帕金森病患者睡眠障碍的多导睡眠图、多次睡眠潜伏期试验分析

目的 使用多导睡眠图、多次睡眠潜伏期试验客观分析帕金森病(PD)患者睡眠障碍特征.方法 对26例临床确诊的PD患者(PD组)和31名无明显中枢神经系统疾病的对照者(对照组)行全夜可移动视频多导睡眠监测及次日多次睡眠潜伏期试验,分析比较2组患者睡眠结构及平均睡眠潜伏期、入睡期快速眼球运动(REM)睡眠(SOREMPs)、睡眠发作(Sas)情况.结果 PD组N2睡眠期百分比(32.8%±13.1%)、REM睡眠期百分比(8.6%±5.3%)、平均睡眠潜伏期(9.6±4.4)min]较对照组40.2%±9.1%、11.5%±5.1%、(15.7±3.1)min]明显降低(t=-2.515、-2.054、-6.164,P＜0.05),PD组醒觉指数(41.8±32.1)次/h]较对照组(28.6±11.0)次/h]明显升高(t=2.151,P＜0.05).PD患者中出现日间过度瞌睡(EDS)7例(7/26,26.9%),明显高于对照组(1/31,3.2%;×2=4.764,P＜0.05).多元逐步线性回归分析显示校正睡眠效率、呼吸暂停低通气指数、醒觉指数,PD患者平均睡眠潜伏期的缩短与年龄(β=-0.328)、左旋多巴等效剂量(β=-0.008)的增加呈线性相关(t=-2.829、-2.352,均P＜0.05).PD组有5例(5/26,19.2%)出现SOREMPs,3例(11.5%)出现Sas,而对照组均无出现SOREMPs和Sas.结论 PD患者睡眠结构改变和EDS较常见,虽然PD患者中Sas不多见,但临床医师需提高警惕.

Analysis of sleep disorders in patients with Parkinson' s disease using polysomnogram and multiple sleep latency test

Objective To objectively analyze the manifestation of sleep disorders in patients with Parkinson' s disease (PD) using polysomnogram (PSG) and multiple sleep latency test (MSLT). Method Twenty-six patients (PD group)with PD and 31 controls without CNS diseases( control group) underwent all night ambulatory video-polysomnographic monitoring and MSLT on the next day. Sleep architecture, mean sleep latency,sleep onset rapid eye movement (REM) periods(SOREMPs) and sleep attacks(Sas) of the two groups were analyzed. Results When compared to the controls, percentage of NREM stage 2 sleep,percentage of REM sleep, mean sleep latency in the PD patient group were significantly decreased (32.8% ±13.1% vs40.2% ±9.1%,t = -2.515;8.6% ±5.3% vs 11.5% ±5.1%,t = -2.054;(9.6 ± 4. 4) min vs ( 15.7 ± 3. 1 ) min, t = - 6. 1 64, all P ＜ 0. 05 ), while arousal index was significantly increased ( (41.8 ± 32. 1 )/h vs ( 28.6 ± 1 1. 0 )/h, t = 2. 151, P ＜ 0. 05 ). The prevalence of excessive daytime sleepiness (EDS; 7/26, 26. 9% ) was higher in the PD patient group than in the controls (1/31,3. 2%; ×2 =4. 764,P＜0. 05). Multivariate linear regression analysis showed that after adjusting for sleep efficiency, apnea hypopnea index, arousal index, decreasing mean sleep latency in PD patients was significantly associated with both age( β = -0. 328) and levodopa equivalents( β = -0. 008; t = -2. 829,-2. 352,all P ＜ 0.05). SOREMPs occurred in 5 of 26 (19.2%) PD patients and Sas occurred in 3 ( 11.5% ) PD patients but did not occur in the controls. Conclusion Changes in sleep architectures and EDS are more common in PD patients. Physicians should be highly vigilant in recognizing Sas, which are uncommon in PD patients.