Clinical Features Of Parkinson’s Disease With Excessive Daytime Sleepiness And Its Correlation With Peripheral Iron Metabolism

Objective: To analyze the clinical characteristics of patients with Parkinson’s disease(PD)accompanied by excessive daytime sleepiness(EDS),and explore the relationship between PD and PD accompanied by EDS and serum iron,ferritin and transferrin.Method: A total of 80 PD patients admitted to the Department of Neurology,the Second Affiliated Hospital of Xinjiang Medical University from October 2021 to February 2023 were selected.All PD patients were evaluated by Epworth Sleepiness Scale(ESS),and 36 patients were divided into Parkinson’s disease with excessive daytime sleepiness(PD-EDS)group according to ESS score.Forty-four patients with Parkinson’s disease without excessive daytime sleepiness(PD-NEDS)were included in the control group,and 74 healthy subjects were included in the control group.The Unified Parkinson’s Disease Scale Ⅲ(UPDRSⅢ),Hoehn-Yahr(H-Y)staging,Simple Mental State Assessment Scale(MMSE),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Parkinson’s Disease Fatigue Scale(PFS),and the Sleep Questionnaire(RBDQ)of the Department of Psychiatric Sciences of the Chinese University of Hong Kong-HK),the anosmia Rating Scale(HRS),the Constipation Score Scale(Wexner),and the 39-item Parkinson’s Disease Quality of Life questionnaire(PDQ39)were used to evaluate the motor symptoms,non-motor symptoms and quality of life of PD patients.Colorimetric method was used to detect serum iron levels,ELISA method was used to detect serum ferritin and transferrin levels,to explore the relationship between serum iron,ferritin,transferrin and PD and PD with EDS,and Spearman correlation was used to analyze the correlation between serum iron,ferritin,transferrin levels and PD with EDS.The risk factors of PD with EDS were analyzed by logistic regression.Results: 1.The incidence of PD-EDS was 45%,which was higher in males(P < 0.05).2.Compared with PD-NEDS patients,PD-EDS patients had a later H-Y stage,a higher proportion of PIGD type,more severe motor symptoms and non-motor symptoms,and worse quality of life(P < 0.05).3.The levels of serum iron and ferritin in PD group were lower than those in control group(P < 0.05),and the level of transferrin in PD group was significantly higher than that in control group(P < 0.01);The serum iron level of PD-EDS group was significantly lower than that of PD-NEDS group(P < 0.01).4.Spearman correlation analysis suggested that serum iron level was negatively correlated with daytime sleepiness in PD(P < 0.01).5.Logistic regression analysis suggested that male gender and fatigue were risk factors for PD with EDS.Conclusions: EDS is very common in PD,and PD-EDS patients have more serious motor symptoms and non-motor symptoms.Peripheral iron metabolism disorder may be involved in the occurrence and development of PD,and serum iron metabolism may be involved in the pathogenesis of PD-EDS.