Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Department of Neurology, Regional Hospital of Bolzano, Bolzano, Italy.
J Clin Sleep Med. 2023 Jan 1;19(1):63-71. doi: 10.5664/jcsm.10268.
Sleep disorders, daytime sleepiness, and autonomic dysfunction are commonly reported among patients with multiple system atrophy and Parkinson disease (PD). We aimed to assess sleep and autonomic function in these patients to evaluate the relationships between sleep disorders, excessive daytime sleepiness, and autonomic function.
Twenty patients with multiple system atrophy (n = 7) and PD (n = 13) underwent clinical assessment including questionnaires for autonomic function and sleep. Cardiovascular autonomic function tests and 2-night video-polysomnography were followed by administration of the Multiple Sleep Latency Test. Rapid eye movement sleep without atonia was quantified in the chin, flexor digitorum superficialis, tibial anterior, and sternocleidomastoid muscles.
Rapid eye movement sleep behavior disorder was associated with orthostatic hypotension ( = .017) and constipation ( = .019) in PD. Patients with orthostatic hypotension had higher rapid eye movement sleep without atonia indices than those without orthostatic hypotension ( < .001). The Sleep Innsbruck Barcelona rapid eye movement sleep without atonia index ("any" chin and/or flexor digitorum superficialis) correlated with systolic/diastolic blood pressure fall upon tilt-table examination in patients with multiple system atrophy ( < .05) and with gastrointestinal ( = .010), urinary ( = .022), and total Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction scores ( = .006) in all patients. Patients with a pathological deep breathing ratio showed higher Sleep Innsbruck Barcelona indices ( = .031). Objective daytime sleepiness was exclusively present in PD ( = .034) and correlated with levodopa-equivalent dosage ( = .031).
The relationship of autonomic dysfunction with rapid eye movement sleep without atonia in PD and multiple system atrophy is accounted for by shared brainstem neuropathology and likely identifies patients in a more advanced stage of disease. Excessive daytime sleepiness is found exclusively in PD and may be secondary to levodopa treatment and not related to α-synuclein disease.
Eckhardt C, Fanciulli A, Högl B, et al. Analysis of sleep, daytime sleepiness, and autonomic function and multiple system atrophy and Parkinson disease: a prospective study. 2023;19(1):63-71.
睡眠障碍、日间嗜睡和自主神经功能障碍在多系统萎缩症（MSA）和帕金森病（PD）患者中较为常见。我们旨在评估这些患者的睡眠和自主神经功能，以评估睡眠障碍、日间过度嗜睡和自主神经功能之间的关系。
20 名 MSA 患者（n=7）和 PD 患者（n=13）接受了临床评估，包括自主神经功能和睡眠问卷。进行心血管自主神经功能测试和 2 晚视频多导睡眠图后，进行多次睡眠潜伏期试验。定量分析颏肌、指浅屈肌、胫骨前肌和胸锁乳突肌的 REM 睡眠无动。
PD 患者的 REM 睡眠行为障碍与直立性低血压（r=0.017）和便秘（r=0.019）相关。直立性低血压患者的 REM 睡眠无动指数高于无直立性低血压患者（p<0.001）。多系统萎缩症患者的睡眠因斯布鲁克-巴塞罗那 REM 睡眠无动指数（“任何”颏肌和/或指浅屈肌）与倾斜试验检查时的收缩压/舒张压下降相关（r<0.05），与胃肠道（r=0.010）、泌尿（r=0.022）和帕金森病自主神经功能障碍总评分量表（r=0.006）相关。呼吸比异常的患者睡眠因斯布鲁克-巴塞罗那指数较高（r=0.031）。PD 患者存在客观日间嗜睡（r=0.034），与左旋多巴等效剂量相关（r=0.031）。
PD 和 MSA 中自主神经功能障碍与 REM 睡眠无动的关系归因于共同的脑干神经病理学，并且可能识别出处于疾病更晚期的患者。PD 患者中仅发现过度日间嗜睡，可能与左旋多巴治疗有关，与α-突触核蛋白病无关。
Eckhardt C, Fanciulli A, Högl B, et al. 分析睡眠、日间嗜睡和自主神经功能与多系统萎缩和帕金森病的关系：一项前瞻性研究。 2023;19(1):63-71.
