Department of Neurology, University Hospital, Zurich, Switzerland.
J Sleep Res. 2012 Dec;21(6):710-7. doi: 10.1111/j.1365-2869.2012.01027.x. Epub 2012 Jul 2.
Sleep-wake disturbances are frequent in patients with Parkinson's disease, but prospective controlled electrophysiological studies of sleep in those patients are surprisingly sparse, and the pathophysiology of sleep-wake disturbances in Parkinson's disease remains largely elusive. In particular, the impact of impaired dopaminergic and hypocretin (orexin) signalling on sleep and wakefulness in Parkinson's disease is still unknown. We performed a prospective, controlled electrophysiological study in patients with early and advanced Parkinson's disease, e.g. in subjects with presumably different levels of dopamine and hypocretin cell loss. We compared sleep laboratory tests and cerebrospinal fluid levels with hypocretin-deficient patients with narcolepsy with cataplexy, and with matched controls. Nocturnal sleep efficiency was most decreased in advanced Parkinson patients, and still lower in early Parkinson patients than in narcolepsy subjects. Excessive daytime sleepiness was most severe in narcolepsy patients. In Parkinson patients, objective sleepiness correlated with decrease of cerebrospinal fluid hypocretin levels, and repeated hypocretin measurements in two Parkinson patients revealed a decrease of levels over years. This suggests that dopamine and hypocretin deficiency differentially affect sleep and wakefulness in Parkinson's disease. Poorer sleep quality is linked to dopamine deficiency and other disease-related factors. Despite hypocretin cell loss in Parkinson's disease being only partial, disturbed hypocretin signalling is likely to contribute to excessive daytime sleepiness in Parkinson patients.
睡眠-觉醒障碍在帕金森病患者中很常见，但对这些患者睡眠进行前瞻性对照电生理学研究的却少之又少，帕金森病睡眠-觉醒障碍的病理生理学仍然很大程度上难以捉摸。特别是，多巴胺能和下丘脑分泌素（食欲素）信号受损对帕金森病睡眠和觉醒的影响仍不清楚。我们对早期和晚期帕金森病患者进行了前瞻性对照电生理学研究，例如在多巴胺和下丘脑分泌素细胞丢失程度不同的患者中进行研究。我们将睡眠实验室测试和脑脊液水平与伴有猝倒的发作性睡病伴下丘脑分泌素缺乏患者以及匹配的对照组进行了比较。晚期帕金森病患者的夜间睡眠效率下降最明显，而早期帕金森病患者的睡眠效率仍低于发作性睡病患者。白天过度嗜睡在发作性睡病患者中最为严重。在帕金森病患者中，客观嗜睡与脑脊液下丘脑分泌素水平下降相关，对两名帕金森病患者的重复下丘脑分泌素测量显示，水平随时间下降。这表明多巴胺和下丘脑分泌素缺乏会以不同的方式影响帕金森病患者的睡眠和觉醒。较差的睡眠质量与多巴胺缺乏和其他与疾病相关的因素有关。尽管帕金森病中下丘脑分泌素细胞的丢失只是部分的，但下丘脑分泌素信号的紊乱可能会导致帕金森病患者白天过度嗜睡。
