The Clinical Characteristics Analysis Of Sleep Disorders In Parkinson's Disease And The Study Of Them By Polysomnogram

Background: Sleep disorders is common in Parkinson's disease with a prevalence from 42 to 98%, becoming one of the earliest non-motor symptoms ahead of motor symptoms, even as the first symptom, has a certain value in the early recognition and diagnosis in PD. At present, few study regarding sleep disorders in PD has been reported. Lack of sufficient sample size and objective assessment method, highly rely on subjective sleep assessment scale without unified classification and diagnostic criteria via PSG, which majorly hinder the evaluation of Sleep disorders. It is controversial about incidence rate, manifestation and other related factors about Sleep disorders.Objective: Using PSG to monitor sleep architecture and processes of PD patients, we also analyze the manifestations, characteristics and the relationship with age, duration, UPDRS-?scores, Hoehn-Yahr stage, the average daily levodopa equivalent doses(1evodopa equivalent doses, LDE) of sleep disorders, furthermore, to compare the difference in PD patients with different clinical characteristic and explore the possible pathophysiological mechanisms.Methods: Through the case-control study, we used the PSG to evaluate the 16 PD patients with sleep and 20 volunteers without complaint about sleep, furthermore, to compare sleep parameters including total sleep time, sleep efficiency, total wake time, sleep latency, REM sleep latency, each sleep period and the percentage of each sleep period during sleep. According to the results of PSG, PD patients with sleep disorders were divided into early-onset and late-onset group according to age of onset, duration(?5 years) and duration(>5 years) group according to the length of diseases, tremor-dominant group, akinetic-rigid-dominant group and PIGD-dominant group according to the dyskinesia type, early group(Hoehn-Yahr stage from 1.0 to 2.0) and the late group(Hoehn-Yahr stage from 2.5 to 5.0) according to the Hoehn-Yahr stage. All the sleep parameters were compared among different groups. Finally via analyzing the correlation between the partial parameters and factors including age, disease duration, UPDRS-?scores, Hoehn-Yahr stage and the dose of levodopa(LDE) in different groups to study the clinical characteristics and related factors about sleep disorders in patients with PD. Results:1.The prevalence rate of fragmented sleep(75%) in PD group was significantly higher than the control group(40%)(p=0.049), but the difference on the prevalence rate of difficulty falling asleep and early awakening were not statistically significant(p>0.05).2.The parameters regarding on time in bed, sleep latency, REM sleep latency, N1, the percentage of N1 sleep period, N2, the percentage of N2 sleep period, the percentage of N3 sleep period, the percentage of NREM sleep period were not statistically different between groups(p>0.05),while total sleep time, sleep efficiency, N3, NREM, REM, the percentage of REM sleep period in PD group were significantly higher in the control group(p<0.05), moreover, total wake time was significantly lower in the control group(p=0.014). 3.With the progress of PD, total sleep time, sleep efficiency, REM, the percentage of REM sleep period showed a gradually decreasing trend, while total wake time showed an gradually increasing trend in the early and late group, no effects on sleep structure including age of onset, duration and dyskinesia type in PD were observed. 4.Pearson correlation analysis showed that sleep parameters containing TST, SE, TWT, REM, the percentage of REM sleep period acquired from PSG were not correlated to age, disease duration, UPDRS- scores, Hoehn?-Yahr stage and LDE in PD group(p>0.05).Conclusion:1.Sleep disorders mostly occurred in PD with a high incidence rate, manifesting as fragmented sleep.2.Total sleep time, sleep efficiency, N3, NREM, REM and the percentage of REM were decreased, while total wake time extended. A gradually decreasing trend in total sleep time, sleep efficiency, REM and the percentage of REM and increasing trend in total wake time were observed in the progress of PD. However, no significant influences on sleep architecture such as the age of onset, duration and type of dyskinesia were confirmed. 3. Sleep disorders are common early symptom in PD, would benefit to identify pre-clinical PD patients combining olfactometry test, transcranial sonograph and so on. So the polysomnography should be listed as a routine examination in patients with PD.