Relationship Between Cognitive Impairment And Sleep Disorders In Parkinson’s Disease Patients With Excessive Daytime Sleepiness

Objective:To analyze the cognitive function characteristics and influencing factors of patients with Parkinson’s disease(PD)accompanied with excessive daytime sleepiness(EDS),and to explore the relationship between cognitive impairment and sleep disorders in Parkinson’s disease patients with excessive daytime sleepiness.Methods: 1)Parkinson’s disease patients who met the PD diagnostic criteria of the International Association of Dyskinesia Diseases were recruited from January 2018 to December 2018 in the outpatient and inpatient departments of the Neurological and Sleep Medical Center of our hospital.According to the Epworth Sleepiness Scale(ESS)score,they were divided into two groups: the EDS group(Epworth Sleepiness Scale score ≥10)and the NEDS group(Epworth Sleepiness Scale score < 10).2)General data(name,sex,age,unilateral onset,course of PD)were collected by specialists,and Parkinson’s disease rating scale(UPDRS),Pittsburgh sleep quality index(PSQI),Hamilton Anxiety Scale(HAMA),Hamilton were used.The Hamilton Depression Scale(HAMD)was used to evaluate and analyze the two groups of PD patients.3)All patients were monitored by polysomnography(PSG),and the characteristics and differences of total sleep time,sleep efficiency,sleep latency,time and proportion of sleep stages,sleep breathing events,micro-awakening index,sleep apnea hypopnea index and sleep periodic limb movement index between the two groups were analyzed and compared.4)Compare the difference of total scores and sub-items of Montreal Cognitive Assessment(MOCA)between the two groups,and use Pearson correlation analysis to compare the correlation of cognitive function scores with each scale score and sleep parameters of EDS patients.Results: 1)Among the 49 patients included,3 were unable to complete the whole night polysomnography monitoring due to difficulty in falling asleep and turning over,2 were withdrawn because of disagreement to continue the study.Finally,44 PD patients were included in the study,including 21 cases in EDS group(47.72%)and 23 cases in NEDS group(52.27%).2)The scores of UPDRS I,UPDRS II,HAMA and HAMD(15.24±5.95,20.52±6.01,10.24±4.31,8.81±3.83)in EDS group were higher than those in NEDS group(11.78±5.08,16.13±5.82,7.57±3.75,6.01±3.24),and the differences were statistically significant(P<0.05).There was no significant difference in sex,age,education,unilateral onset,duration of PD,Pittsburgh sleep quality index and UPDRS III scores between the two groups(P > 0.05).3)Overnight polysomnography monitoring analysis showed that the sleep latency of EDS group(21.66±17.20 minutes)was significantly shorter than that of NEDS group(33.43±17.59 minutes),the difference was statistically significant(P = 0.030).There were no significant differences in total sleep time,sleep efficiency,time and proportion of sleep stages,apnea-hypopnea index(AHI),micro-arousal index(RERAs)and periodic limb movement index(PLMSI)between the two groups(P > 0.05).4)Compared with the total score of MOCA and each item,the total score of MOCA,memory score and attention score in EDS group(23.14±4.87,3.43±1.25,3.48±0.68)were lower than those in NEDS group(25.61±2.45,4.09±0.79,4.22±0.85),and the differences were statistically significant(P < 0.05),while the visual space,naming,language,abstraction and orientation,There was no significant difference(all P > 0.05).Pearson correlation analysis showed that the MOCA scores of EDS group were negatively correlated with age(r=-0.440),ESS(r=-0.496),HAMA(r=-0.526),HAMD(r=-0.492),PSQI(r=-0.526)and AHI(r=-0.462)(all P<0.05).There was no correlation with education years,UPDRS scores,total sleep time and REMS time(all P > 0.05).After controlling the age of EDS group with partial correlation analysis,MOCA score was negatively correlated with ESS(r=-0.447),PSQI(r=-0.449),HAMA(r=-0.445),HAMD(r=-0.476),but not with AHI(r=-0.366,p=0.112).The total score of MOCA was taken as dependent variable,age,ESS,PSQI,AHI,HAMA,HAMD,UPDRS I and UPDRS II as independent variables for stepwise regression analysis.Finally,PSQI entered regression equation p=0.014,F=7.276,R2=0.277,and adjusted R2=0.239.Conclusion: 1)The cognitive impairment of PD patients with EDS is more serious,mainly manifested in memory and attention field impairment.2)The worse the daytime sleepiness and the worse the sleep quality,the more obvious the cognitive impairment,but the effect of nocturnal hypoxia on the cognitive impairment is not obvious.3)The sleep quality is the main factor affecting cognitive impairment in PD patients with EDS.