帕金森病患者睡眠障碍特点及其影响因素分析  

Characteristics and influencing factors of sleep disorders in patients with Parkinson′s disease

作　　者：司慧丽 纪别克[1] 赵鸿雁 宋阳 庄艳华 朱倩倩 曹辉[1] 苏俊红[1] 张庆梅[1] SI Hui-li;JI Bie-ke;ZHAO Hong-yan;SONG Yang;ZHUANG Yan-hua;ZHU Qian-qian;CAO Hui;SU Jun-hong;ZHANG Qing-mei(Department of Neurology,the People's Hospital of Shihezi,Shihezi 832000,Xinjiang,China)

机构地区：[1]石河子市人民医院神经内科一病区

出　　处：《广东医学》2020年第1期61-65,共5页Guangdong Medical Journal

基　　金：第八师石河子市人民医院科技计划项目(2018LC07)

摘　　要：目的探讨帕金森病患者睡眠障碍特点,并分析睡眠障碍影响因素。方法选取帕金森病患者65例,依据有无睡眠障碍将其分为睡眠障碍组(40例)及非睡眠障碍组(25例)。收集患者基本临床资料并行睡眠量表(PDSS、ESS)、情感量表(HAMA、HAMD)、认知量表(MMSE)测定及视频多导睡眠监测。结果 (1)睡眠障碍组总睡眠时间、睡眠效率、N3期比例、快速眼动睡眠(rapid eye movement, REM)期比例低于非睡眠障碍组,而周期性肢动指数、N1期比例、N2期比例高于非睡眠障碍组,差异均有统计学意义(P<0.01);(2)睡眠障碍组多巴丝肼片等效剂量、HAMA、HAMD、PDSS、ESS、同型半胱氨酸(Hcy)水平高于非睡眠障碍组,而三酰甘油(TG)、总胆固醇(TC)、尿酸水平低于非睡眠障碍组,差异均有统计学意义(P<0.05);且TG、TC、尿酸水平与睡眠障碍呈负相关(r=-0.346、-0.379、-0.839,P<0.01),多巴丝肼片等效剂量、Hcy、HAMA、HAMD水平与睡眠障碍呈正相关(r=0.321、0.287、0.615、0.445,P<0.05);(3)二元logistic回归分析显示多巴丝肼片等效剂量、HAMA、HAMD的水平增高可能是睡眠障碍发生的危险因素,OR值分别为4.661(95%CI 1.489~14.593)、1.325(95%CI 1.085~1.616)及1.243(95%CI 1.012~1.527);尿酸、TG、TC的降低可能是睡眠障碍发生的保护因素,OR值分别为0.869(95%CI 0.777~0.972)、0.267(95%CI 0.086~0.828)及0.188(95%CI 0.049~0.720)。结论帕金森病伴睡眠障碍者睡眠结构是紊乱的,多巴丝肼片等效剂量、HAMA、HAMD的水平升高可能是帕金森病睡眠障碍发生的危险因素,而尿酸、TG、TC水平升高可能是帕金森病睡眠障碍发生的保护因素,其可能有助于防止帕金森病的发生。Objective To investigate the characteristics of sleep disorders in patients with Parkinson′s disease, and to analyze its influencing factors. Methods Sixty-five patients with Parkinson′s disease were divided into sleep disorder group(40 cases) and non-sleep disorder group(25 cases). The basic clinical data of patients were collected, and the sleep scale(PDSS, ESS), emotional scale(HAMA, HAMD), cognitive scale(MMSE) and video polysomnography were measured. Results The total sleep time, sleep efficiency, N3 phase ratio and REM phase ratio in the sleep disorder group were significantly lower than those in the non-sleep disorder group;while the cyclic limb movement index, N1 phase ratio and N2 phase ratio were significantly higher than those in the non-sleep disorder group. The equivalent dose of madopar, HAMA, HAMD, PDSS, Epworth and Hcy levels in sleep disorder group were significantly higher than those in non-sleep disorder group;while the levels of TG, TC and uric acid were significantly lower than those in sleep disorder group. The levels of TG, TC and uric acid were significantly negatively correlated with sleep disorders(P<0.01);while the levels of equivalent dose of madopar, Hcy, HAMA and HAMD were significantly positively correlated with sleep disorders(P<0.05). Bivariate logistic regression analysis showed that the increase of equivalent dose of madopar, HAMA and HAMD levels might be the risk factors of sleep disorders;with ORs of 4.661(95%CI: 1.489-14.593), 1.325(95% CI: 1.085-1.616) and 1.243(95% CI: 1.012-1.527), respectively. The reduction of uric acid, TG and TC might be the protective factors of sleep disorders;with the ORs of 0.869(95%CI: 0.777-0.972), 0.267(95%CI: 0.086-0.828) and 0.188(95%CI: 0.049-0.720), respectively. Conclusion The sleep structure of Parkinson′s disease patients with sleep disorder is distorted. Increased levels of equivalent dose of Madopa, HAMA and HAMD may be risk factors for them;while the reduction of uric acid, TG and TC may be the protective factors of sleep disorde

关 键 词：帕金森病 睡眠障碍 多导睡眠监测 影响因素 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学]