在帕金森病中，将日间过度嗜睡与日常生活活动联系起来的途径：自主神经功能障碍的纵向中介效应。
The path linking excessive daytime sleepiness and activity of daily living in Parkinson's disease: the longitudinal mediation effect of autonomic dysfunction.
机构信息
Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, 030001, China.
Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, China.
出版信息
Neurol Sci. 2022 Aug;43(8):4777-4784. doi: 10.1007/s10072-022-06081-0. Epub 2022 Apr 30.
BACKGROUND
Excessive daytime sleepiness (EDS) and autonomic dysfunction have been verified to impair activity of daily living (ADL) in patients with Parkinson's disease (PD). Whether EDS can affect ADL in PD patients through autonomic dysfunction is still unclear. The purpose of this study is to explore the longitudinal mediation effect of autonomic dysfunction between EDS and ADL.
METHODS
Data used in this study were from six-follow-up visits of 413 patients with newly diagnosed PD from the Parkinson's Progression Markers Initiative (PPMI). We used latent growth mediation modeling (LGMM) to explore whether the autonomic dysfunction is a longitudinal mediator between EDS and ADL.
RESULTS
The results showed that as the disease progresses, EDS (P < 0.001) and autonomic dysfunction (P < 0.001) gradually worsened and ADL (P < 0.001) gradually decreased in PD patients. In addition, the more severe the patients' EDS symptom, the more worsened the symptoms of autonomic dysfunction, which result in a decrease in ADL. Both the intercept (95% CI: 0.142, 0.308) and the slope (95% CI: 0.083, 0.331) of autonomic dysfunction showed a partial mediating effect, and a longitudinal mediation effect was presented.
CONCLUSION
Longitudinal changes in EDS affect the ADL of PD patients directly or indirectly by affecting the symptoms of autonomic dysfunction. Controlling the symptoms of autonomic dysfunction may improve the ADL of PD patients with EDS.
背景
日间过度嗜睡（EDS）和自主神经功能障碍已被证实会影响帕金森病（PD）患者的日常生活活动（ADL）。然而，EDS 是否通过自主神经功能障碍影响 PD 患者的 ADL 尚不清楚。本研究旨在探讨自主神经功能障碍在 EDS 和 ADL 之间的纵向中介作用。
方法
本研究使用的数据来自帕金森进展标志物倡议（PPMI）中 413 例新诊断的 PD 患者的 6 次随访。我们使用潜在增长中介模型（LGMM）来探讨自主神经功能障碍是否是 EDS 和 ADL 之间的纵向中介。
结果
结果表明，随着疾病的进展，PD 患者的 EDS（P<0.001）和自主神经功能障碍（P<0.001）逐渐恶化，ADL（P<0.001）逐渐下降。此外，患者 EDS 症状越严重，自主神经功能障碍症状越严重，导致 ADL 下降。自主神经功能障碍的截距（95%CI：0.142，0.308）和斜率（95%CI：0.083，0.331）均显示出部分中介作用，呈现出纵向中介效应。
结论
EDS 的纵向变化通过影响自主神经功能障碍的症状，直接或间接地影响 PD 患者的 ADL。控制自主神经功能障碍的症状可能会改善伴有 EDS 的 PD 患者的 ADL。
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