帕金森病患者客观睡眠障碍的特点  

Study on objective sleep disturbances in patients with Parkinson＇ s disease

作　　者：熊康平[1] 李洁[1] 毛成洁[1] 沈丝丝[1] 唐晴[1] 黄隽英[1] 赵敏艳[1] 韩菲[2] 陈锐[2] 刘春风[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215004 [2]苏州大学附属第二医院睡眠中心,215004

出　　处：《中华神经科杂志》2012年第6期377-381,共5页Chinese Journal of Neurology

基　　金：苏州市科技发展计划项目资助（SS0701）;苏州市科教兴卫青年科技项目资助（201013）

摘　　要：目的研究帕金森病（PD）患者客观睡眠障碍的特点及相关因素。方法收集患者病史资料，对101例PD患者（PD组）和90名年龄、性别相匹配的健康体检者（对照组）进行多导睡眠图监测，分析睡眠参数及其相关因素。结果PD组与对照组比较：睡眠潜伏期差异无统计学意义；非快速眼运动睡眠1期比例（％）显著增多（27．9±17．8与21．2±11．7，t=3．034，P=0．003），非快速眼运动睡眠2期比例（％）显著减少（47．8±17．4与54．7±12．9，t=-3．043，P=0．003）；睡眠效率下降，慢波睡眠比例、快速眼运动睡眠比例减少，觉醒次数增多，快速眼运动睡眠潜伏期延长，但差异均无统计学意义。PD患者部分睡眠参数与增龄、疾病严重程度、抑郁程度相关。40．6％（41／101）PD患者睡眠期周期性肢体运动指数（PLMSI）大于15，而未主诉相关症状；PD组PLMSI显著高于对照组，且随年龄增大，PLMSI增高（r=0．261，P〈0．01）。PD组呼吸暂停低通气指数、氧减指数较对照组无显著降低，最低血氧饱和度显著高于对照组。82．2％（83／101）PD患者出现快速眼运动睡眠期肌张力失弛缓现象，其中38例（37．6％）诊断为快速眼运动睡眠期行为障碍；PD组快速眼运动睡眠期行为障碍、肌张力失弛缓的发生率均较对照组[0和8例（8．9％）]明显增高（X^2=42．271、102．480，均P〈0．01）。结论PD患者睡眠结构等多项睡眠参数发生改变，其入睡困难不明显，以睡眠维持困难、睡眠结构紊乱为主，睡眠参数与增龄、疾病严重程度、抑郁程度相关；无症状的周期性肢体运动发生率高，不需特殊处理；患者可发生呼吸暂停或低通气，但血氧饱和度降低不严重，快速眼运动睡眠期行为障碍发生率高。Objective To investigate the characteristics of the objective sleep disturbances in Parkinson＇ s disease （PD） and the factors related to it. Methods One hundred and one PD patients and 90 age- and sex- matched controls underwent a video-polysomnography. The sleep parameters and its related factors in two groups were analyzed. Results Sleep latency was not statistically different in comparing two groups. PD patients had a higher percentage of non-rapid eye movement（non-REM） sleep stage 1 and a lower percentage of non-REM sleep stage 2 compared with controls （27. 9± 17.8 vs 21.2 ± 11.7, t = 3. 034, P = 0. 003 ;47.8 ± 17.4 vs 54. 7 ± 12. 9, t = - 3. 043, P = 0. 003 ）. Reduced sleep efficiency, decreased the proportion of slow wave sleep and REM sleep, increased awake time and longer REM sleep latency occurred in PD patients. There were no significant differences of these above parameters. Some sleep parameters in PD patients were correlated with advancing age, the severity of PD, and the degree of depression. The index of periodic leg movements in sleep （PLMSI） of 41 PD patients （40.6%） was more than 15. These PD patients didn＇ t complain corresponding symptoms about their legs. The PLMSI in PD patients were significantly higher than the controls. PLMSI increased with aging in the PD group（ r = 0. 261 ,P 〈0. 01 ）. PD patients didn＇ t suffer significantly lower apnea- hypopnea index and oxygen desaturation index. The lowest SPO2 （L-SPO：）increased in the PD group. REM sleep without atonia occurred in 83 patients （82. 2% ） with PD. Thirty-eight patients （37.6%） were diagnosed with REM sleep behavior disorder （RBD）. The incidences of REM without atonia and RBD in the PD group were significantly higher than in the controls（0 and 8 patients （8.9%） , X^2 =42. 271,102. 480; both P 〈 0. 01 ）. Conclusions The sleep parameters in PD patients are changed. For PD patients, there is no difficulty in falling asleep. The PD patients also have sleep structure disorder a

关 键 词：帕金森病 睡眠障碍 多道睡眠描记术 

分 类 号：R742.5[医药卫生—神经病学与精神病学]