伴自主神经功能障碍的帕金森病患者的睡眠结构及其与快速眼动睡眠障碍的相关性  

Sleep structure in Parkinson’s disease with autonomic dysfunction and its correlation with rapid eye movement sleep behavior disorder

作　　者：王文婷[1] 张忠霞[1] 陈鸿旭 解冰川[1] 张丽娜[2] 张振清[1] 邵云[3] 顾平[1] WANG Wen-ting;ZHANG Zhong-xia;CHEN Hong-xu(Department of Neurology, the First Hospital of Hebei Medical University, Shijiazhuang 050031, China)

机构地区：[1]河北医科大学第一医院神经内科,050031 [2]河北医科大学第一医院教务处,050031 [3]河北医科大学第一医院超声科,050031

出　　处：《临床神经病学杂志》2019年第4期249-253,共5页Journal of Clinical Neurology

基　　金：河北省卫生和计划生育委员会医学科学研究重点课题计划项目(ZL20140254)

摘　　要：目的探讨伴发自主神经功能障碍的帕金森病(PD)患者的睡眠结构及其与快速眼动睡眠障碍(RBD)的关系。方法收集48例PD患者的一般资料。根据皮肤交感反应(SSR)检查,将患者分为SSR正常组及SSR障碍组。应用统一PD评定量表第三部分(UPDRS-Ⅲ)、Hoehn-Yahr(H-Y)分级、汉密尔顿焦虑量表(HAMA14)、汉密尔顿抑郁量表(HAMD24)、匹兹堡睡眠指数量表(PSQI)、MMSE、蒙特利尔认知评估量表(MoCA)、自主神经症状量表(SCOPA-AUT)评估患者的运动、非运动症状及自主神经功能;RBD筛查量表(RBDSQ)评定患者RBD症状;多导睡眠监测(PSG)记录睡眠参数。结果与SSR正常组比较,SSR障碍组病程显著延长,H-Y分级及HAMA14、HAMD24、PSQI、SCOPA-AUT、RBDSQ量表评分显著升高(P<0.05~0.01)。与SSR正常组相比,SSR障碍组患者睡眠效率及非快速眼动期(NREM)-Ⅱ期睡眠百分比显著下降,觉醒指数、NREM-Ⅰ期睡眠百分比、周期性腿动指数(PLMI)显著增高(P<0.05~0.01)。SSR障碍组周期性腿动和RBD比率均显著高于SSR正常组(χ^2=4.463,P=0.035;χ^2=8.889,P=0.003)。RBDSQ与SCOPA-AUT评分、NREM-Ⅰ期睡眠百分比、REM期睡眠百分比、呼吸暂停-低通气指数、PLMI和觉醒指数呈正相关(均P<0.01),与总睡眠时间、睡眠潜伏期、REM潜伏期、睡眠效率、NREM-Ⅱ期睡眠百分比、NREM-Ⅲ期睡眠百分比呈负相关(均P<0.01),与总觉醒时间无相关性。结论伴自主神经功能障碍的PD患者病程长,病情重,容易存在焦虑、抑郁情绪,客观存在睡眠结构紊乱,RBD发生率高。PD患者RBD的严重程度与自主神经功能障碍程度密切相关。Objective To investigate the sleep structure in patients of Parkinson’s disease(PD) with autonomic dysfunction, and its correlation with rapid eye movement sleep behavior disorder(RBD).Methods The general informations of 48 patients with PD were collected. The patients were divided into skin sympathetic response(SSR) normal group and SSR disorder group according to the SSR measurement. The motor, non-motor symptoms and autonomic function were assessed by Unified PD rating scale(UPDRS-Ⅲ), Hoehn-Yahr(H-Y) stage, Hamilton anxiety scale(HAMA14), Hamilton depression scale(HAMD24), Pittsburgh sleep index scale(PSQI), MMSE, montreal cognitive assessment scale(MoCA) and the scale for outcome in PD-autonomic(SCOPA-AUT). RBD symptoms were detected by RBD screening scale(RBDSQ), and sleep parameters were recorded by polysomnography(PSG). Results Compared with those in SSR normal group, the course of SSR disorder group was significantly longer, the H-Y stage and HAMA14, HAMD24, PSQI, SCOPA-AUT and RBDSQ scores were significantly higher(P<0.05-0.01). Compared with those in SSR normal group, the sleep efficiency and the percentage of non-rapid eye movement(NREM)-Ⅱ sleep in SSR disorder group were significantly decreased, and the awakening index, percentage of NREM-Ⅰ sleep, periodic leg movement index(PLMI) in SSR disorder group were significantly increased(P<0.05-0.01). The ratios of periodic limb movement and RBD in SSR disorder group were significantly higher than those in SSR normal group(χ^2=4.463,P=0.035;χ^2=8.889, P=0.003). RBDSQ score was positively correlated with SCOPA-AUT score, the percentage of NREM-Ⅰ and REM sleep, apnea-hypopnea index, PLMI and awakening index(all P<0.01), while negatively correlated with total sleep time, sleep latency,latency,sleep efficiency,the proportion of NREM-ⅡREM sleep and NREM-Ⅲ sleep( all P < 0. 01). There was no significant correlation between RBDSQ score and total awake time. Conclusions The course of PD patients with autonomic dysfunction is long,the condition is sev

关 键 词：帕金森病 快速眼动睡眠行为障碍 多导睡眠图 自主神经功能 皮肤交感反应 

分 类 号：R742.5[医药卫生—神经病学与精神病学]