Sleep Disorders Of Parkinson's Disease And Multiple System Atrophy

BackgroundVarious forms of sleep disorders are common in parkinson's disease(PD) and multiple system atrophy(MSA).According to recent international literature,REM sleep behavior disorder(RBD) has closely associated with synucleinopathies and probably has diagnostic or predicting value to it.Up to date,the relationship between RBD and synucleinopathies had not been paid enough attention to in our country and thus rarely been reported.Objective1.Study the characters,manifestations and influence factors of sleep disorders in PD and MSA.2.Investigate the incidence rate,onset time and electrophysiological characters of RBD. Study the electrophysiological diagnostic criteria of RBD in PD and MSA,and the relationship between RBD and synucleinopathies.Material and MethodSleep questionnaires and video-polysomnography(PSG) are used to study sleep disturbance of PD and MSA by subjective and objective ways.(1) Subjective sleep assessments:All subjects,including 63 PD patients,65 age and sex matched healthy controls and 7 MSA patients,completed the questionnaires of HAD,PDSS,RBDSQ, ESS.The sleep disturbances and influence factors of PD patients were analyzed,and then got the messages of RBD incidence rate and onset time.(2) Objective sleep assessments: 8 PD patients,7 MSA patients,and 15 age and sex matched healthy controls underwent video-PSG recording on two consecutive nights.Sleep architect were analyzed.We analyzed the PSG characters of RBD accompany with PD and MSA,and then try to determine the electrophysiological diagnostic parameters of it.Result1,In PD patients,the total PDSS scores and PDSS individual items are lower than control,while ESS score are higher.PDSS scores are correlated with Hoehn-Yahr stage and anxiety,unrelated with length of disease and L-DA dosage.ESS scores are associated with Hoehn-Yahr stage,total PDSS scores,length of disease and L-DA dosage.2,The common sleep architecture characters of PD and MSA are more awakenings, lower sleep efficiency,less sleep spindle density,higher percentage of stageâ… ,more REM without atonia(RWA) and chin phasic EMG activity densities.PD patients also have longer sleep latency and less percentage of stageâ…¢+â…£.3,Patients with PD or MSA have a higher prevalence of RBD.RBD are seen in 60.3% PD patients and 100%MSA patients,among those,47.37%and 85.7%precede the waking symptoms of MSA and PD.4,The main PSG characters of RBD accompany with PD and MSA are chin REM without atonia(RWA) and movement.Conclusion1.PD sleep disorders are characterized by difficulty in falling asleep at night,sleep fragmentation and excessive daytime sleepiness.Influence factors of PD night sleep disorders are disease severity and anxiety.Influence factors to excessive daytime sleepiness are L-DA dosage,disease length and disease severity.Sleep disorders of MSA are fragment sleep.2.The relatively higher RBD prevalence in MSA and PD patients indicates RBD has close relationship with PD and MSA.Whether RBD is the early marker of PD and MSA needs to be further studied.The main PSG characters of RBD accompany with PD and MSA are chin REM without atonia(RWA) and the motor manifestations.RWA and phasic EMG activity density are supposed to be the PSG diagnostic parameters.