Cao Xiang-Yang, Zhang Jin-Ru, Shen Yun, Mao Cheng-Jie, Shen Yu-Bing, Cao Yu-Lan, Gu Han-Ying, Wang Fen, Liu Chun-Feng
Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China.
Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu 223002, China.
Chin Med J (Engl). 2020 Dec 16;134(6):668-674. doi: 10.1097/CM9.0000000000001303.
Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients.
Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances.
Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep (P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) (P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score.
Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.
许多帕金森病（PD）患者抱怨存在慢性疲劳和夜间睡眠障碍。本研究的目的是通过对PD患者进行多导睡眠图（PSG）检查来确定疲劳与睡眠障碍之间的关系。
本研究招募了232例PD患者（152例轻度疲劳患者和80例重度疲劳患者）。收集了人口统计学信息和临床症状。应用疲劳严重程度量表（FSS）评估疲劳严重程度，并对所有PD患者进行PSG检查。FSS≥4被定义为重度疲劳，FSS<4被定义为轻度疲劳。采用多因素逻辑回归和线性回归模型研究疲劳与睡眠障碍之间的关联。
重度疲劳患者往往病程更长、统一帕金森病评定量表评分更高、Hoehn和Yahr分期更晚、每日左旋多巴等效剂量更高、抑郁和焦虑更严重、日间嗜睡评分更高。此外，他们的快速眼动（REM）睡眠百分比更低（P = 0.009），且更有可能出现REM睡眠行为障碍（RBD）（P = 0.018）。多因素逻辑回归分析发现，RBD的存在和REM睡眠比例是疲劳的独立预测因素。在调整年龄、性别、病程、体重指数、疾病严重程度、汉密尔顿抑郁评定量表评分、汉密尔顿焦虑评定量表评分和其他睡眠障碍后，PD患者的REM睡眠比例和无张力性REM睡眠程度仍与FSS评分相关。
考虑到疲劳、RBD与睡眠结构改变之间的关联，疲劳是PD中的一种特殊亚型，应更多地关注这种使人衰弱的症状。
