摘要：

研究背景 阻塞性睡眠呼吸暂停低通气综合征（OSAHS）和快速眼动睡眠期行为障碍（RBD）是帕金森病（PD）两种常见睡眠障碍，本研究探讨帕金森病合并两种睡眠障碍的临床特点和睡眠参数变化，以及二者之间相互作用机制。 方法 采用统一帕金森病评价量表（UPDRS）、简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）中文版、Epworth 嗜睡量表（ESS）和匹兹堡睡眠质量指数（PSQI）、非运动症状问卷（NMSQuest）、帕金森病预后量表-自主神经功能部分（SCOPA-AUT）、39 项帕金森病调查表（PDQ-39）和Hoehn-Yahr 分期评价190 例帕金森病患者运动症状、非运动症状（认知功能、睡眠质量、自主神经功能等）和病情严重程度，并行多导睡眠图监测记录睡眠参数。 结果 共73 例合并阻塞性睡眠呼吸暂停低通气综合征患者，其中22 例同时发生快速眼动睡眠期行为障碍（PD + OSAHS +RBD 组），51 例不发生快速眼动睡眠期行为障碍（PD + OSAHS-RBD 组）。PD + OSAHS + RBD 组患者UPDRSⅠ 评分（P = 0.015）、UPDRSⅡ 评分（P = 0.023）、ESS 评分（P = 0.002）、PSQI 评分（P = 0.048）、NMSQuest评分（P = 0.001）和SCOPA-AUT 评分（P = 0.026），以及平均动脉血氧饱和度（P = 0.029）、最低动脉血氧饱和度（P = 0.001）、快速眼动睡眠期最低动脉血氧饱和度（P = 0.000）、快速眼动睡眠期紧张性（P = 0.000）和时相性（P = 0.000）下颏肌电活动均高于PD + OSAHS- RBD 组，而MoCA 评分低于PD +OSAHS- RBD 组（P = 0.013）。相关分析显示，呼吸暂停低通气指数和氧减指数与NMSQuest（r_s = 0.252，P = 0.032；r_s = 0.229，P = 0.010）、SCOPA-AUT（r_s = 0.322，P = 0.005；r_s = 0.247，P = 0.037）和PDQ-39（r_s = 0.340，P = 0.004；r_s = 0.269，P = 0.023）评分呈正相关关系。 结论 帕金森病同时合并阻塞性睡眠呼吸暂停低通气综合征和快速眼动睡眠期行为障碍的患者认知功能障碍、日间嗜睡程度、自主神经功能障碍等非运动症状更加严重。尽管发生快速眼动睡眠期行为障碍的患者夜间动脉血氧饱和度较高，但并不能显著改善帕金森病合并阻塞性睡眠呼吸暂停低通气综合征患者总体缺氧症状。

关键词: 帕金森病, 睡眠呼吸暂停, 阻塞性, REM 睡眠行为障碍, 多道睡眠描记术

Abstract:

Background Obstructive sleep apnea-hypopnea syndrome (OSAHS) and rapid eye movement sleep behavior disorder (RBD) are two common sleep disorders in Parkinson's disease (PD). This paper aims to explore the changes of clinical features and sleep parameters, as well as the mutual effect in PD patients with concurrent OSAHS and RBD.  Methods  Unified Parkinson's Disease Rating Scale (UPDRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) Chinese Version, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Non-Motor Symptoms Questionnaire (NMSQuest), Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), 39-Item Parkinson's Disease Questionnaire (PDQ-39) and Hoehn-Yahr stage were used to assess the motor symptoms, non-motor symptoms (cognitive function, sleep quality, autonomic function), and the severity of disease of 190 PD patients. Polysomnography (PSG) monitoring was done to record sleep parameters. Results  Among those patients, 73 patients were accompanied by OSAHS, among whom 22 patients also suffered from RBD (PD + OSAHS + RBD), and 51 patients did not present RBD (PD + OSAHS - RBD). The scores of UPDRSⅠ (P = 0.015), UPDRSⅡ (P = 0.023), ESS (P = 0.002), PSQI (P = 0.048), NMSQuest (P = 0.001) and SCOPA - AUT (P = 0.026) in PD + OSAHS + RBD group were significantly higher than those in PD + OSAHS - RBD group, while MoCA score was significantly lower (P = 0.013). PSG monitoring showed mean artery oxygen saturation (SaO₂, P = 0.029), mini SaO₂ (P = 0.001), mini SaO₂ in REM (P = 0.000), tonic EMG activity (P = 0.000) and phasic EMG activity (P = 0.000) in REM in PD + OSAHS + RBD group were significantly higher than those in PD + OSAHS - RBD group. Correlation analysis showed that apnea hypopnea index (AHI) and oxygen desaturation index (ODI) were positively correlated with the scores of NMSQuest (r_s = 0.252, P = 0.032; r_s = 0.229, P = 0.010), SCOPA-AUT (r_s = 0.322, P = 0.005; r_s = 0.247, P = 0.037) and PDQ-39 (r_s = 0.340, P = 0.004; r_s = 0.269, P = 0.023). Conclusions PD with concurrent OSAHS and RBD can aggravate the non-motor symptoms such as cognitive dysfunction, daytime sleepiness and autonomic dysfunction. Although RBD patients present higher SaO₂ at night, it cannot release the symptom of anoxia in PD patients with OSAHS.

Key words: Parkinson disease, Sleep apnea, obstructive, REM sleep behavior disorder, Polysomnography