van Dijk Karin D, Møst Els I S, Van Someren Eus J W, Berendse Henk W, van der Werf Ysbrand D
Department of Neurology, VU University Medical Center Amsterdam, De Boelelaan 1118, Amsterdam, The Netherlands.
Mov Disord. 2009 Apr 30;24(6):878-84. doi: 10.1002/mds.22462.
Sleep disorders are common in Parkinson's disease (PD) and have profound negative influences on quality of life. Sleep structure in healthy participants can be changed by repetitive transcranial magnetic stimulation (rTMS), but this has never been studied systematically in PD. Therefore, we characterized sleep in PD patients and examined effects of rTMS using a combination of actigraphy and a pressure sensitive pad. Thirteen PD patients received 5 Hz rTMS over the motor or parietal cortex. Actigraphic sleep estimates were obtained before, during and after rTMS, as well as compared with 8 healthy, age-matched controls. Motor symptoms and mood were evaluated before and after rTMS. Mixed-model regression analyses indicated that PD patients slept shorter (350 +/- 17 vs. 419 +/- 24 min., P = 0.02), more fragmented (fragmentation index 41 +/- 4 vs. 22 +/- 2, P = 0.0004) and had a lower sleep efficiency (77 +/- 2 vs. 86 +/- 2%, P = 0.002) and longer nocturnal awakenings (3.4 +/- 0.2 vs. 2.3 +/- 0.2 min., P = 0.003) than healthy controls. rTMS over the parietal, but not over the motor cortex improved sleep fragmentation (P = 0.0002) and sleep efficiency (P = 0.0002) and reduced the average duration of nocturnal awakenings (P = 0.02). No change of motor symptoms or mood was observed. Disturbed sleep in PD patients may partly be reversed by parietal rTMS, without affecting motor symptoms or mood.
睡眠障碍在帕金森病（PD）中很常见，对生活质量有深远的负面影响。重复经颅磁刺激（rTMS）可改变健康参与者的睡眠结构，但在PD中从未进行过系统研究。因此，我们对PD患者的睡眠进行了特征描述，并使用活动记录仪和压力感应垫相结合的方法检查了rTMS的效果。13名PD患者在运动皮层或顶叶皮层接受5Hz的rTMS。在rTMS之前、期间和之后获得活动记录仪的睡眠估计值，并与8名年龄匹配的健康对照者进行比较。在rTMS之前和之后评估运动症状和情绪。混合模型回归分析表明，与健康对照者相比，PD患者睡眠时间更短（350±17分钟对419±24分钟，P = 0.02），睡眠更碎片化（碎片化指数41±4对22±2，P = 0.0004），睡眠效率更低（77±2%对86±2%，P = 0.002），夜间觉醒时间更长（3.4±0.2分钟对2.3±0.2分钟，P = 0.003）。顶叶皮层而非运动皮层的rTMS改善了睡眠碎片化（P = 0.0002）和睡眠效率（P = 0.0002），并减少了夜间觉醒的平均持续时间（P = 0.02）。未观察到运动症状或情绪的变化。PD患者的睡眠障碍可能部分通过顶叶rTMS得到改善，而不影响运动症状或情绪。
