Tang Xiaohui, Liang Qian, Li Tao, Ouyang Yetong, Huang Zhe Xue, Tang Xiaoshun, Jin Jiayi, Yu Lijia, Wang Xijin
Department of Neurology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Department of Neurology, Zhabei Central Hospital, Shanghai, People's Republic of China.
Neuropsychiatr Dis Treat. 2024 Dec 13;20:2517-2527. doi: 10.2147/NDT.S485339. eCollection 2024.
Impulse control disorders (ICDs) and excessive daytime sleepiness (EDS) are common symptoms in Parkinson's disease (PD). Few longitudinal studies have focused on the association between EDS and ICDs. This longitudinal study aimed at assessing association between EDS and ICDs in PD.
Patients without ICDs were incorporated from the Parkinson's Progression Markers Initiative. All patients were followed until the onset of ICDs or the end of 4 years. A total of 260 PD patients were included. Univariable and multivariable logistic regression were used to explore association between EDS and ICDs.
The overall frequency of ICDs at the end of follow-up was 23.8% (62 patients). The mean duration from dopamine replacement therapy to develop ICDs was 3.30 ± 2.42 years. Patients with ICDs had significantly higher Epworth Sleepiness Scale (ESS) score ( = 0.002) and higher proportion of EDS ( = 0.030) when compared to patients without ICDs. The multivariable logistic regression analysis indicated that high ESS (OR = 2.01, 95% CI 1.01-4.04, p = 0.049) score, high dopamine agonist equivalent daily dose (OR = 2.54, 95% CI 1.37-4.71, p = 0.003), high Geriatric Depression Scale (OR = 2.33, 95% CI 1.27-4.28, p = 0.006) score and postural instability (OR = 3.03, 95% CI 1.26-7.29, p = 0.013) were associated with ICDs occurrence.
Our results indicated that EDS acts as a risk for ICDs occurrence in PD. Clinicians should pay attention to EDS in clinical practice. This may be a promising new approach to better understand and therapy ICDs.
冲动控制障碍（ICD）和日间过度嗜睡（EDS）是帕金森病（PD）的常见症状。很少有纵向研究关注EDS与ICD之间的关联。这项纵向研究旨在评估PD中EDS与ICD之间的关联。
从帕金森病进展标志物计划中纳入无ICD的患者。所有患者均随访至ICD发作或4年结束。共纳入260例PD患者。采用单变量和多变量逻辑回归来探讨EDS与ICD之间的关联。
随访结束时ICD的总体发生率为23.8%（62例患者）。从多巴胺替代治疗到发生ICD的平均持续时间为3.30±2.42年。与无ICD的患者相比，有ICD的患者Epworth嗜睡量表（ESS）评分显著更高（P = 0.002），EDS比例更高（P = 0.030）。多变量逻辑回归分析表明，高ESS评分（OR = 2.01，95%CI 1.01 - 4.04，P = 0.049）、高多巴胺激动剂等效日剂量（OR = 2.54，95%CI 1.37 - 4.71，P = 0.003）、高老年抑郁量表评分（OR = 2.33，95%CI 1.27 - 4.28，P = 0.006）和姿势不稳（OR = 3.03，95%CI 1.26 - 7.29，P = 0.013）与ICD的发生相关。
我们的结果表明，EDS是PD中发生ICD的一个风险因素。临床医生在临床实践中应关注EDS。这可能是更好地理解和治疗ICD的一种有前景的新方法。
