Characteristics, Affecting Factors And Metabolomics Analysis Of Sleep Disorder In Parkinson’s Disease

Part one Validation study of REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ) in ChinaObjectives:To evaluate the application of Chinese version of rapid eye movement sleep behavior disorder screening scale (RBDSQ).To determine the optimal cut-off value of RBDSQ scale in China.Methods:We translated the RBDSQ into Chineseand revised. Then 147 patients who complained of sleep disorderswere enrolled.Their RBDSQ scores were compariedwith their polysomnography (PSG) results.Results:(1)The cronbach’s a coefficient of Chinese versionRBDSQ was 0.813. Retest reliability r=0.914 (P<0.01).(2)The RBDSQ score of RBD group (8.04±2.56) was higher than non-RBD group (3.08±1.67) (p<0.01).(3)The cut-off value of RBDSQ total score was ≥5, with a sensitivity of 91.5% and a specificity of 81.8%. The area under the curve (AUC) was 0.930 (0.885-0.976).Compared with a minimum score of 0.5, there was a significant difference (p<0.01). (4) RBDSQ score had no correlation with duration of disease, and the frequency of attacks.Conclusions:Chinese version of RBDSQ, a reliable screening tool, can be used for further screening.Part two Clinical features and related factors of sleep disorders in Parkinson’s diseaseObjectives:To observe the clinical manifestations of sleep disorders in Parkinson’s disease and the related factors, especially concerning the clinical features of rapid eye movement sleep behavior disorder (RBD).Methods:The consecutive 133patients with idiopathic PD and a total of 51 healthy controls were collected.The sleep disorders and PSG features between these two groups werecompared. The motor symptoms, anxiety and depression, pain, quality of life between PD patients with sleep disorders and without sleep disorders werecompared, and the correlation between these factors were detected. By RBDSQ, the PD patients were divided into two groups RBD group and non-RBD group.The incidence of RBD was observed in PD.The clinical and PSG characteristics of these two groups werecompared.Results:The incidence of sleep disorders in PD patients was 59.39%, significantly higher than the healthy control.PD patients with sleep disorders were associated with more daytime sleepiness, more severe PD, more prone to depression, anxiety, more pain and lower quality of life. H & Y stage, HAMD score and pain is a factor of sleep disorders in PD patients. The incidence of RBDin PD patients was 42.86%. PD patients with RBD were more common in men, with longer duration, higher H & Y stage, more nighttime sleep disorders and depression situation than non-RBD group. PSG analysis showed that H & Y stage, N1% and PLMS index were higherin RBD group.Conclusions:Sleep disorders were more common in PD patients. H & Y stage, HAMD score and pain were associated with sleep disorders in PD patients. PD patients have increased incidence of RBD. PD patients with RBD may have more severe or more extensive lesions.Part Three The impact of rotigotine on sleep quality in Parkinson’s diseaseObjectives:To observe the impact of rotigotine on objective sleep assessment of PD patients by polysomnography testing.Methods:Totally 19PD were enrolled. Scale assessment were performed in front and after a period ofstabilization treatment of rotigotine treatment. PSG were carried outto observethe sleep quality changesobjectively.Results:Polysomnography confirmed that rotigotine can improve nocturnalsleepin PD.Sleep efficiencyand N1% increased, sleep latency, number of awakenings after sleep and PLMS index decreased. Severity of RBD symptoms improved significantly, especially the items related to frequency and severity of abnormal motor behavior RBD. PSG showed that total sleep time and N1% increase, but PLMS index decreased.Conclusions:Rotigotine can improve nocturnalsleep in PD patients. Rotigotine can improve RBD symptoms in PD with RBD patients.Part Four Metabolomics studies of REM sleep behavior disorders and Parkinson’s DiseaseObjectives:To observe the plasma metabolomic changes of PD and RBD. Looking for biomarkers representing RBD and PD pathological process.Methods:Totally 24 healthy subjects,24 iRBD patients,21 PD patients and 20 PD with RBD patients were enrolled. The fasting plasma of every subjects were taken. Gas chromatography-time of flight mass spectrometry spectra were analyzed to obtain metabolic data of every sample. The differences of the major metabolites among blood samples from the four groups were analysised by combining with principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA).Results:Metabolomics detected significant metabolites outline changes between iRBD group and the healthy subjects, obtained22 known kinds of metabolic differences products. Metabolomics detected 31 known kinds of differences products between PD patients and the healthy subjects. Metabolomics detected 12 known kinds of differences products between sRBD patients and PD patients. Metabolomics detected 39 known kinds of differences products between sRBD patients and iRBD patients.Conclusions:There is a difference of plasma levels of metabolic molecules between the iRBD, PD, PD with RBD patients and healthy controls. These results help for the discovery of potential biomarkers.