Smit Marenka, Kamphuis Arwen S J, Bartels Anna L, Han Vladimir, Stewart Roy E, Zijdewind Inge, Tijssen Marina A
Department of Neurology University Medical Center Groningen University of Groningen Groningen the Netherlands.
Department of Neurology Ommelander Hospital Group Delfzijl the Netherlands.
Mov Disord Clin Pract. 2016 Dec 5;4(4):517-523. doi: 10.1002/mdc3.12459. eCollection 2017 Jul-Aug.
Nonmotor symptoms (NMS) are highly prevalent in cervical dystonia (CD). In general, fatigue and sleep are important NMS that determine a decreased health-related quality of life (HR-QoL), but their influence in CD is unknown. The authors systematically investigated fatigue, excessive daytime sleepiness (EDS), and sleep quality in patients with CD and controls and assessed the influence of psychiatric comorbidity, pain, and dystonia motor severity. They also examined the predictors of HR-QoL.
The study included 44 patients with CD and 43 matched controls. Fatigue, EDS, and sleep quality were assessed with quantitative questionnaires and corrected for depression and anxiety using analysis of covariance. The Toronto Western Spasmodic Torticollis Rating Scale and the Clinical Global Impression Scale-jerks/tremor subscale were used to score motor severity and to assess whether motor characteristics could explain an additional part of the variation in fatigue and sleep-related measures. HR-QoL was determined with the RAND-36 item Health Survey, and predictors of HR-QoL were assessed using multiple regression.
Fatigue scores were increased independently from psychiatric comorbidity (4.0 vs. 2.7; <0.01), whereas EDS (7.3 vs. 7.4; =0.95) and sleep quality (6.5 vs. 6.1; =0.73) were highly associated with depression and anxiety. In patients with CD, motor severity did not explain the variations in fatigue (change in the correlation coefficient [ΔR] = 0.06; =0.15), EDS (ΔR = 0.00; =0.96), or sleep quality (ΔR = 0.04; =0.38) scores. Fatigue, EDS, psychiatric comorbidity, and pain predicted a decreased QoL.
Independent from psychiatric comorbidity and motor severity, fatigue appeared to be a primary NMS. Sleep-related measures were highly associated with psychiatric comorbidity, but not with motor severity. Only NMS predicted HR-QoL, which emphasizes the importance of attention to NMS in patients with CD.
非运动症状（NMS）在颈部肌张力障碍（CD）中非常普遍。一般来说，疲劳和睡眠是重要的非运动症状，会导致健康相关生活质量（HR-QoL）下降，但其在CD中的影响尚不清楚。作者系统地研究了CD患者和对照组的疲劳、日间过度嗜睡（EDS）和睡眠质量，并评估了精神共病、疼痛和肌张力障碍运动严重程度的影响。他们还研究了HR-QoL的预测因素。
该研究纳入了44例CD患者和43例匹配的对照组。使用定量问卷评估疲劳、EDS和睡眠质量，并通过协方差分析校正抑郁和焦虑因素。使用多伦多西部痉挛性斜颈评定量表和临床总体印象量表-抽搐/震颤子量表对运动严重程度进行评分，并评估运动特征是否可以解释疲劳和睡眠相关指标变化的额外部分。使用RAND-36项健康调查确定HR-QoL，并使用多元回归评估HR-QoL的预测因素。
疲劳评分的增加与精神共病无关（4.0对2.7；<0.01），而EDS（7.3对7.4；=0.95）和睡眠质量（6.5对6.1；=0.73）与抑郁和焦虑高度相关。在CD患者中，运动严重程度并不能解释疲劳（相关系数变化[ΔR]=0.06；=0.15）、EDS（ΔR=0.00；=0.96）或睡眠质量（ΔR=0.04；=0.38）评分的变化。疲劳、EDS、精神共病和疼痛预示着生活质量下降。
与精神共病和运动严重程度无关，疲劳似乎是主要的非运动症状。与睡眠相关的指标与精神共病高度相关，但与运动严重程度无关。只有非运动症状可预测HR-QoL，这强调了关注CD患者非运动症状的重要性。
