早期帕金森病患者睡眠障碍分析  

Analysis of sleep disorders in Parkinson disease patients at early stage

作　　者：李琳[1] 刘振国[1] 干静[1] 周明珠[1] 周桢源[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经科,200092

出　　处：《中国现代神经疾病杂志》2008年第3期217-221,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：教育部留学回国人员科研启动基金资助项目;上海市教育委员会科研项目(项目编号:06BZ048)

摘　　要：目的评价早期帕金森病患者睡眠质量,分析其睡眠障碍临床特点及其相关影响因素。方法根据英国帕金森病协会(UKPDS)诊断标准,选择连续就诊且诊断明确的早期帕金森病(Hoehn-Yahr分级Ⅰ～Ⅱ级)患者67例和年龄与之相匹配的正常对照者60例,采用Hoehn-Yahr分级、汉密尔顿抑郁评价量表、帕金森病睡眠量表和Epworth嗜睡量表对其疾病严重程度、抑郁程度及睡眠状况进行评价和分析。结果早期帕金森病组患者帕金森病睡眠量表总评分[(119.56±15.73)分]显著低于对照组[(133.36±16.73)分](P=0.000)。在各分项的比较中,除入睡困难(PDSS-2)、幻觉(PDSS-7)、尿失禁(PDSS-9)和晨起困倦(PDSS-14)等问题两组间比较差异无统计学意义(均P>0.05),其余各项组间差异均有统计学意义(P<0.05)。早期帕金森病患者睡眠障碍的主要类型为失眠,其中入睡困难占23.88%(16/67)、睡眠维持困难占38.81%(26/67)、早醒占16.42%(11/67)。在导致失眠的原因中以夜尿症最为常见,约占55.22%(37/67),其次是逼真梦境(25.37%,17/67)、震颤(22.39%,15/67)、翻身困难(17.91%,12/67)和肢体痉挛疼痛(7.46%,5/67)。不宁腿综合征、白天过度嗜睡等亦可在早期帕金森病患者中出现。Spearman相关分析提示,早期帕金森病患者睡眠障碍与年龄无关(P>0.05);而与Hoehn-Yahr分级、汉密尔顿抑郁评价量表评分及多巴胺剂量有关(均P<0.05)。结论早期帕金森病患者即存在不同类型的睡眠障碍,其发生与病情严重程度、服药剂量以及抑郁程度有关。除对运动症状进行治疗外,尚需注意对睡眠障碍的处理。Objective To evaluate the quality of sleep, and analyse clinical characteristics of sleep disorders and the influencing factors in patients of Parkinsen disease （PD） at early stage. Methods Based on United Kingdom Parkinson Disease Society （UKPDS） diagnostic criteria, 67 consecutive PD patients at early stage （Hoehn-Yahr grade Ⅰ-Ⅱ ） and age-matched 60 healthy controls participated in this study. The severity of PD was evaluated by Hoehn-Yahr grade, the level of depression by Hamilton Depression Rating Scale （HAMD）. Sleep assessment was done by using the Parkinsen Disease Sleep Scale （PDSS） and Epworth Sleepiness Scale （ESS）. Results The total PDSS seore in PD group （119.56±15.73） was significantly lower than that in control group （133.36±16.73） （P=0.000）. There were significant differences between the patients and controls for most items （P〈0.05, for all） except PDSS-2 （difficulty in falling asleep）, PDSS-7 （hallucination）, PDSS-9 （incontinence of urine）, and PDSS-14 （sleep refreshment） （P〉0.05, for all）. The main type of sleep disorders was insomia, including difficulties in the initiation of sleep （23.88%, 16/67）, fragmented sleep （38.81%, 26/67）, waking early （16.42%, 11/67）. We found that nocturia （55.22%, 37/67）, nightmares （25.37%, 17/67）, tremor （22.39%, 15/67）, difficulty to turn in bed （17.91%, 12/67）, and nighttime cramps （7.46%, 5/67） seem to be the important nocturnal disabilities in PD patients at early stage. Restless legs syndrome and excessive daytime sleepiness were also found. Using Spearman＇s rank correlation, we found that the sleep disorders in PD patients at early stage were associated significantly with Hoehn-Yahr grade, HAMD and dopamine dosage （P〈0.05, for all）, but independent of the age （P〉0.05）. Conclusion Different types of sleep disorder could be found in PD patients at early stage. They are related to the severity of disorder, doses,and depression degree. Besides treat

关 键 词：帕金森病 入睡和睡眠障碍 过度嗜睡性障碍 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R749.71[医药卫生—临床医学]