帕金森病伴发睡眠障碍的临床特点、相关因素及视频多导睡眠图的变化  

The clinical features,related factors and the changes of video polysomnography in patients with Parkinson disease accompanied with sleep disorders

作　　者：郭鹏[1] 余舒扬[1] 左丽君[1] 刘丽[1] 李丽霞[1] 朴英善[1] 扈杨 连腾宏 王瑞丹[2] 余秋瑾 金朝[2] 朱荣彦[2] 张巍[1,2,3,4,5,6] GUO Peng;YU Shuyang;ZUO Lijun;LIU Li;LI Lixia;PIAO Yingshan;HU Yang;LIAN Tenghong;WANG Ruidan;YU Qiujin;JIN Zhao;ZHU Rongyan;ZHANG Wei(Department of Geriatrics,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;China National Clinical Research Center for Neurological Diseases,Beijing 100050,China;Key Laboratory of Neurodegenerative Diseases(Capital Medical University),Ministry of Education,Beijing 100050,China;Center of Parkinson s Disease,Beijing Institute for Brain Disorders,Beijing 100053,China;Beijing Key Laboratory on Parkinson Disease,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京天坛医院老年病科,100050 [2]首都医科大学附属北京天坛医院神经病学中心,100050 [3]国家神经系统疾病临床医学研究中心 [4]教育部神经变性疾病重点实验室 [5]北京脑重大疾病研究院帕金森病研究所 [6]帕金森病研究北京市重点实验室

出　　处：《中国神经免疫学和神经病学杂志》2018年第1期26-31,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金资助项目(81571229;81071015;30770745);北京市自然科学基金重点项目(kz201610025030;41610047082032);首都临床特色应用研究资助项目(z12110700100000;z121107001012161)

摘　　要：目的探讨帕金森病(PD)患者伴发睡眠障碍(SD)的临床特点、相关因素、视频多导睡眠图(v-PSG)变化及其对患者生活质量的影响。方法收集2014-06—2016-06就诊于北京天坛医院老年病科的94例PD患者,记录患者的人口学资料。采用匹茨堡睡眠质量指数量表(PSQI)评估患者的睡眠状况,根据评测结果将患者分为PD伴发SD组(PSQI≥5分,PD-SD组)及未伴发SD组(PSQI<5分,PD-NSD组)。对PD患者进行统一帕金森病评分量表第三部分(UPDRS-Ⅲ)、蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、爱泼沃斯思睡量表(ESS)、疲劳严重度量表(FSS)、UPDRSⅡ量表、日常生活能力量表(ADL)、39项PD生活质量问卷(PDQL-39)及PSQI评分检测,比较两组患者运动症状、非运动症状、生活质量以及睡眠质量等变化。结果 (1)94例PD患者中57例(60.64%)存在SD。(2)PD-SD组和PD-NSD组在性别构成、年龄、起病年龄、受教育水平及病程方面比较均无统计学差异(P>0.05)。(3)PSQI量表评分结果显示,PD-SD组睡眠质量、睡眠潜伏期、睡眠时间、睡眠效率、SD、使用睡眠药及日间功能障碍评分均较PD-NSD组高(均P<0.01)。(4)PD-SD组患者UPDRSⅠ评分、FSS评分、HAMD评分、HAMA评分和ESS评分、UPDRSⅡ评分、ADL评分、PDQL-39评分明显高于PD-NSD组(P<0.05或P<0.01)。(5)32例PD患者行v-PSG监测,与PD-NSD组比较,PD-SD组总睡眠时间减少(P<0.05),睡眠效率及最低血氧饱和度降低(均P<0.05)。结论 PD患者SD的发生率较高;PD-SD患者SD更严重,整体睡眠质量更差;SD明显影响PD患者其他非运动症状。Objective To investigate the clinical characteristics,related factors,changes of video-polysomnography(v-PSG)and its influence on the quality of life in Parkinson disease(PD)patients accompanied with sleep disturbances(SD).Methods Ninety-four patients with PD were enrolled in Beijing Tiantan Hospital from June 2014 to June 2016,and we recorded the demographic data.The Pittsburgh sleep quality index scale(PSQI)was used to assess the patients sleep status,according to the evaluation results,patients were divided into PD with SD group(PSQI≥5,PD-SD group)and PD without SD group(PSQI<5,PD-NSD group).PD patients were assessed with unified Parkinson s disease rating scale(UPDRS)Ⅲ,mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),Epworth Sleeping Scale(ESS),fatigue severity scale(FSS),UPDRSⅡ,ADL scale,39 PD quality of life questionnaire and PSQI.We compared the two groups of patients motor and non-motor symptoms,quality of life and sleep quality changes.Results(1)Fifty-seven of the 94 PD patients(60.64%)were accompanied by SD.(2)There was no significant difference in gender,age,education level,age of onset and course of disease between the PD-SD group and the PD-NSD group(P>0.05).(3)The PD-SD group and the PD-NSD group were significantly different in subjective sleep quality,sleep latency,sleep time,sleep efficiency,sleep disorders and daytime dysfunction(all P<0.01).(4)The scores of UPDRSⅠand FSS scores were significantly higher in the PD-SD group than those in the PD-NSD group(P<0.01);HAMD,HAMA and ESS were significantly higher in the PD-SD group than the PD-NSD group(P<0.05).The scores of UPDRSⅡ,activity of daily life were both significantly higher in the PD-SD group than the PD-NSD group(P<0.05).The score of Parkinson s Disease Quality of Life Questionnaire was significantly higher in the PD-SD group than the PD-NSD group(P<0.05).(5)There were 21 SD patients and 11 PD-NSD patients completed v-PSG.Compared with the PD-NSD grou

关 键 词：帕金森病 睡眠障碍 相关因素 视频多导睡眠图 生活质量 

分 类 号：R742.5[医药卫生—神经病学与精神病学]