帕金森病患者快速眼动期睡眠行为障碍的多项睡眠图分析  

The analysis of REM sleep behavior disorder in patients with Parkinson＇s disease by polysomnography

作　　者：严金柱[1] 季晓林[1] 叶华[1] 林细康[1] 吴美娜[1] 黄鸿旗[1] 

机构地区：[1]福建省级机关医院（福建卫生职业技术学院附属医院）神经内科,福建福州350003

出　　处：《癫痫与神经电生理学杂志》2011年第3期156-161,共6页Journal of Epileptology and Electroneurophysiology(China)

基　　金：基金项目：福建省卫生厅青年科研基金资助（2009-1-25）

摘　　要：目的：客观地分析帕金森病（PD）患者快速眼动期睡眠行为障碍（RBD）的多项睡眠网（PSG）表现。方法：采用UPDRS-III评分、HoehnYahr评分及用药调查表分别对28例PD患者的疾病严重程度、病程、多巴胺能药物应用等情况进行评定和计算，并结合全夜可移动的同步视频多项睡眠网（V—PSG）监测进行分析比较各项睡眠结构、睡眠进程以及睡眠相关事件。结果：利用同步V-PSG并结合临床病史，发现28例PD患者中有14例（占50％）伴有RBD。PD伴RBD组的病程[（6．76±3．44）年]较PD不伴RBD组病程[（2．96±1．99）年]长，其Hoehn—Yahr评分为（3．21±0．89）、非快速眼动（NREM）睡眠1期（N1）百分比[（23．56％±13．64）％]、醒觉指数[（54．41±36．45）次／h]、睡眠期周期性腿动指数（5．9次／h）较PD不伴RBD组的相应值[（2．21±0．80）、（11．47％±7．34）％、（26．55±17．25）次／h、1．5次/h]明显升高（P〈0．05）；而两组患者间的UPDRS-III评分、左旋多巴等效剂量、睡眠效率、N2、N3、REM睡眠期百分比及呼吸暂停低通气指数等比较差异无统计学意义。14例PD伴RBD患者中有3例（占21％）出现相关睡眠致伤。结论：同步V—PSG结合临床病史可以提高RBD诊断的准确性。PD伴RBD患者可影响部分睡眠结构，还可能存在相关睡眠致伤的风险。Objective： To objectively analyse the manifestation of sleep disorder in patients with Parkinson disease（PD）with REM sleep behavior disorder （RBD）by polysomnography（PSG）. Methods： The severity and course of PD, the dosage of dopaminergic drugs and other information were evaluated by unified Parkinson disease rating scale III （UPDRS-III ）, Hoehn -Yahr stages, and medication questionnaire in 28 PD patients with RBD. They were monitored by whole night ambulatory V-PSG. The parameters of sleep architecture, sleep progress and sleep related episodes were analysed in them. Results： RBD occured in 14 of the 28 PD patients（50%）by synchronized V-PSG recording and clinical history analysis. About the course of disease, Hoehn Yahr stages, percentage of NREM stage 1 sleep （N1%）, arousal index, periodic limb movement in sleep index increased respectively in PD patients with RBD group than that in PD without RBD group （（6.76±3.44）y vs （2.96±1.99）y,t=3. 579;3.21±0.89 vs 2.21±0.80,t= 3. 119;23.56±13.64% vs 11.47±7.34%,t=2. 920; （54.41±36.45）/h vs （26.55±17.25）/h,t= 2. 585;5.9/h vs 1.5/h,z=-2. 529,all P〈0.05）. But there was no statistical significance in UPDRS III , the dosage of levodopa equivalents（LDE）, sleep efficiency, percentage of other NREM stages of sleep and REM sleep, apnea hypopnea index（AHI） between the two groups. Sleep related injuries（SRI） oc cured in 3 of the 14 PD with RBD patients（21 % ）. Conclusion： Synchronized V-PSG recording and clinical history analysis may improve the accuracy of diagnosising RBD. PD with RBD may affect partially the pa rameters of sleep architecture, but also may take a risk of SRI.

关 键 词：帕金森病(PD) 快速眼动期睡眠行为障碍(RBD) 多项睡眠图(PSG) 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]