[目的]探讨帕金森病(PD)患者睡眠障碍与运动、非运动症状的相关性.[方法]选取2016年1月至2017年12月于本院就诊的265例原发性PD患者为研究对象,根据其匹兹堡睡眠质量指数(PSQI)评分分为睡眠障碍组和无睡眠障碍组,比较两组的基线资料、H-Y分期,PD统一评分量表Ⅲ(U PDRSⅢ)、蒙特利尔认知评估量表(MoCA)、帕金森病自主神经症状量表(SCOPA-AUT)、疲劳量表-14(FS-14)及非运动症状评价量表(NMSS)评分结果.采用Pearson相关系数来分析PD患者的PSQI评分与其他评分结果的相关性,并采用多因素Logistic回归分析探讨PD患者发生睡眠障碍的影响因素.[结果]①265例患者中有107例存在睡眠障碍,发生率为40.4%;两组的年龄、性别、病程、起病侧别等基线资料比较,差异均无统计学意义(P>0.05).②睡眠障碍组的U PDRS-Ⅲ评分显著高于无睡眠障碍组,差异有统计学意义(P<0.05);两组的 H-Y分期结果有显著差异,睡眠障碍组Ⅴ ~ Ⅵ期的比例显著高于无睡眠障碍组,差异有统计学意义(P<0.05);相关性分析表明全部患者的 PSQI评分与 UPDRS-Ⅲ评分、H-Y 分期均呈显著正相关(r=0.216、0.153,P<0.05).③睡眠障碍组的体位性头晕、不安腿、对周围事情失去兴趣、悲哀/情绪低落、焦虑/紧张、难以集中注意力、记忆力降低、便秘、不能解释的疼痛、味觉或嗅觉功能减退等非运动症状(NMS)的发生率、SCOPA-AUT、FS-14评分均显著高于无睡眠障碍组,MoCA评分显著低于无睡眠障碍组,差异有统计学意义(P<0.05).相关性分析表明全部患者的 PSQI评分与 SCOPA-AUT、FS-14评分均呈显著正相关(r= 0.306、0.328,P<0.05),与MoCA评分呈显著负相关(r= -0.266,P<0.05).④多因素Logistic回归分析结果表明,悲哀/情绪低落、UPDRS-Ⅲ评分与SCOPA-AUT评分升高是睡眠障碍发生的独立危险因素(P<0.05), MoCA评分升高是独立保护因素(P<0.05).[结论]PD患者容易出现睡眠障碍,其除了与运动症状有关外,还与抑郁情绪、自主神经功能障碍、认知障碍等NMS密切相关.
[Objective]To study the correlation between sleep disturbance and motor,non-motor symp-toms in patients with Parkinson's disease(PD).[Methods]A total of 265 PD patients with PD from January 2016 to December 2017 were enrolled the study and divided into sleep disturbance group and non-sleep disturb-ance group according the score of Pittsburgh sleep quality index(PSQI).The baseline data,results of Unified Parkinson's Disease Rating Scale Ⅲ(UPDRSⅢ),H-Y stage,Montreal Cognitive Assessment(MoCA),the Scale For Outcomes in PD For Autonomic Symptoms(SCOPA-AUT),Fatigue Scale-14(FS-14)and non-mo-tor symptoms scale(NMSS)were compared between the two groups.Pearson correlation coefficient was used to analyze the correlation between PSQI score and other results,and multivariate logistic regression was per-formed to explore the influencing factors of sleep disturbance.[Results]⑴In all 265 patients,sleep disturbance occurred in 107 cases,whose incidence was 40.4%.There were no significant differences in the baseline data including age,sex,course of disease and onset of disease between the two groups(P<0.05).⑵The UPDRS-Ⅲ score in sleep disturbance group was significantly higher than that in the non-sleep disturbance group(P<0.05).There was significant difference in H-Y stage between the two groups,and the proportion of stage Ⅴ ~Ⅵ in the sleep disturbance group was significantly higher than that in the non-sleep disturbance group(P <0.05).The result of correlation analysis showed that PSQI score of all patients had a significant positive corre-lation with the UPDRS-Ⅲ score and H-Y stage(r =0.216 and 0.153,P<0.05).⑶The incidences of non-mo-tor symptoms including orthostatic dizziness,restless legs,losing interest in things around,sad/depression, anxiety/tension,difficult concentrating,loss memory,constipation,unexplained pain and gustatory or olfac-tory dysfunction,SCOPA-AUT and FS-14 scores in the sleep disturbance group were significantly higher than those in the non-sleep disturbance group,and the MoCA score was significantly lower than that in the non-sleep disturbance group(P <0.05).The result of correlation analysis showed that PSQI scores were positive-ly correlated with SCOPA-AUT and FS-14 scores(r = 0.306 and 0.328,P <0.05),and negatively correla-ted with MoCA score(r = -0.266,P <0.05).⑷Multivariate logistic regression showed that sad/depres-sion,increased UPDRS-Ⅲ and SCOPA-AUT score were the independent risk factors of sleep disturbance(P<0.05),while increased MoCA score was an independent protective factor(P <0.05).[Conclusion]PD pa-tients have high incidence of sleep disturbance,and it is not only related to motor symptom,but also closely correlated with NMS including depression,autonomic dysfunction and cognitive impairment.