早期与中晚期帕金森病患者睡眠障碍比较及其对生活质量的影响  

Comparative study of sleep disorder and its effect on health-related quality of life in patients with Parkinson's disease between early-stage and middle- and late-stages

作　　者：桂小红[1] 王黎萍[1] 吴承龙[1] 孙新芳[1] Gui Xiaohong;Wang Liping;Wu Chenglong;Sun Xinfang(Department of Neurology,Shaoxing People's Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院神经内科,312000

出　　处：《中华神经医学杂志》2019年第1期22-27,共6页Chinese Journal of Neuromedicine

摘　　要：目的比较早期与中晚期帕金森病(PD)患者睡眠障碍特点,分析其影响因素及对生活质量的影响。方法选择自2014年9月至2016年5月在绍兴市人民医院神经内科就诊的PD患者151例,根据Hoehn-Yahr(H&Y)病情分级将其分为早期患者(1-2级,n=82)及中晚期患者(2.5-5级,n=69)。分别采取简易智能精神状态量表(MMSE)、哈密尔顿焦虑量表(HAMA)、哈密尔顿抑郁量表(HAMD)、统一帕金森病评定量表第三部分(UPDRSⅢ)评分、H&Y分级、非运动并发症30题问卷(PDNMS)及帕金森病睡眠评分量表(PDSS)对2组患者的认知功能及睡眠质量等进行评定。采用39项帕金森病生活质量调查表(PDQ39)评价PD患者健康相关生活质量。结果中晚期PD患者PDSS总分明显低于早期PD患者,差异具有统计学意义(P<0.05)。早期及中晚期PD患者睡眠障碍主要类型均以睡眠破碎(31.7%,47.8%)及日间过度嗜睡(38.7%,43.5%)为主。2组患者睡眠障碍与病程、HAMA、HAMD、UPDRSⅢ评分及H&Y分级呈负相关关系,与MMSE评分呈正相关关系(P<0.05);中晚期PD患者睡眠障碍与PDNMS评分及左旋多巴等效剂量(LED)呈负相关关系(P<0.05)。中晚期PD患者PDSS总分与PDQ39总分及运动功能、日常生活能力、社会交往及躯体不适呈负相关关系(P<0.05)。结论中晚期PD患者睡眠障碍明显重于早期PD患者,生活质量较早期PD患者进一步降低;病程对PD患者睡眠障碍影响较大。Objective To compare the characteristics of sleep disorder and its effect on health-related quality of life in patients with Parkinson's disease (PD) between early-stage and middle- and late-stages. Methods One hundred and fifty-one patients collected in our hospital from September 2014 to May 2016 were divided into PD patients at early stage (grading 1-2, n=82) and PD patients at middle- and late-stages (grading 3-5, n=69) according to Hoehn-Yahr (H-Y) grading. Mini-Mental Status Examination (MMSE), Hamilton Anxiety Rating (HAM-A) scale and Hamilton Depression Rating (HAM-D) scale, Unified Parkinson's Disease Rating Scale III (UPDRSIII), H-Y grading, Non-motor Symptoms Questionnaire (NMS) and Parkinson's Disease Sleep Scale (PDSS) were used to evaluate cognition states, emotion states, movement functions, disease severity, nonmotor symptoms and sleep disturbances of patients from the two groups. The 39-item Parkinson's Disease Questionnaire (PDQ-39) was used to evaluate the quality of life of PD patients. Results The incidence of sleep disorder in PD patients at middle- and late-stages was significantly higher than that in PD patients at early stage (P<0.05), and the total scores of PDSS in PD patients at middle- and late-stages were significantly lower than those in PD patients at early stage (P<0.05). Fragmented sleep (31.7% and 47.8%) and excessive sleepiness at daytime (38.7% and 43.5%) were the most common problems in patients from the two groups. Sleep disorder was negatively correlated with duration, and scores of HAM-A, HAM-D, UPDRSIII and H-Y grading, while it was positively correlated with MMSE scores in patients from the two groups (P<0.05). Sleep disorder was negatively correlated with NMS scores and daily levodopa equivalent dose in PD patients at middle- and late-stages (P<0.05). Multivariate regression analysis indicated that PDSS total scores were negatively correlated with HAMD scores and positively correlated with MMSE scores in all patients (P<0.05). PDSS total scores were negatively correlate

关 键 词：帕金森病 睡眠障碍 生活质量 

分 类 号：R742.5[医药卫生—神经病学与精神病学]