Department of Psychiatry, University of California, San Francisco, CA, USA.
Department of Neurology, University of California, San Francisco, CA, USA.
Int J Epidemiol. 2018 Oct 1;47(5):1679-1686. doi: 10.1093/ije/dyy098.
It is unknown whether subjective daytime sleepiness or objective napping could precede the risk of Parkinson's disease (PD) in the long term.
We studied 2920 men (mean age 76 years) without a history of PD and followed them for 11 years. Excessive daytime sleepiness (EDS) was defined as having an Epworth Sleepiness Scale score >10. Objective naps were defined as ≥5 consecutive minutes of inactivity as measured by actigraphy, and napping duration was the accumulated time of naps outside the main sleep period. We used logistic regression to compare PD risk across four groups: no EDS& napping <1 h/day (N = 1739, 59.5%; referent group), EDS& napping <1 h/day (N = 215, 7.4%), no EDS& napping ≥ 1 h/day (N = 819, 28.1%) and EDS& napping ≥ 1 h/day (N = 147, 5.0%).
We identified 106 incident PD cases over 11 years. After multivariable adjustment, men with napping ≥ 1h/day alone were twice as likely [odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.25-3.08], and men with both EDS and napping ≥ 1 h/day were almost three times as likely to develop PD (2.52, 1.21-5.27), compared with the referent group. Compared with those with naps for <30 min, men who napped for ≥1 h/day had more than double the risk of PD. No association was found for EDS alone and PD risk. Further adjustment for chronotype and circadian stability, or excluding PD cases identified within 2 years after napping measurements, showed similar results.
Objective long napping rather than subjective EDS was prospectively associated with a higher risk of PD in older men. Objective measures of napping might be valuable as a preclinical marker for PD.
目前尚不清楚主观日间嗜睡或客观小睡是否会在长期内导致帕金森病（PD）的风险增加。
我们研究了 2920 名男性（平均年龄 76 岁），他们没有 PD 病史，随访时间为 11 年。白天过度嗜睡（EDS）的定义为 Epworth 嗜睡量表评分>10。客观小睡定义为活动记录仪测量的连续 5 分钟以上的不活动，小睡时间为主要睡眠时间以外的累积小睡时间。我们使用逻辑回归比较了四个组的 PD 风险：无 EDS&小睡<1 小时/天（N=1739，59.5%；参考组）、EDS&小睡<1 小时/天（N=215，7.4%）、无 EDS&小睡≥1 小时/天（N=819，28.1%）和 EDS&小睡≥1 小时/天（N=147，5.0%）。
在 11 年的时间里，我们共发现 106 例新发 PD 病例。经多变量调整后，仅小睡≥1 小时/天的男性发生 PD 的风险增加一倍[比值比（OR）=1.96，95%置信区间（CI）1.25-3.08]，同时存在 EDS 和小睡≥1 小时/天的男性发生 PD 的风险几乎增加三倍（2.52，1.21-5.27），与参考组相比。与小睡时间<30 分钟的男性相比，小睡时间≥1 小时/天的男性患 PD 的风险增加了一倍以上。单独 EDS 与 PD 风险之间没有关联。进一步调整昼夜类型和昼夜节律稳定性，或排除小睡测量后 2 年内确诊的 PD 病例，结果相似。
客观的长时间小睡，而不是主观的 EDS，与老年男性 PD 风险的增加呈前瞻性相关。客观的小睡测量可能是 PD 的一种有价值的临床前标志物。
