Walker S L, Fine A, Kryger M H
Department of Medicine, University of Manitoba, St. Boniface General Hospital, Winnipeg, Canada.
Sleep. 1996 Apr;19(3):214-8.
Restless legs syndrome (RLS) and periodic limb movements during sleep (PLMS) are sleep disorders that are common and distressing to uremic patients. There are few data regarding effective treatment in this population. Five chronic hemodialysis patients completed a double-blind, placebo-controlled, crossover study using a single bedtime dose of controlled release L-DOPA/carbidopa (100/25 mg) for treatment of RLS and sleep disruption. Leg movements per hour of sleep and percentage of sleep time accompanied by leg movements were decreased with treatment (101.0 +/- 29.1 events/hour on placebo vs. 61.0 +/- 28.3 events per hour on drug, p = 0.006; and 15.1 +/- 4.9% of sleep time with leg movements on placebo vs. 8.6 +/- 4.0% on drug, p = 0.014). In addition, arousals associated with leg movements (mean 209 +/- 49 events on placebo, mean 108 +/- 46 events on drug) and the leg movement arousal index (mean 59 +/- 23 events/hour on placebo, mean 23 +/- 9 events/hour on drug) were decreased by active medication (p = 0.03 and 0.04, respectively). Patients, however, continued to have very disrupted sleep and we could not document consistent subjective or objective improvement in overall sleep except for an increase in slow-wave sleep (SWS) from 9.0% to 22.8% (p = 0.01). The patterns of movements during sleep were not uniform in different patients, and the movements, although often periodic, were much longer than defined for PLMS. Because of this, finding suitable objective parameters to analyze was problematic. Measuring the percentage of sleep time during which there were leg movements was probably the most efficient and reproducible means of quantitating this disorder. Thus, although controlled-release L-DOPA/carbidopa at a dose of 100/25 mg given once nightly reduced leg movements and increased SWS, sleep continued to be disrupted. Whether higher doses or more frequent dosing is effective requires further investigation.
不宁腿综合征（RLS）和睡眠期周期性肢体运动（PLMS）是常见的睡眠障碍，给尿毒症患者带来困扰。关于该人群有效治疗的数据很少。五名慢性血液透析患者完成了一项双盲、安慰剂对照、交叉研究，使用睡前单次剂量的控释左旋多巴/卡比多巴（100/25毫克）治疗RLS和睡眠中断。治疗后每小时睡眠中的腿部运动次数以及伴有腿部运动的睡眠时间百分比均有所下降（安慰剂组每小时101.0±29.1次事件，药物组每小时61.0±28.3次事件，p = 0.006；安慰剂组有腿部运动的睡眠时间为15.1±4.9%，药物组为8.6±4.0%，p = 0.014）。此外，与腿部运动相关的觉醒（安慰剂组平均209±49次事件，药物组平均108±46次事件）以及腿部运动觉醒指数（安慰剂组平均59±23次事件/小时，药物组平均23±9次事件/小时）通过活性药物治疗而降低（分别为p = 0.03和0.04）。然而，患者的睡眠仍然非常紊乱，除了慢波睡眠从9.0%增加到22.8%（p = 0.01）外，我们无法证明总体睡眠在主观或客观上有持续改善。不同患者睡眠期间的运动模式并不一致，这些运动虽然通常是周期性的，但比PLMS所定义的要长得多。因此，找到合适的客观参数进行分析存在问题。测量有腿部运动的睡眠时间百分比可能是量化这种障碍最有效且可重复的方法。因此，尽管每晚一次给予100/25毫克剂量的控释左旋多巴/卡比多巴可减少腿部运动并增加慢波睡眠，但睡眠仍然受到干扰。更高剂量或更频繁给药是否有效需要进一步研究。
