Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China.
Department of Radiology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian 364000, China.
Chin Med J (Engl). 2019 Aug 5;132(15):1788-1795. doi: 10.1097/CM9.0000000000000329.
Sleep disorders are one of the earliest non-motor symptoms of Parkinson's disease (PD). Sleep disorders could, therefore, have value for recognition and diagnosis in PD. However, no unified classification and diagnostic criteria exist to evaluate sleep disorders by polysomnography (PSG). Utilizing PSG to monitor sleep processes of patients with PD and analyze sleep disorder characteristics and their relationship with demographic parameters could aid in bridging this gap. This preliminary study aimed to evaluate the clinical characteristic of sleep disorders in PD using PSG.
PSG was used to evaluate sleep disorders in 27 patients with PD and 20 healthy volunteers between August 2015 and July 2018 in Fujian Medical University Union Hospital. Total sleep time (TST), sleep efficiency (SE), total wake time, and other parameters were compared between the two groups. Finally, the correlation between sleep disorders and age, disease duration, Unified Parkinson's Disease Rating Scale-III scores, Hoehn-Yahr stage, and levodopa dose were analyzed. The main statistical methods included Chi-square test, two independent samples t test, Fisher exact test, and Pearson correlation.
Sleep fragmentation in the PD group was significantly increased (74.1%) while difficulty falling asleep and early awakening were not, as compared to healthy controls. No significant differences were found in time in bed, sleep latency (SL), non-rapid eye movement (NREM) stage 1 (N1), N1%, N2, N2%, N3%, and NREM% between PD and control groups; but TST (327.96 ± 105.26 min vs. 414.67 ± 78.31 min, P = 0.003), SE (63.26% ± 14.83% vs. 76.8% ± 11.57%, P = 0.001), R N3 (20.00 [39.00] min vs. 61.50 [48.87] min, P = 0.001), NREM (262.59 ± 91.20 min vs. 337.17 ± 63.47 min, P = 0.003), rapid-eye-movement (REM) (32.50 [33.00] min vs. 85.25 [32.12] min, P < 0.001), REM% (9.56 ± 6.01 vs. 15.50 ± 4.81, P = 0.001), REM sleep latency (157.89 ± 99.04 min vs. 103.47 ± 71.70 min, P = 0.034) were significantly reduced in PD group.
This preliminary study supported that sleep fragmentation was an important clinical characteristic of sleep disorders in PD. Whether sleep fragmentation is a potential quantifiable marker in PD needs to be further investigated in the future study.
睡眠障碍是帕金森病（PD）最早出现的非运动症状之一。因此，睡眠障碍对于 PD 的识别和诊断可能具有价值。然而，目前尚无统一的分类和诊断标准来通过多导睡眠图（PSG）评估睡眠障碍。利用 PSG 监测 PD 患者的睡眠过程，并分析睡眠障碍特征及其与人口统计学参数的关系，可以有助于填补这一空白。本初步研究旨在使用 PSG 评估 PD 患者的睡眠障碍的临床特征。
2015 年 8 月至 2018 年 7 月，在福建医科大学附属协和医院，使用 PSG 评估 27 例 PD 患者和 20 名健康志愿者的睡眠障碍。比较两组的总睡眠时间（TST）、睡眠效率（SE）、总清醒时间等参数。最后，分析睡眠障碍与年龄、病程、帕金森病评定量表第三部分评分、Hoehn-Yahr 分期和左旋多巴剂量之间的相关性。主要的统计方法包括卡方检验、两独立样本 t 检验、Fisher 确切概率法和 Pearson 相关分析。
与健康对照组相比，PD 组的睡眠片段化明显增加（74.1%），入睡困难和早醒则没有明显差异。PD 组和对照组在卧床时间、睡眠潜伏期（SL）、非快速眼动（NREM）期 1（N1）、N1%、N2、N2%、N3、NREM%等方面均无显著差异；但 TST（327.96±105.26 min 比 414.67±78.31 min，P=0.003）、SE（63.26%±14.83%比 76.8%±11.57%，P=0.001）、R N3（20.00[39.00] min 比 61.50[48.87] min，P=0.001）、NREM（262.59±91.20 min 比 337.17±63.47 min，P=0.003）、快速眼动（REM）（32.50[33.00] min 比 85.25[32.12] min，P<0.001）、REM%（9.56±6.01 比 15.50±4.81，P=0.001）、REM 睡眠潜伏期（157.89±99.04 min 比 103.47±71.70 min，P=0.034）明显降低。
本初步研究支持睡眠片段化是 PD 睡眠障碍的一个重要临床特征。睡眠片段化是否是 PD 潜在的可量化标志物，还需要在未来的研究中进一步探讨。
