老年帕金森病患者日间过度思睡的临床调查及相关因素分析

目的了解老年帕金病(PD)患者日间过度思睡(EDS)的临床情况及相关因素。方法收集北京医院老年PD患者80例和年龄、性别相匹配的健康对照者50名,采用爱泼沃斯思睡量表(ESS)评定EDS,简易精神状态量表(MMSE)评定智能状况,比较PD患者和健康对照的EDS情况,同时对PD患者进行改良Webster评分、Hoehn-Yahr(H-Y)分期、Hamilton抑郁和焦虑量表调查,并询问是否具有夜间易醒、疲倦、不宁腿综合征、日间睡眠发作、夜间入睡困难、是否应用多巴受体激动剂及多巴胺药物的用量。根据ESS评分情况将PD患者分为EDS组(ESS≥10)和非EDS组(ESS<10分),并对两组间的上述调查项目进行比较。同时以ESS总分为因变量,以计量资料年龄、Hoehn-Yahr分级、左旋多巴用量、Webster评分、病程、Hamilton抑郁和焦虑评分及睡眠时间为自变量进行多元逐步回归分析,分析ESS评分与以上各因素的相关性。结果 80例PD患者中23例(28.8%)ESS≥10分,健康对照组5名(10.0%)ESS≥10分,两组有差异有统计学意义(χ2=6.40,P=0.01)。EDS组23例(男10例、女13例),年龄(72.26±5.94)岁,日间疲倦18例(78.26%),Hamilton抑郁量表评分(13.57±3.31)分,Hamilton焦虑量表评分(19.13±5.38)分,病程(7.65±4.12)年,非EDS组57例(男40例、女17例),年龄(68.58±5.27)岁,日间疲倦18例(31.58%),Hamilton抑郁量表评分(7.32±2.71)分,Hamilton焦虑量表评分(13.25±5.12)分,病程(5.55±3.40)年,两组间比较有统计学差异(均P<0.05);两组患者Hoe-hn-Yahr分级、改良Webster评分、应用左旋多巴剂量、是否应用多巴受体激动剂、夜间睡眠时间、入睡困难、不宁腿综合征、夜间易醒均无统计学差异(均P>0.05)。多元逐步回归分析结果显示,PD患者年龄和抑郁程度与ESS评分相关(分别回归系数=0.10,标准偏回归系数=0.16,P=0.04;回归系数=0.59,标准偏回归系数=0.66,P=0.00),抑郁程度相关性更强。结论老年PD患者EDS较为常见,可能受年龄和抑郁情绪的影响,但与疾病严重程度可能不存在相关性。

Daytime sleepiness in elderly patients with Parkinson disease and related factors

Objective To analyze the occurrence and related factors of excessive daytime sleepiness(EDS) in elderly patients with Parkinson disease(PD). Methods Epworth sleepiness scale(ESS),and mini-mental state examination(MMSE) were used to evaluate 80 cases of elderly patients with PD and 50 age-and sex-matched healthy controls,while patients were also evaluated with modified Webster score,Hoehn-Yahr stage,Hamilton depression and anxiety scale.The patients were asked whether they were waken up easily and had difficulty falling asleep at night,whether they experienced daytime fatigue and sleep attacks,restless leg syndrome and using dopamine agonist drugs,and levodopa dosage and duration of the disease.According to ESS score,PD patients were divided into EDS(ESS ≥ 10) and non-EDS(ESS <10 points) groups,and the survey items between the two groups were compared.The multiple regression analysis was adopted to analyze the relevance between the ESS score and the age of patients,Hoehn-Yahr stage,levodopa dosage,Webster score,duration of the disease,Hamilton depression and anxiety scores,and sleep time. Results There were 23 patients(28.8%) with EDS(ESS≥10),which was higher compared with the control group(10%)(χ2=6.40,P=0.01).In the EDS group(10 males and 13 females with age 72.26 ± 5.94),18 cases experienced daytime fatigue(78.26%),Hamilton Depression Rating Scale(HAMD) score was 13.57 ± 3.31 points,Hamilton Anxiety Rating Scale(HAMA) score 19.13 ± 5.38 points,duration of the disease 7.65 ± 4.12 years.In the non-EDS group(40 males and 17 females with age 68.58 ± 5.27),daytime fatigue was present in 18 cases(31.58%),HDMD score was 7.32 ± 2.71 points,HDMA score 13.25 ± 5.12 points,duration of the disease 5.55 ± 3.40 years.There were significant differences between the two groups in above parameters(all P<0.05).There were no significant differences between the two groups of patients regarding Hoehn-Yahr stage,modified Webster score,levodopa metering application,the application of dopamine receptor agonists,night sleep,difficulty in falling asleep,restless legs syndrome,and night fitfully(P>0.05).Multivariate analysis revealed that age and severity of depression affected the ESS score(regression coefficients=0.10,P=0.04;regression coefficients=0.59,P=0.00,respectively),especially the degree of depression(standard partial regression coefficients = 0.66). Conclusions EDS was more common in elderly patients with PD as compared with the controls.Many factors were possibly related to it,especially age and depression.There may be no correlation between EDS and disease severity.The reasons on EDS occurrence in PD remain to be further explored.