帕金森病伴快动眼睡眠行为障碍视频多导睡眠图变化的特点  

Video-polysomnography features of Parkinson's disease patients with rapid eye movement sleep behavior disorders

作　　者：扈杨 左丽君[1] 连腾宏 余舒扬[1] 王方[2] 余秋瑾 王瑞丹[2] 张巍[1,2,3,4,5,6] HU Yang;ZUO Lijun;LIAN Tenghong;YU Shuyang;WANG Fang;YU Qiujin;WANG Ruidan;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 for Neurodegenerative Disorders of the Ministry of Education,Capital Medical University,Beijing 100069;Center of Parkinson s Disease,Beijing Institute for Brain Disorders,Beijing 100053,China;Beijing Key Laboratory on Parkinson s 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,100050 [4]教育部神经退行性疾病重点实验室,100069 [5]北京市脑重大疾病研究院帕金森病研究所,100053 [6]北京市帕金森病重点实验室,100053

出　　处：《中国神经免疫学和神经病学杂志》2018年第5期316-320,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家重点研发计划(2016YFC1306000;2016YFC1306300);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;4161004;7082032);首都临床特色应用研究资助项目(z12110700100000;z121107001012161);北京市保健科研课题(京15-2)

摘　　要：目的研究帕金森病(PD)伴快动眼睡眠行为障碍(PD-RBD)患者的视频多导睡眠图(v-PSG)变化特点。方法连续收集作者医院就诊的PD患者42例,采用RBD筛查量表(RBDSQ)对患者的RBD进行评价,采用v-PSG进行睡眠指标监测。比较PD不伴RBD(PD-NRBD)组和PD-RBD组人口学特征、疾病分期、运动症状严重程度、非运动症状(NMS)个数、用药情况及睡眠指标的结果,并对PD-RBD患者睡眠指标与人口学特征、疾病分期、运动症状严重程度及NMS个数进行Spearman相关性分析。结果 (1)42例PD患者中,PD-RBD组16例(38.10%)。(2)PD-RBD组较PD-NRBD组病程更长,病情分期更高,统一帕金森病评价量表第3部分(UPDRSⅢ)评分更高,强直-运动迟缓型发生率更高,NMS总个数更多。(3)PD-RBD组较PD-NRBD组睡眠效率明显降低,1期睡眠时间及百分比明显升高,微觉醒指数明显升高,低通气指数明显降低,PD-RBD组周期性腿动指数明显高于PD-NRBD组。(4)PD-RBD组总睡眠时间与年龄、病程、Hoehn-Yahr(H-Y)分期及UPDRSⅢ评分均呈负相关,睡眠效率与年龄、病程、UPDRSⅢ评分及NMS总个数均呈负相关;1期睡眠时间与H-Y分期呈正相关,觉醒次数与年龄和H-Y分期均呈正相关,微觉醒指数与H-Y分期和UPDRSⅢ评分均呈正相关,周期性腿动指数与病程、UPDRSⅢ评分及NMS总个数均呈正相关。结论 PD-RBD患者浅睡眠明显增多,微觉醒及周期性腿动明显增加,导致患者睡眠效率明显降低;PD-RBD患者REM睡眠期低通气指数明显降低。PD-RBD患者随着年龄增大、病程延长、运动症状及NMS的加重,其总睡眠时间明显减少,睡眠结构发生明显改变,睡眠效率明显降低,觉醒及周期性腿动明显增多。Objective To explore the character of video-polysomnography(v-PSG)changes in Parkinson s disease(PD)patients with rapid eye movement sleep behavior disorder(RBD).Methods We consecutively recruited 42 PD patients who were from Tiantan Hospital.PD patients were evaluated by RBD screening questionnaire(RBDSQ)and v-PSG.The clinical information including demographic information,disease stage,severity of PD movement symptoms,number of non-movement symptoms(NMS),sleep parameters of v-PSG etc.were compared between PD non-RBD(PD-NRBD)and PD-RBD groups.Pearson correlation analyses were made among sleep parameters and demographic information,disease stage,severity of motor symptoms and number of NMS.Results (1)16 out of the 42 PD patients had RBD(38.10%).(2)The PD-RBD group had significantly longer disease duration,more advanced H-Y stage,higher UPDRSⅢscore,higher incidence of rigidity-bradykinesia type of PD and more total number of NMS than the PD-NRBD group.(3)The PD-RBD group had poorer sleep efficiency,increased stage 1 sleep time and percentage of stage 1 sleep time,elevated awakening index,decreased hypopnea index than the PD-NRBD group.Periodic limb movement disorder(PLMD)index of the PD-RBD group was higher than that of the PD-NRBD group.(4)In the PD-RBD group,total sleep time was negatively correlated with patients age,disease duration,H-Y stage and UPDRSⅢscore.Sleep efficiency was negatively correlated with age,disease duration,UPDRSⅢscore and total number of NMS.Stage 1 sleep time was positively correlated with H-Y stage.Number of awakenings was positively correlated with age and H-Y stage.Awakening index was positively correlated with H-Y stage and UPDRSⅢscore.PLMD index was positively correlated with disease duration,UPDRSⅢscore and total number of NMS.Conclusions PD-RBD patients have significantly increased light sleep,awakening index and PLMD index,resulting in significantly decreased sleep efficiency.The REM sleep hypopnea index is significantly reduced to protect hypoxia in PD-RBD patients.PD-RBD

关 键 词：帕金森病 REM睡眠行为障碍 多道睡眠描记术 非运动症状 运动症状 

分 类 号：R742.5[医药卫生—神经病学与精神病学]