The Study Of Sleep Disorders In Patients With Parkinson's Disease By Polysomnogram(psg) And Multiple Sleep Latency Tests (mslt)

[OBJECTIVE]To objectively analyze the manifestation of sleep disorder in patients with parkinson's disease(PD)by polysomnogram(PSG) and multiple sleep latency tests (MSLT),and investigate the characteristics of nocturnal and diurnal sleep disturbances in PD. To explore potential factors related to sleep disorders and probable pathogenesis in PD.[METHODS]Disease severity, disease duration,the dosage of dopaminergic drugs and other information were evaluated by unified Parkinson's disease rating scaleâ…¢(UPDRS-â…¢),Hoehn-Yahr stages,and medication questionnaire in 26 patients with PD.26 patients with PD and 31 age- and sex-matched controls without documented diseases of the CNS were monitored by all night ambulatory video-polysomnographic monitoring and followed by MSLT.The parameters of sleep architecture , sleep progress and sleep-related episodes in two groups were analyzed.[RESULT]1,According to PSG and MSLT recordings,the prevalence of fragmented sleep(76.0%), REM sleep without atonia(69.2%), REM sleep behavior disorder(50.5%), periodic limb movement disorder(61.5%), EDS (26.9%)were increased in PD patients group than that in controls;But there was no statistical significance in the prevalence of sleep apnea syndrome(SAS) between them.Body mass index(BMI),percentage of NREM stage 2 sleep(N2%), percentage of REM sleep(R%),hypopnea index,mean sleep latency in PD patients group were significantly decreased than that in controls (P<0.05);while arousal index, periodic limb movement in sleep index were significantly increased than that in controls (P<0.05).2,Course of disease,Hoehn-Yahr stages, percentage of NREM stage 1 sleep (N1%), arousal index, periodic limb movement in sleep index were increased in PD with RBD group than that in PD without RBD group (P<0.05).3,Multivariate linear regression analysis showed that arousal index was positively related to age,Hoehn-Yahr stages in PD patients,but not related to disease duration,UPDRS-â…¢,Levodopa equivalents(LDE).Mean sleep latency was negatively related to age,LDE in PD patients;but not related to sleep efficiency,apnea hypopnea index(AHI), arousal index.4,Sleep-onset REM periods(SOREMPs) occured in five of our 26 PD patients(19.2%)and in seven(5.5%) out of 128 nap opportunities, respectively.Two narcolepsy-like phenotype (> or = 2 SOREMPs) was found in it,while no one in controls.Sleep attacks(SAs) occured in three of our 26 PD patients(11.5%),but no one in controls.[CONCLUSION]1,The prevalence of sleep disorder was high in PD patients,the main type consisted of sleep fragment,RWA,RBD,PLMD,EDS by PSG and MSLT.We should improve to recognize the characteristics of nocturnal and diurnal sleep disturbances in PD patients clinically.2,The change of the parameters of sleep architectures and progress in PD patients by PSG indicated that they had the disturbance of sleep architecture and physiological sleep-arousal mechanism.Arousal index in PD patients was affected by age and Hoehn-Yahr stages.3,The incidence of RBD became increasingly prevalent with the progression of the disease.Clinical history and synchronized video-polysomnographic recording might improve the accuracy of diagnosising RBD.It not only affected the parameters of sleep architecture , but also caused a significant increase in percentage of NREM stage 1 sleep(N1%) and periodic limb movement in sleep index,which contributed to a increase in arousal index.PD patients with RBD might injure themselves and their bed partners.4,MSLT had been used for the diagnosis of EDS in the PD population.The precise etiology of EDS in patients with PD was difficult to ascertain because of the various potential contributing factors,and we must think highly of the factors of age and LDE.The precise mechanism of sleep attacks in PD patients remained unknown. Even if SAs was rare in PD,physicians should be highly vigilant in recognizing it.