Insomnia and Sleepiness in Parkinson Disease: Associations with Symptoms and Comorbidities
Insomnia and Sleepiness in Parkinson Disease: Associations with Symptoms and Comorbidities
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DOI：
10.5664/jcsm.3150
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发表时间：
2013-01-01
影响因子：
4.3
通讯作者：
Chervin, Ronald D.
中科院分区：
文献类型：
--
作者：
Chung, Seockhoon;Bohnen, Nicolaas I.;Chervin, Ronald D.
研究目的：帕金森病（PD）患者的常见主诉是失眠和白天嗜睡，但其主要原因尚不清楚。我们研究了运动和非运动症状的PD对睡眠problems.Methods的潜在影响：PD患者（n = 128）进行了评估，使用Inflammation严重程度指数，埃普沃思嗜睡量表，统一帕金森病评定量表，贝克抑郁量表，疲劳严重程度量表，自主神经症状调查，和39项帕金森病问卷。受试者子集结果：多元逐步Logistic回归模型显示，主观失眠与抑郁情绪独立相关（OR = 1.79; 95%置信区间（CI）[1.01-3.19]）、自主神经症状（1.77 [1.08-2.90]）、疲劳（1.19 [1.02-1.38]）和年龄（0.61 [0.39-0.96]）。主观日间嗜睡与多巴胺能药物剂量（1.74 [1.08-2.80]）和疲劳（1.14 [1.02-1.28]）相关。在多导睡眠图上，较长的睡眠潜伏期与自主神经症状（rho = 0.40，p = 0.01）和统一PD评定量表的第I部分（非运动症状）（rho = 0.38，p = 0.02）相关。睡眠效率降低与自主神经症状相关（rho =-0.42，p < 0.0001）。然而，多导睡眠图和MSLT在有或无失眠或白天嗜睡的患者之间无显著差异。较高的呼吸暂停事件的发生率并预测较短的睡眠laveliment上的MSLTs.Conclusions：非运动症状似乎与主观失眠，而疲劳和多巴胺能药物与主观白天嗜睡。尽管客观测量阻塞性睡眠呼吸暂停可预测嗜睡恶化，但客观的睡眠实验室数据对失眠和嗜睡的投诉几乎没有提供深入的了解。
Study Objectives: Insomnia and daytime sleepiness are common complaints in Parkinson disease (PD), but the main causes remain unclear. We examined the potential impact of both motor and non-motor symptoms of PD on sleep problems.Methods: Patients with PD (n = 128) were assessed using the Insomnia Severity Index, Epworth Sleepiness Scale, Unified Parkinson Disease Rating Scale, Beck Depression Inventory, Fatigue Severity Scale, Survey of Autonomic Symptoms, and the 39-item Parkinson Disease Questionnaire. A subset of subjects (n = 38, 30%) also completed nocturnal polysomnography and a multiple sleep latency test (MSLT).Results: Multivariate stepwise logistic regression models revealed that subjective insomnia was independently associated with depressed mood (odds ratio [OR] = 1.79; 95% confidence interval (CI) [1.01-3.19]), autonomic symptoms (1.77 [1.08-2.90]), fatigue (1.19 [1.02-1.38]), and age (0.61 [0.39-0.96]). Subjective daytime sleepiness was associated with dosage of dopaminergic medication (1.74 [1.08-2.80]) and fatigue (1.14 [1.02-1.28]). On polysomnography, longer sleep latency correlated with autonomic symptoms (rho = 0.40, p = 0.01) and part I (non-motor symptoms) of the Unified PD Rating Scale (rho = 0.38, p = 0.02). Decreased sleep efficiency correlated with autonomic symptoms (rho = -0.42, p < 0.0001). However, no significant difference emerged on polysomnography and MSLTs between patients with or without insomnia or daytime sleepiness. Higher rates of apneic events did predict shorter sleep latencies on the MSLTs.Conclusions: Non-motor symptoms appear to be associated with subjective insomnia, whereas fatigue and dopaminergic medication are associated with subjective daytime sleepiness. Objective sleep laboratory data provided little insight into complaints of insomnia and sleepiness, though obstructive sleep apnea predicted worsened sleepiness when measured objectively.