帕金森病患者睡眠障碍的临床特征及相关因素分析
发布时间：2018-08-21 13:06
【摘要】：研究目的:1.分析PD患者睡眠障碍的临床特点。2.分析不同类型、不同严重程度的PD患者睡眠障碍的特点。3.探讨PD患者睡眠障碍与其他临床特征的相关性。研究方法:连续收集2016年1月至2017年1月就诊于我院并诊断为原发性PD患者81例,同期健康体检者80例作为对照。询问受试者的一般信息,包括姓名、性别、年龄、文化程度等。对于PD患者:采用修订后Hoehn-Yahr分期(H-Y分期)、统一帕金森病评定量表第三部分(UPDRS-III)评定PD患者的疾病严重程度及类型,H-Y分期:1~2期为轻度,2.5~3期为中度,4~5期为重度;根据PD患者症状的表现形式分为震颤型、强直型、混合型。对于受试者睡眠方面评估:采用帕金森病睡眠量表(PDSS)评估夜间睡眠情况、Epworth睡眠量表(ESS)评价日间嗜睡情况、快眼动期睡眠行为障碍(RBD)筛查问卷评估RBD的存在情况。其他非运动症状:采用自主神经症状量表(SCOPA-AUT)评价自主神经功能;汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评价焦虑、抑郁状态;蒙特利尔认知评估量表(Mo CA)、简易精神状态检查量表(MMSE)评价认知功能;日常生活活动能力量表(ADL)来评估日常生活能力。研究结果:1.PD患者中男性49例(60.5%),女性32例(39.5%);年龄25~89岁,平均(61.85±11.47)岁;病程0.5~10年,平均(2.33±2.51)年;脑力劳动者37例(45.7%),体力劳动者44例(54.3%);H-Y分期0~5期,平均为(1.80±1.05)期;UPDRS-Ⅲ分值1~82,平均为(27.43±16.585)。PD患者:早期61例(75.3%),中期16例(19.8%),晚期4例(4.9%);强直型20例(24.7%),震颤型11例(13.6%),混合型50例(61.7%)。2.PD组与对照组相比,SCOPA-AUT、HAMA、HAMD总分差异有统计学意义。PD组焦虑发生率12.3%,显著高于对照组,差异有统计学意义(c2=14.393,P0.001)。PD组抑郁发生率为7.4%,显著高于对照组,差异有统计学意义。PD组与对照组在PDSS-2~15、PDSS-T、ESS、RBDSQ总分值上差异有统计学意义,PDSS-1差异无统计学意义。以PDSS各项评分≤5分为各睡眠症状严重的标准,PD组在PDSS-1、PDSS-3~13、PDSS-15、ESS、RBDSQ与对照组,两组间比较差异有统计学意义(P0.05);PDSS-2、PDSS-14与对照组比较,差异无统计学意义。PD组睡眠障碍的发生率为58.0%,高于对照组36.3%,差异有统计学意义(P0.05)。PD组日间嗜睡发生率17.3%,显著高于对照组2.5%,差异有统计学意义。RBDSQ6可认为存在RBD,PD组RBD的发生率9.9%,与对照组1.3%相比差异有统计学意义。3.早期、中期、晚期PD患者三组之间PDSS总分及PDSS-1~15、ESS、RBDSQ分值差异无统计学意义。三组之间由于不能行动而导致的尿失禁(PDSS-9)的发生率差异有统计学意义,晚期PD患者显著高于早、中期。4.强直型、震颤型、混合型PD患者,三组之间PDSS-1~15、PDSS-T、ESS、RBDSQ总分之间差异无显著性。三组之间的睡眠障碍症状的发生率在PDSS-1~8、PDSS-10~11、PDSS-13、PDSS-15、ESS之间差异有统计学意义。5.PDSS与NMS(r=-0.341,P=0.002)、SCOPA-AUT(r=-0.340,P=0.002)、HAMA(r=-0.549,P0.001)、HAMD(r=-0.423,P0.001)呈负相关;与年龄(r=-0.218,P=0.05)、性别(r=-0.209,P=0.061)、职业(r=0.037,P=0.744)、病程(r=-0.087,P=0.438)、程度(r=-0.141,P=0.209)、分型(r=-0.055,P=0.626)、H-Y分期(r=-0.151,P=0.181)、UPDRS-Ⅲ(r=-0.181,P=0.107)、MMSE(r=-0.083,P=0.463)、Mo CA(r=-0.091,P=0.418)、ADL(r=-0.198,P=0.076)不具有相关性。研究结论:1.PD患者睡眠障碍发生率高,表现形式以夜间总体睡眠质量差、入睡困难、保持睡眠困难、夜间排尿、夜间梦境困扰为主,且存在白天过度嗜睡、RBD。2.不同严重程度、不同临床亚型的PD患者睡眠障碍的表现形式不同。晚期患者较中、早期患者相比更容易出现不能行动而导致的尿失禁;混合型PD患者较震颤型、强直型PD患者睡眠障碍的发病率高,三者之间睡眠障碍的表现形式显著不同。3.焦虑、抑郁、自主神经功能障碍是PD患者睡眠障碍的影响因素。
[Abstract]:Objective: 1. To analyze the clinical characteristics of sleep disorders in PD patients. 2. To analyze the characteristics of sleep disorders in different types and severity of PD patients. 3. To explore the correlation between sleep disorders and other clinical features in PD patients. For PD patients, the revised Hoehn-Yahr staging (H-Y staging) and the Unified Parkinson's Disease Rating Scale (UPDRS-III) were used to assess the severity and type of the disease. H-Y staging: 1-2 was mild, and 2.5-3 was mild. According to the manifestations of symptoms in PD patients, they were divided into tremor type, ankylosing type and mixed type. Other non-motor symptoms: autonomic nervous function was assessed with SCOPA-AUT; anxiety and depression were assessed with Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD); cognitive function was assessed with Montreal Cognitive Assessment Scale (Mo CA), Simple Mental State Examination Scale (MMSE); daily living activities (ADL). Results: 1. Among the patients with PD, 49 (60.5%) were males and 32 (39.5%) were females; the age ranged from 25 to 89 years, with an average of (61.85 + 11.47) years; the course of disease ranged from 0.5 to 10 years, with an average of (2.33 + 2.51) years; 37 (45.7%) were mental workers, 44 (54.3%) were manual workers; the H-Y stage ranged from 0 to 5, with an average of (1.80 + 1.05); UPDRS-III score. PD patients: 61 cases (75.3%), 16 cases (19.8%) in the early stage, 4 cases (4.9%) in the late stage, 20 cases (24.7%), 11 cases (13.6%) in the ankylosing type, and 50 cases (61.7%) in the mixed type. 2. Compared with the control group, the total scores of SCOPA-AUT, HAMA and HAMD in the PD group were significantly different. The incidence of anxiety in the SCOPA-AUT, HAMA and HAMD group was 12.3%, significantly higher than that in the control group. The incidence of depression in PD group was 7.4%, which was significantly higher than that in the control group. The total scores of PDSS-2-15, PDSS-T, ESS and RBDSQ in PD group and the control group were significantly different. There was no significant difference in PDSS-1. The incidence of sleep disorders in PD group was 58.0%, higher than that in control group (36.3%, P 0.05). The incidence of daytime sleepiness in PD group was 17.3%, significantly higher than that in control group (2.5%). The incidence of RBD was 9.9% in the PD group and 1.3% in the control group. 3. There was no significant difference in the total score of PDSS and PDSS-1-15, ESS and RBDSQ among the three groups in the early, middle and late stages of PD. There was no significant difference in the total scores of PDSS-1-15, PDSS-T, ESS and RBDSQ among the three groups. The incidence of sleep disorders among the three groups was significantly higher than that among the early, middle and late PD patients. 41,P=0.002),SCOPA-AUT(r=-0.340,P=0.002),HAMA(r=-0.549,P0.001),HAMD(r=-0.423,P0.001)鍛堣礋鐩稿叧;涓庡勾榫，
本文编号：2195826
[Abstract]:Objective: 1. To analyze the clinical characteristics of sleep disorders in PD patients. 2. To analyze the characteristics of sleep disorders in different types and severity of PD patients. 3. To explore the correlation between sleep disorders and other clinical features in PD patients. For PD patients, the revised Hoehn-Yahr staging (H-Y staging) and the Unified Parkinson's Disease Rating Scale (UPDRS-III) were used to assess the severity and type of the disease. H-Y staging: 1-2 was mild, and 2.5-3 was mild. According to the manifestations of symptoms in PD patients, they were divided into tremor type, ankylosing type and mixed type. Other non-motor symptoms: autonomic nervous function was assessed with SCOPA-AUT; anxiety and depression were assessed with Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD); cognitive function was assessed with Montreal Cognitive Assessment Scale (Mo CA), Simple Mental State Examination Scale (MMSE); daily living activities (ADL). Results: 1. Among the patients with PD, 49 (60.5%) were males and 32 (39.5%) were females; the age ranged from 25 to 89 years, with an average of (61.85 + 11.47) years; the course of disease ranged from 0.5 to 10 years, with an average of (2.33 + 2.51) years; 37 (45.7%) were mental workers, 44 (54.3%) were manual workers; the H-Y stage ranged from 0 to 5, with an average of (1.80 + 1.05); UPDRS-III score. PD patients: 61 cases (75.3%), 16 cases (19.8%) in the early stage, 4 cases (4.9%) in the late stage, 20 cases (24.7%), 11 cases (13.6%) in the ankylosing type, and 50 cases (61.7%) in the mixed type. 2. Compared with the control group, the total scores of SCOPA-AUT, HAMA and HAMD in the PD group were significantly different. The incidence of anxiety in the SCOPA-AUT, HAMA and HAMD group was 12.3%, significantly higher than that in the control group. The incidence of depression in PD group was 7.4%, which was significantly higher than that in the control group. The total scores of PDSS-2-15, PDSS-T, ESS and RBDSQ in PD group and the control group were significantly different. There was no significant difference in PDSS-1. The incidence of sleep disorders in PD group was 58.0%, higher than that in control group (36.3%, P 0.05). The incidence of daytime sleepiness in PD group was 17.3%, significantly higher than that in control group (2.5%). The incidence of RBD was 9.9% in the PD group and 1.3% in the control group. 3. There was no significant difference in the total score of PDSS and PDSS-1-15, ESS and RBDSQ among the three groups in the early, middle and late stages of PD. There was no significant difference in the total scores of PDSS-1-15, PDSS-T, ESS and RBDSQ among the three groups. The incidence of sleep disorders among the three groups was significantly higher than that among the early, middle and late PD patients. 41,P=0.002),SCOPA-AUT(r=-0.340,P=0.002),HAMA(r=-0.549,P0.001),HAMD(r=-0.423,P0.001)鍛堣礋鐩稿叧;涓庡勾榫，
本文编号：2195826
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