Terzaghi Michele, Spelta Laura, Minafra Brigida, Rustioni Valter, Zangaglia Roberta, Pacchetti Claudio, Manni Raffaele
Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy.
Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy.
Sleep Med. 2017 May;33:114-118. doi: 10.1016/j.sleep.2017.01.009. Epub 2017 Jan 27.
Obstructive sleep apnea (OSA) is highly prevalent in Parkinson disease (PD) and is known to contribute to cognitive impairment and daytime sleepiness. We investigated feasibility of continuous positive airway pressure treatment (CPAP) and its effects on subjective daytime sleepiness and cognitive profile in PD plus OSA subjects in a longitudinal three months follow up study.
Seventy (age 71.7 ± 7.6, disease duration 9.9 ± 12.3, UPDRS-III 33.7 ± 12.5, MMSE 25.3 ± 3.6; years of education 7.7 ± 3.2) out of 228 consecutive PD patients undergoing in-lab video-polysomnography were found to have obstructive sleep apnea. Thirty-six subjects accepted to titrate therapeutic CPAP. Video-polysomnography, neuropsychological battery evaluating different cognitive domains and subjective scales for daytime sleepiness were scheduled at baseline and after three months. All the patients were given educational informations relative to diagnosis of OSA and benefits of OSA treatment, and an individualized training with CPAP.
Twenty-seven (75%) subjects dropped out of the study due to CPAP intolerance. No demographic or disease-related variables (in particular, severity of OSA), could be found between subjects who completed the study versus those who dropped out. Nine subjects completed the three-month follow up, and there were no significant changes in subjective sleepiness, neuropsychological scores and sleep structure (except for reduction in apnea/hypopnea index and a trend toward increase in stage N3 sleep).
Our data show that feasibility of CPAP treatment can be significantly threatened by overall attrition rates. Further studies should consider well-structured adherence promoting interventions. The actual role of OSA as a determinant of the profile of subjective daytime sleepiness and cognition in PD, and the effects of CPAP in PD need to be further studied.
阻塞性睡眠呼吸暂停（OSA）在帕金森病（PD）中非常普遍，已知其会导致认知障碍和日间嗜睡。在一项为期三个月的纵向随访研究中，我们调查了持续气道正压通气治疗（CPAP）在PD合并OSA患者中的可行性及其对主观日间嗜睡和认知状况的影响。
在228例接受实验室视频多导睡眠图检查的连续PD患者中，有70例（年龄71.7±7.6岁，病程9.9±12.3年，统一帕金森病评定量表第三部分[UPDRS-III]评分为33.7±12.5，简易精神状态检查表[MMSE]评分为25.3±3.6；受教育年限7.7±3.2年）被发现患有阻塞性睡眠呼吸暂停。36名受试者接受了CPAP治疗滴定。在基线和三个月后安排进行视频多导睡眠图检查、评估不同认知领域的神经心理测试组以及主观日间嗜睡量表评估。所有患者均获得了关于OSA诊断和OSA治疗益处的教育信息，并接受了CPAP个体化培训。
27例（75%）受试者因CPAP不耐受而退出研究。在完成研究的受试者与退出者之间，未发现人口统计学或疾病相关变量（特别是OSA的严重程度）存在差异。9名受试者完成了为期三个月的随访，主观嗜睡、神经心理评分和睡眠结构均无显著变化（除呼吸暂停/低通气指数降低以及N3期睡眠有增加趋势外）。
我们的数据表明，CPAP治疗的可行性可能会受到总体失访率的显著威胁。进一步的研究应考虑结构完善的依从性促进干预措施。OSA作为PD患者主观日间嗜睡和认知状况决定因素的实际作用以及CPAP在PD中的作用仍需进一步研究。
