Clinical Characteristics And Biomarker Research In Early Parkinson's Disease With Obstructive Sleep Apnea Hypopnea Syndrome

Part ? Clinical Characteristics and relationship between cognitive function and Sleep Apnea in Early Parkinson' s Disease with Obstructive Sleep Apnea Hypopnea SyndromeObjective This study aimed to investigate the Clinical Characteristics especially the cognitive function and determine the relationship between cognitive function and sleep apnea in early PD with Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS).Methods We recruited 152 early PD patients,44 age-and sex-matched OSAHS patients and 17 controls.All participants underwent clinical investigation,Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment Beijing Version(MoCA)and polysomnography(PSG).All PD patients were assessed motor and non-motor symptoms by Unified Parkinson,s Disease Rating(UPDRS),Hoehn and Yahr Stage(H-Y),Hamilton Rating Scale for Depression(HRSD),Hamilton Rating Scale for Anxiety(HAMA),Epworth Sleepiness Scale(ESS),39-items Parkinson's Disease Questionnaire(PDQ-39).Then,we investigated the Clinical Characteristics especially the cognitive function and determine the relationship between cognitive function and sleep apnea in early PD with OSAHS.Results The incidence of OSAHS in early PD was 34.9%(53/152).The percentage of mild OSAHS was 54.7%(29/53)and the percentage of moderate and severe OSAHS was 45.3%(24/53).The body mass index(BMI)of PD patients with OSAHS was higher than PD patients without OSAHS.The MMSE score and MoCA score were both lower in PD with((25.72±2.13)and(23.02±2.38))and without OSAHS patients((26.43±2.26)and(23.43±2.72)).The MMSE score of PD patients with OSAHS was significant lower than PD patients without OSAHS.There was a lower trend on the scores of visuospatial/executive,attention,and delayed recall domains in PD patients with OSAHS compared to PD patients without OSAHS.The MMSE score and MoCA score of PD patients with mild OSAHS((24.63±2.08)and(22,21±2.55))were significant lower than PD patients with moderate and severe OSAHS((26.62±1.74)and(23.69±2.04))(p=0.001 and p=0.039).Decreased MoCA scores in early PD patients with OSAHS were significantly associated with higher apnea and hypopnea index(AHI)and oxygen desaturation index(ODI)(p=0.002 and p<0.001).There were no significant differences on total sleep time(TST)?sleep efficiency(SE)?sleep latency(SL)?awakenings?percentage of time spent in NREM and REM sleep,the Index of periodic limb movements,the tonic chin electromyography activity density and the phasic chin electromyography between PD patients with and without OSAHS.Conclusion The incidence of OSAHS in early PD was high.The severity of OSAHS in early PD patients was mild dominated.Compared to PD patients without OSAHS,the BMI of PD patients with OSAHS was higher.There was a lower trend on the scores of visuospatial/executive,attention,and delayed recall domains in PD patients with OSAHS compared to PD patients without OSAHS.Decreased MoCA scores in early PD patients with OSAHS were significantly associated with higher AHI and ODI.There were no significant differences on other sleep parameters except sleep disordered breathing parameters between PD patients with and without OSAHS.OSAHS played an important role in cognitive dysfunction by chronic intermittent hypoxia in early PD patients.Part ? Increased Serum Cystatin C and its relationship with Sleep Apnea in Early Parkinson ' s DiseaseObjective This study aimed to determine the concentration of Serum Cystatin C and its relationship with sleep apnea in early PD.Methods We recruited 106 early PD patients and 146 age-and sex-matched controls.All participants underwent clinical investigation and video-polysomnography.Sleep parameters and serum levels of CysC were measured.Then,we investigated the relationships between CysC and clinical variables and the severity of sleep apnea in early PD patients.Results The mean serum level of CysC was significantly higher in patients with early PD(1.03±0.19 mg/L)compared to controls(0.96 ± 0.15 mg/L)(p=0.009).There were significantly positive correlations between serum CysC levels and age(r=0.334,p<0.001),gender(r=.264,p=0.013),and creatinine levels(r=0.302,p=0.018)in early PD patients.The mean serum level of CysC was significantly higher in male patients with early PD(1.06 ± 0.18 mg/L)compared to female patients with early PD(0.96 ± 0.18 mg/L)(p=0.004).Increased serum CysC levels in early PD patients were significantly associated with higher apnea and hypopnea index(AHI)(r=0.231,p=0.017),especially hypopnea index(r=0.333,p<0.001).In early PD patients,elevated serum CysC levels were positively correlated with oxygen desaturation index(r=0.223,p=0.021),percentage of time spent at oxygen saturation(SaO2)<90%(r=0.644,p<0.001),arousal with respiratory event during sleep(r=0,247,P=0.013).On the contrary,the elevated serum CysC levels were negatively correlated with mean and minimal SaO2(r=-0.323,-0.315,both p=0.001)in PD patients.Conclusion The level of serum CysC was higher in early PD patients,especially in male PD.PD patients with elevated serum CysC levels had more respiratory events and more severe oxygen desaturation.Therefore,the serum CysC levels may predict the severities of sleep-disordered breathing problems in early PD patients.