Zhu Kangdi, van Hilten Jacobus J, Marinus Johan
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Parkinsonism Relat Disord. 2016 Mar;24:34-40. doi: 10.1016/j.parkreldis.2016.01.020. Epub 2016 Jan 22.
Excessive daytime sleepiness (EDS) is a common feature of Parkinson's disease (PD) that contributes to the disease burden and increases risk of harm. The aim of this study was to examine persistency, cross-sectional and longitudinal associations, and risk factors for EDS in patients with PD.
Analyses were performed on data from the SCOPA-PROPARK cohort, a 5-year hospital-based longitudinal cohort of over 400 PD patients who were examined annually. Cross-sectional analyses were conducted to evaluate differences between patients with and without EDS at baseline, while linear mixed models using data of all patients were used to identify factors associated with longitudinal changes in SCOPA-SLEEP-Daytime Sleepiness (SCOPA-SLEEP-DS) scores. A survival analysis was done using data of patients without EDS at baseline to identify risk factors for future EDS.
EDS proved a non-persistent symptom, although persistency and the proportion of patients with EDS increased with longer follow-up. At baseline 43% of patients had EDS, while 46% of patients without EDS at baseline developed this symptom during follow-up. Male gender, poorer nighttime sleep, cognitive and autonomic dysfunction, hallucinations, less severe dyskinesias, dose of dopamine agonists and use of antihypertensives were associated with higher EDS scores over time, while use of benzodiazepines was associated with lower scores. Baseline SCOPA-SLEEP-DS score and PIGD phenotype were risk factors for future EDS.
With longer disease duration a large proportion of patients develop EDS. Some risk factors are modifiable and patients should be monitored to improve quality of life and reduce risk of harm.
日间过度嗜睡（EDS）是帕金森病（PD）的常见特征，会加重疾病负担并增加伤害风险。本研究旨在探讨PD患者EDS的持续性、横断面和纵向关联以及危险因素。
对SCOPA-PROPARK队列的数据进行分析，该队列是一个基于医院的为期5年的纵向队列，有400多名PD患者，每年接受检查。进行横断面分析以评估基线时有无EDS患者之间的差异，同时使用所有患者的数据进行线性混合模型分析，以确定与SCOPA-睡眠-日间嗜睡（SCOPA-睡眠-DS）评分纵向变化相关的因素。使用基线时无EDS患者的数据进行生存分析，以确定未来发生EDS的危险因素。
EDS被证明是一种非持续性症状，尽管随着随访时间延长，EDS的持续性和患者比例有所增加。基线时43%的患者有EDS，而基线时无EDS的患者中有46%在随访期间出现了这种症状。男性、夜间睡眠较差、认知和自主神经功能障碍、幻觉、运动障碍较轻、多巴胺激动剂剂量以及使用抗高血压药物与随时间推移较高的EDS评分相关，而使用苯二氮䓬类药物与较低评分相关。基线SCOPA-睡眠-DS评分和姿势不稳-步态障碍（PIGD）表型是未来发生EDS的危险因素。
随着病程延长，很大一部分患者会出现EDS。一些危险因素是可改变的，应对患者进行监测，以提高生活质量并降低伤害风险。
