Joy Sanju P, Sinha Sanjib, Pal Pramod Kumar, Panda Samhita, Philip M, Taly Arun B
Department of Neurology, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
Department of Biostatistics, National Institute of Mental health and Neurosciences, Bangalore, Karnataka, India.
Ann Indian Acad Neurol. 2015 Jul-Sep;18(3):309-13. doi: 10.4103/0972-2327.160102.
We studied the sleep macroarchitecture with polysomnography (PSG) in drug naïve patients with Parkinson's disease (PD) and reassessed them following treatment with levodopa.
This prospective hospital-based study included 15 patients with PD (age: 59 ± 11.2 years, duration of PD: 11.8 ± 12.3 months; and male: female (M:F) = 11:4). They were assessed for demography, phenotype, modified Hoehn and Yahr staging (H & Y); Schwab and England and Activities of Daily Living (S and E ADL) Scale; and Unified PDRating Scale (UPDRS). Sleep was assessed using Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and National Institute of Mental Health and Neurosciences (NIMHANS) comprehensive sleep disorder questionnaire. They underwent overnight PSG at baseline and after13.3 ± 5.7 months of levodopa (440 mg/day).
Patients with PD had responded to levodopa as indicated by the significant improvement in UPDRS motor score in ON state compared to OFF state. Nocturnal sleep quality indices did not vary significantly, but the excessive daytime somnolence improved (P = 0.04) with levodopa. Sleep efficiency (P = 0.65), latency to sleep onset (P = 0.19), latency to stage 1 (P = 0.12), and duration of stage 1 (P = 0.55) had increased. Duration of 'awake in bed' (P = 0.24), slow wave sleep (P = 0.29), and rapid eye movement (REM) sleep (P = 0.24) decreased with treatment. Periodic leg movements (PLMs) had reduced (P = 0.68) and mean oxygen saturation during sleep improved (P = 0.002). Surprisingly, snore index (P < 0.03) during sleep had increased with levodopa.
Sleep alterations in PD occur even in early stages due to the disease process. There was improvement in most of the parameters of sleep macroarchitecture with levodopa.
我们使用多导睡眠图（PSG）研究了未服用过药物的帕金森病（PD）患者的睡眠宏观结构，并在左旋多巴治疗后对他们进行了重新评估。
这项基于医院的前瞻性研究纳入了15例PD患者（年龄：59±11.2岁，PD病程：11.8±12.3个月；男性∶女性（M∶F）=11∶4）。对他们进行了人口统计学、表型、改良Hoehn和Yahr分期（H&Y）、Schwab和England日常生活活动（S和E ADL）量表以及统一帕金森病评定量表（UPDRS）的评估。使用Epworth嗜睡量表（ESS）、匹兹堡睡眠质量指数（PSQI）和国家心理健康与神经科学研究所（NIMHANS）综合睡眠障碍问卷对睡眠进行评估。他们在基线时以及左旋多巴（440毫克/天）治疗13.3±5.7个月后接受了整夜PSG检查。
与关期相比，PD患者在开期的UPDRS运动评分有显著改善，表明对左旋多巴有反应。夜间睡眠质量指标没有显著变化，但左旋多巴治疗后日间过度嗜睡有所改善（P=0.04）。睡眠效率（P=0.65）、入睡潜伏期（P=0.19）、进入1期的潜伏期（P=0.12）和1期持续时间（P=0.55）均增加。治疗后“床上觉醒”持续时间（P=0.24）、慢波睡眠（P=0.29）和快速眼动（REM）睡眠（P=0.24）减少。周期性腿部运动（PLMs）减少（P=0.68），睡眠期间的平均血氧饱和度提高（P=0.002）。令人惊讶的是，左旋多巴治疗后睡眠期间的打鼾指数（P<0.03）增加。
即使在疾病早期，PD患者也会出现睡眠改变。左旋多巴治疗后，睡眠宏观结构的大多数参数都有所改善。
