Ma Jiangnan, Dou Kaixin, Liu Ruize, Liao Yajin, Yuan Zengqiang, Xie Anmu
Departmentof Neurology, Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Intensive Care Unit, Affiliated Qingdao Municipal Hospital of Qingdao University, Qingdao, China.
Front Aging Neurosci. 2022 Jun 10;14:898149. doi: 10.3389/fnagi.2022.898149. eCollection 2022.
Non-motor symptoms, including sleep disorders and depression, are common in Parkinson's disease (PD). The purpose of our study is to explore the effect of sleep disorders, including the probable rapid eye movement (REM) sleep behavior disorder (pRBD) and the daytime sleepiness, on depressive symptoms in patients with early and prodromal PD.
A total of 683 participants who obtained from the Parkinson Progression Markers Initiative (PPMI) were included, consisting of 423 individuals with early PD, 64 individuals with prodromal PD, and 196 healthy controls (HCs), who were followed up to 5 years from baseline. Multiple linear regression models and linear mixed-effects models were conducted to explore the relationship between sleep disorders and depression at baseline and longitudinally, respectively. Multiple linear regression models were used to further investigate the association between the change rates of daytime sleepiness score and depression-related score. Mediation analyses were also performed.
At baseline analysis, individuals with early and prodromal PD, who had higher RBD screening questionnaire (RBDSQ) score, or who were considered as pRBD, or who manifested specific behaviors of RBD (things falling down when sleep or disturbance of sleep), showed significantly the higher score of depression-related questionnaires. Our 5-year follow-up study showed that sleep disorders, including pRBD and daytime sleepiness, were associated with the increased depressive-related score in individuals with early and prodromal PD. Interestingly, we also found that the increased possibilities of daytime sleepiness were associated with depressive-related score. Finally, mediation analysis demonstrated that the relationship between RBD and depressive symptoms was partially mediated by autonomic symptoms, such as postural hypertension, salivation, dysphagia, and constipation.
Our study shows that sleep disorders, including pRBD and daytime sleepiness, are associated with depression at baseline and longitudinally, which is partially mediated by the autonomic dysfunction in early and prodromal PD, with an implication that sleep management is of great value for disease surveillance.
非运动症状，包括睡眠障碍和抑郁，在帕金森病（PD）中很常见。我们研究的目的是探讨睡眠障碍，包括可能的快速眼动（REM）睡眠行为障碍（pRBD）和日间嗜睡，对早期和前驱期PD患者抑郁症状的影响。
共纳入683名来自帕金森病进展标志物计划（PPMI）的参与者，包括423名早期PD患者、64名前驱期PD患者和196名健康对照（HCs），从基线开始随访5年。分别采用多元线性回归模型和线性混合效应模型来探讨基线时和纵向睡眠障碍与抑郁之间的关系。使用多元线性回归模型进一步研究日间嗜睡评分变化率与抑郁相关评分之间的关联。还进行了中介分析。
在基线分析中，早期和前驱期PD患者中RBD筛查问卷（RBDSQ）得分较高、被认为是pRBD或表现出RBD特定行为（睡眠时东西掉落或睡眠受干扰）的患者抑郁相关问卷得分显著更高。我们的5年随访研究表明，包括pRBD和日间嗜睡在内的睡眠障碍与早期和前驱期PD患者抑郁相关评分增加有关。有趣的是，我们还发现日间嗜睡可能性增加与抑郁相关评分有关。最后，中介分析表明RBD与抑郁症状之间的关系部分由自主神经症状介导，如体位性高血压、流涎、吞咽困难和便秘。
我们的研究表明，包括pRBD和日间嗜睡在内的睡眠障碍在基线时和纵向均与抑郁有关，这在早期和前驱期PD中部分由自主神经功能障碍介导，这意味着睡眠管理对于疾病监测具有重要价值。
