Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA 22060.
Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
J Affect Disord. 2022 Sep 1;312:177-187. doi: 10.1016/j.jad.2022.06.031. Epub 2022 Jun 22.
To evaluate sleep and affective (mood/anxiety) disorders as clinical predictors of incident Parkinson's disease (PD) among women ≥65 years of age.
We performed secondary analyses with available data from the Women's Health Initiative Clinical Trials and Observational Study linked to Medicare claims. Sleep, mood and anxiety disorders at baseline were defined using diagnostic codes. Incident PD was defined using self-reported PD, first PD diagnosis, use of PD medications, and/or deaths attributed to PD. Cox regression was applied to estimate hazard ratios (HR) with 95 % confidence intervals (CI), controlling for socio-demographic/lifestyle/health characteristics. Time-to-event was calculated from baseline (1993-1998) to year of PD event, loss to follow-up, death, or December 31, 2018, whichever came first.
A total of 53,996 study-eligible WHI participants yielded 1756 (3.25 %) PD cases over ~14.39 (±6.18) years of follow-up. The relative risk for PD doubled among women with affective disorders (HR = 2.05, 95 % CI: 1.84, 2.27), mood disorders (HR = 2.18, 95 % CI: 1.97, 2.42) and anxiety disorders (HR = 1.97, 95 % CI: 1.75, 2.22). Sleep disorders alone (without affective) were not significantly associated with PD risk (HR = 0.85, 95 % CI: 0.69, 1.04), whereas affective disorders alone (without sleep) (HR = 1.93, 95 % CI: 1.72, 2.17) or in combination with sleep disorders (HR = 2.18, 95 % CI: 1.85, 2.56) were associated with twice the PD risk relative to no sleep/affective disorders.
Observational design; Selection bias; Information bias; Generalizability.
Among older women, joint sleep/affective disorders and affective disorders alone are strong clinical predictors of incident PD over 14 years.
评估睡眠和情感（情绪/焦虑）障碍作为≥65 岁女性发生帕金森病（PD）的临床预测指标。
我们对妇女健康倡议临床试验和观察研究的可用数据进行了二次分析，并与医疗保险索赔进行了关联。使用诊断代码在基线时定义睡眠、情绪和焦虑障碍。使用自我报告的 PD、首次 PD 诊断、使用 PD 药物以及/或 PD 相关死亡来定义新发 PD。应用 Cox 回归估计风险比（HR）和 95%置信区间（CI），控制社会人口统计学/生活方式/健康特征。从基线（1993-1998 年）到 PD 事件、随访丢失、死亡或 2018 年 12 月 31 日（以先到者为准）计算时间事件。
共有 53996 名符合 WHI 条件的研究参与者，在约 14.39（±6.18）年的随访中发生了 1756 例（3.25%）PD 病例。与没有情感障碍的女性相比，患有情感障碍（HR=2.05，95%CI：1.84，2.27）、情绪障碍（HR=2.18，95%CI：1.97，2.42）和焦虑障碍（HR=1.97，95%CI：1.75，2.22）的女性发生 PD 的相对风险增加了一倍。单独的睡眠障碍（无情感）与 PD 风险无显著相关性（HR=0.85，95%CI：0.69，1.04），而单独的情感障碍（无睡眠）（HR=1.93，95%CI：1.72，2.17）或与睡眠障碍联合（HR=2.18，95%CI：1.85，2.56）与无睡眠/情感障碍相比，PD 风险增加了一倍。
观察性设计；选择偏倚；信息偏倚；可推广性。
在老年女性中，睡眠/情感障碍联合和单独的情感障碍是 14 年内新发 PD 的强有力的临床预测指标。
