抗帕金森病药物可显著改善帕金森病患者的夜间睡眠。
Antiparkinsonian drugs as potent contributors to nocturnal sleep in patients with Parkinson's disease.
机构信息
Parkinson's Disease Advanced Therapy Center, Aichi Medical University Hospital, Nagakute, Japan.
Department of Neurology, Aichi Medical University, Nagakute, Japan.
出版信息
PLoS One. 2021 Jul 28;16(7):e0255274. doi: 10.1371/journal.pone.0255274. eCollection 2021.
OBJECTIVE
To clarify whether antiparkinsonian drugs contribute to nocturnal sleep disturbances in patients with Parkinson's disease (PD).
BACKGROUND
Although the major antiparkinsonian drugs L-dopa and dopamine agonists (DAs) have been found to affect sleep, little is known about the effects of specific drugs on sleep in PD patients.
METHODS
The study participants consisted of 112 PD patients (median age 72.5 years [inter-quartile range: IQR 65-79]; mean disease duration 8.44 years [standard deviation: 7.33]; median Hoehn and Yahr stage 3 [IQR 2-3.75]) taking one of three types of non-ergot extended-release DAs (rotigotine 32; pramipexole 44; ropinirole 36) with or without L-dopa (median daily total dosage of antiparkinsonian drugs 525.5 mg [IQR 376.25-658] levodopa equivalent dose [LED]). Participants were assessed using the PD Sleep Scale-2 (PDSS-2).
RESULTS
For the whole PD patient cohort, the PDSS-2 sleep disturbance domain score and the scores for item 1 assessing sleep quality and item 8 assessing nocturia were positively correlated with daily total dosage of antiparkinsonian drugs and dosage of L-dopa, but not with the dosage of DAs. Sub-analysis according to DA treatment revealed that DA dosage was not correlated with item 1 or 8 score in any of the subgroups. The LED ratio of rotigotine to the total dosage of antiparkinsonian drugs was inversely correlated with the item 1 score.
CONCLUSIONS
These data suggest that antiparkinsonian drugs, in particular L-dopa, adversely affect nocturnal sleep in PD patients, especially in terms of sleep quality and nocturia. Thus, adjusting both the total dosage of antiparkinsonian drugs and the dose-ratio of L-dopa might be key actions for alleviating poor sleep quality in patients with PD. Among DAs, we found a clear positive correlation between the dose-ratio of rotigotine and sleep quality. Thus, partial L-dopa replacement with rotigotine could improve sleep quality in patients with PD.
目的
阐明抗帕金森病药物是否会导致帕金森病（PD）患者的夜间睡眠障碍。
背景
虽然已发现左旋多巴和多巴胺激动剂（DAs）等主要抗帕金森病药物会影响睡眠，但对于 PD 患者中特定药物对睡眠的影响知之甚少。
方法
研究参与者包括 112 名 PD 患者（中位年龄 72.5 岁[四分位距：IQR65-79]；平均病程 8.44 年[标准差：7.33]；中位 Hoehn 和 Yahr 分期 3[IQR2-3.75]），他们正在服用三种非麦角衍生的延长释放型 DAs 中的一种或多种（罗替高汀 32 例；普拉克索 44 例；罗匹尼罗 36 例），并伴有或不伴有左旋多巴（每日抗帕金森病药物总剂量的中位数为 525.5mg[IQR376.25-658]左旋多巴等效剂量[LED]）。参与者使用 PD 睡眠量表-2（PDSS-2）进行评估。
结果
对于整个 PD 患者队列，PDSS-2 睡眠障碍域评分以及评估睡眠质量的第 1 项和评估夜间多尿的第 8 项的评分与抗帕金森病药物的日总剂量和左旋多巴剂量呈正相关，但与 DAs 剂量无关。根据 DA 治疗进行的亚分析显示，在任何亚组中，DA 剂量均与第 1 项或第 8 项评分均无相关性。罗替高汀与抗帕金森病药物总剂量的 LED 比值与第 1 项评分呈反比。
结论
这些数据表明，抗帕金森病药物，特别是左旋多巴，会对 PD 患者的夜间睡眠产生不利影响，尤其是对睡眠质量和夜间多尿的影响。因此，调整抗帕金森病药物的总剂量和左旋多巴的剂量比可能是缓解 PD 患者睡眠质量差的关键措施。在 DAs 中，我们发现罗替高汀的剂量比与睡眠质量之间存在明显的正相关。因此，用罗替高汀部分替代左旋多巴可以改善 PD 患者的睡眠质量。
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