The Clinical Characteristics Of Sleep Disorders In Patients With Parkinson's Disease And The Analysis Of Its Relative Factors

Objective:1.To analyze the clinical features of sleep disorders in patients with PD.2.To analyze the characteristics of sleep disorders in patients with different types and different severity of PD.3.To investigate the correlation between sleep disorders and other clinical features in patients with PD.Methods:We collected 81 cases of idiopathic Parkinson's disease in our hospital from January 2016 to January 2017,and compared those with 80 healthy subjects in the same period.We asked for general information about the subjects,including name,gender,age,education,etc..For patients with PD:We used the Modified Hoehn and Yahr Staging(H-Y staging)and Unified Parkinson's Disease Rating Scale III(UPDRS-III)to evaluate the severity and clinical subtypes of patients with PD.H-Y staging 1~2 for early stage,2.5~3 for middle stage,4~5 for advanced stage.According to the manifestation of symptoms of PD,patients were divided into three types: Tremor predominant,rigidity predominant,type mixed with tremor and rigidity.For subjects' sleep assessment: We use the Parkinson's disease Sleep Scale(PDSS)to assess nocturnal sleep,the Epworth Sleep Scale(ESS)to assess sleep disorders in daytime and the rapid eye movement(RBD)screening questionnaire to assess RBD.Other non motor symptoms' assessment: the autonomic nerve symptom scale(SCOPA-AUT)was used to evaluate autonomic nervous function;the Hamilton Anxiety Scale(HAMA)and the Hamilton Depression Scale(HAMD)were used to assess anxiety and depression;Montreal cognitive assessment scale(Mo CA),Mini Mental State Examination(MMSE)were used to evaluate cognitive function;The activity of daily living scale(ADL)was used to assess daily living ability.Results:1.Among the PD patients,49 were males(60.5%)and 32 were females(39.5%).Age 25~89 years old,mean age(61.85±11.47)years old.There were 37 mental workers(45.7%)and 44 manual workers(54.3%).H-Y stage 0~5,with an average of(1.80±1.05).UPDRS-? score 1~82,with an average of(27.43±16.585).For PD patients: 61 cases(75.3%)were in the early stage,16 cases(19.8%)were in the middle stage and 4 cases(4.9%)were in the advanced stage.There were 20 cases in rigidity predominant type(24.7%),11 in tremor predominant type(13.6%)and 50 in type mixed with tremor and rigidity(61.7%).2.Compared with the control group,PD group's scores of SCOPA-AUT,HAMA and HAMD were statistically significant.The incidence of anxiety in group PD was12.3%,which was significantly higher than that in the control group,the difference was statistically significant(c2=14.393,P<0.001).The incidence of depression in PD group was 7.4%,significantly higher than that in the control group,the difference was statistically significant.The difference of PD group and control group's total score in PDSS-2~15,PDSS-T,ESS,RBDSQ was statistically significant.The difference in Item one of PDSS was not statistically significant.With score of each item of PDSS less or equal 5 for each sleep symptom severity criteria,scores in PDSS-1,PDSS-3~13,PDSS-15,ESS,RBDSQ were significantly different between the two groups(P<0.05).Scores in PDSS-2,PDSS-14 were not statistically significant in PD group compared with the control group.The incidence of sleep disorder in group PD was 58%,which was higher than that in control group(P< 0.05),and the difference was statistically significant(P< 0.05).The incidence of daytime sleepiness in PD group was 17.3%,which was significantly higher than that in control group(P<0.05),and the difference was statistically significant.RBDSQ > 6 can be considered as diagnose criteria of RBD.PD group's incidence of RBD was 9.9%,the control group's was 1.3%.The difference was statistically significant between the two groups.3.There was no significant difference in scores of PDSS,PDSS1-15,ESS and RBDSQ among the three groups(in the early,middle and advanced stage)in PD patients.The incidence of urinary incontinence due to the lack of action(PDSS-9)was significantly different among the three groups.The PD patients in advanced stage were significantly higher than those in the early and middle stages.4.The scores were no significant differences in PDSS-1~15,PDSS-T,ESS and RBDSQ among the three groups in PD patients(rigidity dominant group,tremor dominant group,group mixed with tremor and rigidity).There were significant differences in scores of PDSS-1~8,PDSS-10~11,PDSS-13,PDSS-15 and ESS among the three groups.5.PDSS was negatively correlated with NMS(r=-0.341,P=0.002),SCOPA-AUT(r=-0.340,P=0.002),HAMA(r=-0.549,P<0.001),HAMD(r=-0.423,P<0.001)and has no correlation with age(r=-0.218,P=0.05),gender(r=-0.209,P=0.061),occupation(r=0.037,P=0.744),the course of disease(r=-0.087,P=0.438),degree(r=-0.141,P=0.209),type(r=-0.055,P=0.626),H-Y stage(r=-0.151,P=0.181),UPDRS-?(r=-0.181,P=0.107),MMSE(r=-0.083,P=0.463),Mo CA(r=-0.091,P=0.418)and ADL(r=-0.198,P=0.076).Conclusion:1.The incidence of sleep disorders in PD patients is high.The main manifestations are poor night sleep quality,difficulty of falling asleep,prolonged sleeping difficulty,nocturnal urination,night dream disturbance,excessive daytime sleepiness and RBD.2.Different severity of PD patients with different forms of sleep disorders and the same is true for patients with different types of PD.Patients with advanced stage were more likely to have urinary incontinence due to failure to act than those in middle and early stage.The incidence of sleep disorders in patients with mixed type was higher than that in patients with tremor and rigidity dominant PD patients,the differences among the three groups were significantly different.3.Anxiety,depression and autonomic dysfunction are the influencing factors of sleep disorders in patients with PD.