in the PD+RBD group were analyzed.Results The PD+RBD group showed significantly higher percentage of non-rapideye movement(NREM)at stage 1,arousal index,periodic limb movements during sleep(PLMS)and apnea-hypopnea index(AHI)compared to the PD group,while the percentages of NREM at stage 3,rapid eye movement(REM)sleep,sleep efficiency and lowest oxygen saturation were significantly lower(P<0.05).The PD+RBD group also had significantly higher HAMA,HAMD,UPDRS-Ⅲand SCOPA-AUT scores,and significantly lower MoCA scores compared to the PD group(P<0.05).In the PD+RBD group,the percentages of NREM at stage 1,arousal index,PLMS and AHI were positively correlated with HAMA,HAMD,UPDRS-Ⅲand SCOPA-AUT scores,and negatively correlated with MoCA scores(P<0.05).Conversely,the percentages of NREM at stage 3,REM sleep,sleep efficiency and lowest oxygen saturation were negatively correlated with HAMA,HAMD,UPDRS-Ⅲand SCOPA-AUT scores,and positively correlated with MoCA scores(P<0.05).Conclusion PD patients with RBD exhibit disrupted sleep structure,which is closely associated with cognitive function,depressive state,motor function,and autonomic nervous system function.