帕金森病两种常见睡眠障碍关联性研究  

Study on the correlation between two common sleep disorders in Parkinson's disease

作　　者：马丽婧[1] 傅蕴婷 沈赟[1] 王益[1] 李洁[1] 毛成洁[1] 韩菲[1] 刘春风[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215004

出　　处：《中国现代神经疾病杂志》2017年第1期31-38,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：江苏省科技计划项目(项目编号:BL2014042);江苏省苏州市临床医学中心建设项目(项目编号:Szzx201503)~~

摘　　要：研究背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和快速眼动睡眠期行为障碍(RBD)是帕金森病(PD)两种常见睡眠障碍,本研究探讨帕金森病合并两种睡眠障碍的临床特点和睡眠参数变化,以及二者之间相互作用机制。方法采用统一帕金森病评价量表(UPDRS)、简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)中文版、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数(PSQI)、非运动症状问卷(NMSQuest)、帕金森病预后量表-自主神经功能部分(SCOPA-AUT)、39项帕金森病调查表(PDQ-39)和Hoehn-Yahr分期评价190例帕金森病患者运动症状、非运动症状(认知功能、睡眠质量、自主神经功能等)和病情严重程度,并行多导睡眠图监测记录睡眠参数。结果共73例合并阻塞性睡眠呼吸暂停低通气综合征患者,其中22例同时发生快速眼动睡眠期行为障碍(PD+OSAHS+RBD组),51例不发生快速眼动睡眠期行为障碍(PD+OSAHS-RBD组)。PD+OSAHS+RBD组患者UPDRSⅠ评分(P=0.015)、UPDRSⅡ评分(P=0.023)、ESS评分(P=0.002)、PSQI评分(P=0.048)、NMSQuest评分(P=0.001)和SCOPA-AUT评分(P=0.026),以及平均动脉血氧饱和度(P=0.029)、最低动脉血氧饱和度(P=0.001)、快速眼动睡眠期最低动脉血氧饱和度(P=0.000)、快速眼动睡眠期紧张性(P=0.000)和时相性(P=0.000)下颏肌电活动均高于PD+OSAHS-RBD组,而MoCA评分低于PD+OSAHS-RBD组(P=0.013)。相关分析显示,呼吸暂停低通气指数和氧减指数与NMSQuest(r_s=0.252,P=0.032;r_s=0.229,P=0.010)、SCOPA-AUT(r_s=0.322,P=0.005;r_s=0.247,P=0.037)和PDQ-39(r_s=0.340,P=0.004;r_s=0.269,P=0.023)评分呈正相关关系。结论帕金森病同时合并阻塞性睡眠呼吸暂停低通气综合征和快速眼动睡眠期行为障碍的患者认知功能障碍、日间嗜睡程度、自主神经功能障碍等非运动症状更加严重。尽管发生快速眼动睡眠期行为障碍的患者夜间动脉血氧饱和度较高,但并不能显著改善�Background Obstructive sleep apnea-hypopnea syndrome （OSAHS） and rapid eye movement sleep behavior disorder （RBD） are two common sleep disorders in Parkinson/s disease （PD）. This paper aims to explore the changes of clinical features and sleep parameters, as well as the mutual effect in PD patients with concurrent OSAHS and RBD. Methods Unified Parkinson% Disease Rating Scale （UPDRS）, Mini- Mental State Examination （MMSE）, Montreal Cognitive Assessment （MoCA） Chinese Version, Epworth Sleepiness Scale （ESS）, Pittsburgh Sleep Quality Index （PSQI）, Non-Motor Symptoms Questionnaire （NMSQuest）, Scales for Outcomes in Parkinson＇s Disease-Autonomic （SCOPA-AUT）, 39-Item Parkinson＇s Disease Questionnaire （PDQ- 39） and Hoehn- Yahr stage were used to assess the motor symptoms, non-motor symptoms （cognitive function, sleep quality, autonomic function）, and the severity of disease of 190 PD patients. Polysomnography （PSG） monitoring was done to record sleep parameters.Results Among those patients, 73 patients were accompanied by OSAHS, among whom 22 patients also suffered from RBD （PD ＋ OSAHS ＋ RBD）, and 51 patients did not present RBD （PD ＋ OSAHS-RBD）. The scores of UPDRS I （P = 0.015）, UPDRS Ⅱ （P = 0.023）, ESS （P = 0.002）, PSQI （P = 0.048）, NMSQuest （P = 0.001） and SCOPA - AUT （P = 0.026） in PD ＋ OSAHS ＋ RBD group were significantly higher than those in PD ＋ OSAHS- RBD group, while MoCA score was significantly lower （P = 0.013）. PSG monitoring showed mean artery oxygen saturation （SaO2, P = 0.029）, mini SaO2 （P = 0.001）, mini SaO2 in REM （P = 0.000）, tonic EMG activity （P = 0.000） and phasic EMG activity （P = 0.000） in REM in PD ＋ OSAHS ＋ RBD group were significantly higher than those in PD ＋ OSAHS- RBD group. Correlation analysis showed that apnea hypopnea index （AHI） and oxygen desaturation index （ODI） were positively correlated with the scores of NMSQuest （r, = 0.252, P = 0.032; rs

关 键 词：帕金森病 睡眠呼吸暂停 阻塞性 REM睡眠行为障碍 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]