The Clinical Analysis Of Sleep Disorders In Patients With Parkinson's Disease And The Study Of Them By Polysomnogram

[OBJECTIVE] To analyze the clinical characteristics of sleep disorder, the quality of sleep in patients with Parkinson's disease(PD),and to investigate the influential factors related to it and probable reasons. 2) To observe the polysomnographic manifestation of sleep disorder and the characteristics of sleep architecture in patients with PD.[METHODS] 1) Sleep disorders of 170 patients with PD were evaluated by Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). Meanwhile ,the cognition, disease severity, the level of depression, course, dopamine dosage and other information were investigated by mini-mental state examination (MMSE),unified Parkinson's disease rating scale (UPDRS)- â…¢ ,Hoehn-Yahr stages(H-Y), HAD and self-made sleep information questionnaire. 2) 42 patients with PD and 40 normal controls were monitored by all night polysomnographic recordings. The parameters of sleep architecture and progress in two groups and video-monitoring features were analyzed .[RESULT] 1) Among 170 patients with PD, the poor quality of sleep was observed in 141 patients , the incidence of sleep disorder was 82.94%. The manifestation of sleep disorders of them included: difficulties in the initiation of sleep(60%), fragmented sleep (56.47%), excessive daytime sleepiness (EDS) (34.71%), sleep behavior disorders (47.65%). 2) Multivariate linear regression analysis showed that PSQI was related to UPDRS-â…¢ scores, H-Y grading scores, HAD scores, MMSE scores, dosage of levodopa and age;but not related to gender and duration of illness.3) According to PSG recordings, the incidence of difficulties in the initiation of sleep, fragmented sleep, excessive daytime sleepiness (ESS) were increased in PD patients group than that in controls;TST, NREM-S2 REM-SL, SE, SSD in patient group were shorter or decreased (P<0.01);while SL, ATA> AT> AT(>5^ ESS were increased (P<0.01). SOREMPs occured in 6 patients in PD group, while no one in conrols. In PD group REM without atonia (RWA) was demonstrated in 36 patients, RBD in 19 patients;but in control group was 6 and 2 separatedly. The statistics analysis showed the difference of incidence of RWA and RBD in two groups was significant (P<0.01) .[CONCLUSION] 1) The incidence of sleep disorder was high in Parkinson's disease, the main clinical type included that difficulties in the initiation of sleep, sleep fragment, sleep behavior disorders and excessive daytime sleepiness, etc. Sleep disorder should be recognized as one of the basic symptoms clinically. 2) The level of sleep disorder was associated with the disease severity, cognition state, depression, age and the dosage of dopamine. 3) The change of the parameters of sleep architectures and progress in PD patients by polysomnography indicated that they had the disturbance of sleep architecture and physiological sleep-arousal mechanism, the basic causes were perhaps the changes of neuropathy and neuro-biochemical transmitter. 4 ) The incidence of RBD was high in PD patients and the manifestations diversified, and it could often precede other symptoms of the disorder. So that RBD with unknowm etiology required further following-up. Particularly we should be alert that an old man with unknown origin RBD who had no cognition disorder and dysautonomia would develop as PD patient at last. 5 ) Our investigation brought new ideas as following : we investigated the quality of sleep, the incidence and clinical characteristics of sleep disorder in a large numbers of patients with Parkinson's disease(PD) at first time in China, and analyzed the main influential factors related to it. We also firstly conducted the polysomnographic monitoring and quantuanalysis for sleep disorder in patients with PD in domestic, thus study rudimently the changes of PSG parameters of Chinese PD patients.