Department of Neurology, Second Hospital Affiliated of Xinjiang Medical University, Ürümqi, 830063, Xinjiang, China; Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
Sleep Med. 2024 Mar;115:155-161. doi: 10.1016/j.sleep.2024.02.003. Epub 2024 Feb 8.
Growing evidence supports the potential role of sleep in the motor progression of Parkinson's disease (PD). Slow-wave sleep (SWS) and rapid eye movement (REM) sleep without atonia (RWA) are important sleep parameters. The association between SWS and RWA with PD motor progression and their predictive value have not yet been elucidated.
We retro-prospectively analyzed clinical and polysomnographic data of 136 patients with PD. The motor symptoms were assessed using Unified Parkinson's Disease Rating Scale Part III (UPDRS III) at baseline and follow-up to determine its progression. Partial correlation analysis was used to explore the cross-sectional associations between slow-wave energy (SWE), RWA and clinical symptoms. Longitudinal analyses were performed using Cox regression and linear mixed-effects models.
Among 136 PD participants, cross-sectional partial correlation analysis showed SWE decreased with the prolongation of the disease course (P = 0.046), RWA density was positively correlated with Hoehn & Yahr (H-Y) stage (tonic RWA, P < 0.001; phasic RWA, P = 0.002). Cox regression analysis confirmed that low SWE (HR = 1.739, 95% CI = 1.038-2.914; P = 0.036; FDR-P = 0.036) and high tonic RWA (HR = 0.575, 95% CI = 0.343-0.963; P = 0.032; FDR-P = 0.036) were predictors of motor symptom progression. Furthermore, we found that lower SWE predicted faster rate of axial motor progression (P < 0.001; FDR-P < 0.001) while higher tonic RWA density was associated with faster rate of rigidity progression (P = 0.006; FDR-P = 0.024) using linear mixed-effects models.
These findings suggest that SWS and RWA might represent markers of different motor subtypes progression in PD.
越来越多的证据支持睡眠在帕金森病（PD）运动进展中的潜在作用。慢波睡眠（SWS）和无动性眼动（RWA）是重要的睡眠参数。SWS 和 RWA 与 PD 运动进展的关系及其预测价值尚未阐明。
我们回顾性分析了 136 例 PD 患者的临床和多导睡眠图数据。使用统一帕金森病评定量表第三部分（UPDRS III）在基线和随访时评估运动症状，以确定其进展。采用偏相关分析探讨 SWS 能量（SWE）、RWA 与临床症状的横断面关系。采用 Cox 回归和线性混合效应模型进行纵向分析。
在 136 名 PD 参与者中，横断面偏相关分析显示 SWE 随病程延长而降低（P=0.046），RWA 密度与 Hoehn & Yahr（H-Y）分期呈正相关（紧张性 RWA，P<0.001；冲动性 RWA，P=0.002）。Cox 回归分析证实，低 SWE（HR=1.739，95%CI=1.038-2.914；P=0.036；FDR-P=0.036）和高紧张性 RWA（HR=0.575，95%CI=0.343-0.963；P=0.032；FDR-P=0.036）是运动症状进展的预测因素。此外，我们发现较低的 SWE 预测更快的轴性运动进展率（P<0.001；FDR-P<0.001），而较高的紧张性 RWA 密度与更快的僵硬进展率相关（P=0.006；FDR-P=0.024），使用线性混合效应模型。
这些发现表明 SWS 和 RWA 可能代表 PD 不同运动亚型进展的标志物。
