Simuni Tanya, Caspell-Garcia Chelsea, Coffey Christopher, Chahine Lama M, Lasch Shirley, Oertel Wolfgang H, Mayer Geert, Högl Birgit, Postuma Ron, Videnovic Aleksandar, Amara Amy Willis, Marek Ken
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
The University of Iowa, Iowa City, IA, USA.
Mov Disord. 2015 Sep;30(10):1371-81. doi: 10.1002/mds.26248. Epub 2015 Jun 11.
This study was undertaken to determine the frequency and correlates of excessive daytime sleepiness in de novo, untreated Parkinson's disease (PD) patients compared with the matched healthy controls.
Data were obtained from the Parkinson's Progression Markers Initiative, an international study of de novo, untreated PD patients and healthy controls. At baseline, participants were assessed with a wide range of motor and nonmotor scales, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Excessive daytime sleepiness was assessed based on the Epworth Sleepiness scale (ESS), with a cutoff of 10.
Four hundred twenty-three PD subjects and 196 healthy controls were recruited into the study. Mean ESS (min, max) score was 5.8 (0, 20) for the PD subjects and 5.6 (0, 19) for healthy controls (P = 0.54). Sixty-six (15.6%) PD subjects and 24 (12%) healthy controls had ESS of at least 10 (P = 0.28). No difference was seen in demographic characteristics, age of onset, disease duration, PD subtype, cognitive status, or utilization of sedatives between the PD sleepiness-positive versus the negative group. The sleepiness-positive group had higher MDS-UPDRS Part I and II but not III scores, and higher depression and autonomic dysfunction scores. Sleepiness was associated with a marginal reduction of A-beta (P = 0.05) but not alpha-synuclein spinal fluid levels in PD.
This largest case control study demonstrates no difference in prevalence of excessive sleepiness in subjects with de novo untreated PD compared with healthy controls. The only clinical correlates of sleepiness were mood and autonomic dysfunction. Ongoing longitudinal analyses will be essential to further examine clinical and biological correlates of sleepiness in PD and specifically the role of dopaminergic therapy.
本研究旨在确定初发、未治疗的帕金森病（PD）患者与匹配的健康对照者相比，日间过度嗜睡的频率及其相关因素。
数据来自帕金森病进展标志物倡议研究，这是一项针对初发、未治疗的PD患者和健康对照者的国际研究。在基线时，使用多种运动和非运动量表对参与者进行评估，包括运动障碍协会统一帕金森病评定量表（MDS-UPDRS）。基于爱泼华嗜睡量表（ESS）评估日间过度嗜睡，临界值为10分。
423名PD受试者和196名健康对照者被纳入研究。PD受试者的平均ESS（最小值，最大值）评分为5.8（0，20），健康对照者为5.6（0，19）（P = 0.54）。66名（15.6%）PD受试者和24名（12%）健康对照者的ESS至少为10分（P = 0.28）。PD嗜睡阳性组与阴性组在人口统计学特征、发病年龄、病程、PD亚型、认知状态或镇静剂使用方面均无差异。嗜睡阳性组的MDS-UPDRS第一部分和第二部分评分较高，但第三部分评分无差异，且抑郁和自主神经功能障碍评分较高。在PD中，嗜睡与β-淀粉样蛋白水平略有降低相关（P = 0.05），但与α-突触核蛋白脑脊液水平无关。
这项最大规模的病例对照研究表明，初发未治疗的PD患者与健康对照者相比，过度嗜睡的患病率无差异。嗜睡的唯一临床相关因素是情绪和自主神经功能障碍。持续的纵向分析对于进一步研究PD中嗜睡的临床和生物学相关因素，特别是多巴胺能治疗的作用至关重要。
