García-Fernández C, Vargas-Mendoza A K, López-López B, Blázquez-Estrada M, Suárez-San Martín M E
Hospital Universitario Central de Asturias, Oviedo, España.
Rev Neurol. 2024 Oct 16;79(8):217-221. doi: 10.33588/rn.7908.2024117.
Multiple factors can cause sleep disturbances in Parkinson's disease. The quality of sleep and therefore of life is usually improved with continuous dopaminergic stimulation therapies, such as continuous subcutaneous infusion of apomorphine.
We present an observational retrospective study of patients at our centre with advanced Parkinson's disease, treated with continuous infusion of apomorphine, with treatment extended to nights, between 2011 and 2022. We collected data from 37 patients, and evaluated the indication for nocturnal treatment, efficacy, safety and reasons for withdrawal.
Fifty percent of patients began nocturnal treatment for motor complications, 19% for non-motor complications and 31% for both. The most common non-motor symptoms were sleep fragmentation and disturbances, neuropathic pain, psychiatric symptoms and intense nocturia. Twenty of the 37 patients (54%) were continuing treatment at the end of the study follow-up, 16 (43%) discontinued the infusion, and one (3%) was lost to follow-up. The adverse reactions that led to termination of the infusion were severe nodules (two), dopaminergic psychosis (one) and a positive Coombs test with/without anaemia (one). Four patients terminated the nocturnal infusions while continuing the daytime infusions due to suboptimal adaptation to the device. Patients whose symptoms improved without any significant adverse effects continued the treatment.
Continuous infusion of apomorphine during the night was an effective and safe treatment in our series.
多种因素可导致帕金森病患者出现睡眠障碍。通过持续多巴胺能刺激疗法，如持续皮下输注阿扑吗啡，睡眠质量以及生活质量通常会得到改善。
我们对2011年至2022年间在本中心接受阿扑吗啡持续输注治疗且治疗时间延长至夜间的晚期帕金森病患者进行了一项观察性回顾性研究。我们收集了37例患者的数据，并评估了夜间治疗的指征、疗效、安全性及停药原因。
50%的患者开始夜间治疗是为了应对运动并发症，19%是为了应对非运动并发症，31%是为了应对两者。最常见的非运动症状是睡眠片段化和紊乱、神经性疼痛、精神症状以及严重夜尿症。在研究随访结束时，37例患者中有20例（54%）继续接受治疗，16例（43%）停止了输注，1例（3%）失访。导致输注终止的不良反应包括严重结节（2例）、多巴胺能精神病（1例）以及伴或不伴贫血的抗人球蛋白试验阳性（1例）。4例患者因对设备适应不佳，在继续日间输注的同时终止了夜间输注。症状改善且无任何明显不良反应的患者继续接受治疗。
在我们的研究系列中，夜间持续输注阿扑吗啡是一种有效且安全的治疗方法。
