Clinical Study Of Parkinson’s Disease With Obstructive Sleep Apnea Syndrome

Background:Obstructive sleep apnea syndrome(OSAS)is one of the non-motor symptoms of Parkinson’s disease(PD).At present,there is no relevant data on the incidence,clinical characteristics and influencing factors of OSAS in Chinese PD population with large sample size.In addition,OSAS can lead to a variety of adverse consequences in the general population,including white matter hyperintensity(WMH),gait abnormalities and cognitive dysfunction.However,it is not clear whether OSAS can affect WMH,cognitive and motor disorders in PD patients.The purpose of this study was to preliminarily analyze the clinical characteristics of PD patients with OSAS and the related factors affecting the occurrence of OSAS,and to explore the correlation between OSAS and WMH,cognitive impairment and motor subtypes in PD patients.Methods:(1)According to the apnea hypopnea index(AHI),the patients were divided into PD with OSAS group(AHI≥ 5)and PD without OSAS group(AHI<5).Statistical analysis was carried out as follows:The differences of clinical characteristics,motor and nonmotor symptoms,polysomnography parameters between the two groups were compared.Logistic regression model was used to analyze the independent influencing factors of OSAS in PD patients.And R software was used to establish a nomogram risk prediction model for the related independent influencing factors,and the predictability and accuracy of the model were verified.(2)PD patients who completed polysomnography and MRI examination at the same time were divided into three groups according to the following three ways:According to Fazekas visual analogue scale,the patients were divided into two groups:no-mild white matter lesions(WMH score 0-1)and moderate-severe white matter lesions(WMH score≥2).According to the state of cognitive function,the patients were divided into two groups:PD with cognitive impairment and PD without cognitive impairment.According to the type of motor symptoms,the patients were divided into posture abnormality and gait disorder dominated(postural stability gait discorder,PIGD)group and non-PIGD group.Univariate and multivariate logistic regression models were used to analyze whether OSAS was an independent risk factor for WMH,cognitive impairment and different motor subtypes in PD patients.Results:(1)A total of 239 PD patients underwent polysomnography were collected.Among them,66 patients(27.62%)had OSAS,14.2%(34/239)had mild OSAS,6.7%(16/239)had moderate OSAS,and 6.7%(16/239)had severe OSAS.Compared with PD patients without OSAS(n=173),patients with OSAS(n=66)were older(P=0.001),with higher proportion of male patients(P=0.020),lower proportion of rapid eye movement sleep behavior disorder(RBD)(P=0.005)and lower levodopa equivalent dose(LED).The proportion of overweight and obesity(BMI ≥ 24)(P=0.038),hypertension(P=0.001)and fatty liver(P<0.001)were higher.The Epworth Sleepiness Scale score of patients with OSAS was higher than that of patients without OSAS(P=0.039).Binary logistic regression showed that age≥65 years old[Odds ratio(OR)=3.146,95%confidence interval(95%CI):1.530-6.470,P=0.002]and male(OR=2.576,95%CI:1.203-5.151,P=0.015)were the independent risk factors for OSAS in PD patients,while RBD(OR=0.367,95%CI:0.179-0.749,P=0.006)and LED(OR=0.283,95%CI:0.099-0.813,P=0.019)were the independent protective factors for less OSAS in PD patients.Based on the above four factors,a nomogram model was established to predict the occurrence of OSAS in PD patients.The validation results showed that the model had high predictive performance,with C-index of 0.731(95%CI:0.658-0.804).(2)In this group of PD patients,163 patients completed polysomnography and MRI examination at the same time.Compared with patients without OSAS,the proportion of moderate to severe WMH(P=0.002),deep white matter hyperintensity(DWMH)(P=0.010)and periventricular hyperintensity(PVH)(P=0.016)in PD patients with OSAS was higher.Multivariate analysis showed that OSAS was an independent risk factor for WMH in PD patients(OR=5.734,95%CI:1.195-27.511,P=0.029).Compared with PD without OSAS group,there were no significant differences in cognitive function and motor subtypes in PD with OSAS group.After adjusting for other confounding factors affecting cognitive and motor subtypes,it was found that OSAS was still not a risk factor for cognitive impairment and motor subtypes in PD patients.However,after correcting for other confounding factors,DWMH score(OR=3.947,95%CI:1.580-9.859,P=0.003)was an independent risk factor for PD-PIGD.Moderate to severe PVH(Fazekas≥2)(OR:4.407,95%CI:1.444-13.457,P=0.009)was an independent risk factor for PD with cognitive impairment.Conclusions:(1)There were differences in age,gender,dopaminergic dosage,comorbidity with RBD,daytime excessive sleep,hypertension and fatty liver between PD patients with OSAS and those without OSAS.PD combined with RBD and dopaminergic therapy can reduce the incidence of OSAS,while the elderly and male PD patients had a higher risk of OSAS.(2)Although OSAS in PD was an independent risk factor of WMH,which was positively correlated with motor and cognitive impairment,OSAS has no direct correlation with cognitive disorder and PIGD subtype.It is necessary to expand the sample size for further prospective studies.