帕金森病患者疲劳与睡眠障碍的研究  

Fatigue and sleep disorders in patients with Parkinson's disease

作　　者：秦朝晖[1] 陈彪[2] 顾朱勤[2] 丁晖[2] 胡洪涛[1] 

机构地区：[1]北京积水潭医院神经内科,北京100035 [2]首都医科大学宣武医院老年医学研究所,北京100053

出　　处：《中风与神经疾病杂志》2016年第5期388-391,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家科技部"十一五"科技攻关项目(863)(No.2006AA02A408)

摘　　要：目的调查帕金森病(Parkinson’s disease,PD)患者中疲劳和睡眠障碍的患病率,研究疲劳和睡眠障碍的危险因素及相关性。方法采用疲劳严重度量表(FSS)和匹兹堡睡眠质量指数量表(PSQI)对363例PD患者的疲劳及睡眠状况进行评价。FSS>4界定为疲劳,PSQI≥7界定为睡眠障碍。同时,采用统一帕金森病评分量表(UPDRS)及Hoehn&Yahr评价运动障碍及严重程度,美国国立精神卫生研究所流行病学研究中心编制的抑郁量表(CESD)评价抑郁,阿尔茨海默病评定量表(ADAS-Cog)评价认知,36条目简化医疗结局调查问卷(SF-36)评价生活质量。结果 363例PD患者61.7%存在疲劳,55.1%存在睡眠障碍。其中,136例(37.5%)疲劳与睡眠障碍共存,87例(24%)仅存在疲劳,63例(17%)仅存在睡眠障碍。单因素方差分析显示,疲劳组与对照组比较UPDRS第3部分评分、左旋多巴制剂等效剂量(LDE)、CESD分值均显著升高(均P<0.001);睡眠障碍组与对照组比较UPDRS第3部分评分、LDE、CESD分值均无显著差异(均P>0.05)。多参数Logistic回归显示,UPDRS第3部分评分和CESD分值能预测疲劳的发生,而LDE未被引入疲劳预测模型。与之相反,UPDRS第3部分评分、LDE、CESD分值均不能预测睡眠障碍的发生。结论疲劳和睡眠障碍是PD常见的非运动症状。二者在临床上有所重叠,但危险因素不同,疲劳和睡眠障碍是PD独立的非运动症状。Objective To assess the frequency and severity of fatigue and sleep disorders in patients with idiopathic Parkinson＇s disease（ PD） and to study their relation to motor and non-motor symptoms. Methods we prospectively assessed Fatigue Severity Scale（ FSS） score,Pittsburgh sleep quality index（ PSQI） in 363 patients with idiopathic PD. Subjects who scored 4 on fatigue severity scale（ FSS） were classified as fatigue,≥7 on PSQI were defied as sleep disorder.Motor symptoms and PD severity were assessed using the unified Parkinson ＇s disease rating scale（ UPDRS） and HoehnYahr scale. Other clinical measures,including depression by Center for epidemiological survey depression scale（ CESD）,mental function by Alzheimer s Disease assessment scale-cognitive sections（ ADAS-Cog） and quality of life by medical outcomes study short form 36（ SF-36） were also evaluated. Results Of the total sample,fatigue was found in61. 7%,sleep disorders in 55. 1%,both in 37. 5% of patients with idiopathic PD. However,based on the selection criteria,87（ 24%） of patients in the study group reported pathologic fatigue without overlap of sleepiness. In contrast,63（ 17%）reported pathological sleepiness without overlap of fatigue. ANOVA testing revealed significant difference in UPDRS part3,levodopa dosage equipments（ LDE） and CESD score between predominantly fatigued（ high fatigue / low sleepiness） and normal（ low fatigue / low sleepiness） groups. In contrast,there was no such significant difference found between predominantly sleepy（ high sleepiness / low fatigue） and normal（ low fatigue / low sleepiness） groups. Multinomial regression analyses showed that motor subset of UPDRS and CESD scores were the variables that had the predictive value for the occurrence of highly fatigued（ high fatigue / low sleepiness vs low fatigue / low sleepiness）. However,LDE did not significantly contribute to the model. In contrast,all factors,including UPDRS part3,LDE and CESD did not significantly

关 键 词：帕金森病 睡眠障碍 疲劳 

分 类 号：R742.5[医药卫生—神经病学与精神病学]