帕金森病患者的睡眠呼吸障礙與白日嗜睡、認知功能和生活品質之關聯性研究

近年來，帕金森氏病所造成之睡眠干擾被廣泛地探討，尤其是帕金森氏症治療藥物是否造成白日嗜睡，及快速動眼期行為障礙對睡眠的影響。帕金森氏病和睡眠呼吸中止症都好發於年長者，這些人通常有日間嗜睡、沮喪、認知功能缺損，或是因健康狀況欠佳所導致的較低生活品質。帕金森氏症和睡眠呼吸中止症、白日嗜睡之間的關聯性尚未被徹底研究。方法：收集40位心智正常且無重大身體疾病現象的輕中度帕金森氏症患者，對其進行夜間攜帶式睡眠呼吸障礙檢查，包括鼻、口氣流，胸腹部呼吸運動，脈動式血氧測量以及體位變化，隔天再對病患進行白日嗜睡、憂鬱、認知功能及生活品質的評估。研究結果顯示，40位病患中有15位 (37.5%) ，20位對照組中有7位（35%），其睡眠呼吸障礙指數（RDI） ?d 10，並以阻塞型呼吸中止症為主要表現，兩者並無統計上的顯著差異（P＝0.689）。40位病患中的20位（52.5%），其白日嗜睡量表的分數（ESS）> 10。白日嗜睡量表（ESS）的分數和睡眠呼吸障礙指數（RDI）沒有相關性（P＝0.931），也未和多巴胺藥物或安眠藥的治療有關（P＝0.125＆P＝0.807）。有無睡眠呼吸中止症的帕金森病患者，其認知篩檢工具（CASI）中近期記憶分數的差異主要是因為年齡造成（P＝0.008），而其生活品質量表心理總分的差異主要是憂鬱造成（P＝0.086）。血氧飽和度下降指數（ODI）和生活品質量表之生理總分具有相關性（P＝0.362）。當控制渾淆因子後，平均血氧飽和度仍獨立解釋認知篩檢工具中之注意力（P＝0.031）和抽象思考分數（P＝0.016）。結論：睡眠呼吸中止症在帕金森病人的好發率與一般老年人相同。主觀的白日睡睡在帕金森病人是常見的，但是卻不能以睡眠呼吸中止症來解釋。儘管如此，血氧飽和度下降與帕金森病人的注意力和抽象思考力的障礙，以及體能性的生活品質降低有顯著的關聯性。

關鍵字

帕金森氏症；睡眠呼吸中止症；生活品質；認知功能；白天嗜睡

並列摘要

Sleep disturbances in Parkinson’s disease have been frequently discussed in recent years which focus on excessive daytime sleepiness after taking anti-Parkinson’s drugs and REM Sleep Behavior Disorder. Parkinson’s disease and obstructive sleep apnea/hypopnea (OSAH) not only are common in the elderly but also share many clinical features in terms of excessive daytime sleepiness (EDS), depression, cognitive dysfunction and impaired health-related quality of life. The association between Parkinson’s disease and OSAH is not well studied. I prospectively recruited 40 non-demented and non-depressed patients with mild to moderate Parkinson’s disease and 20 voluntary healthy control for an overnight home sleep study using a portable device which consisted of nasal and oral airflow, chest and abdominal respiratory effort, pulse oximetry and body position. On the morning following sleep study patients underwent assessment of daytime sleepiness, cognitive function and health-related quality of life. The study showed 15 of 40 patients (37.5%) had respiratory distress index ?d 10 with obstructive type predominantly, compared to 7 of 20 control (35%)without statistical difference（P＝0.689）. Twenty-one of 40 patients (52.5%) had Epworth Sleepiness Scale (ESS) > 10. The ESS was neither correlated with RDI nor associated with medications of any dopamine agonist or hypnotic（P＝0.931）. The difference of recent memory score in Cognitive（P＝0.125＆P＝0.807）. Assessment creening Instrument (CASI) between OSAH and control groups was confounded by age and education level（P＝0.008）. The difference of mental summary score in SF-36 was also confounded by depression（P＝0.362）. The abstract and attention scores in CASI were significantly（P＝0.031） and negatively correlated （P＝0.016）with averaged oxygen saturation after adjusting for the confounding factors. The physical summary score in SF-36 was also significantly correlated with oxygen desaturation index. I conclude that the prevalence of OSAH in Parkinson’s disease is not different from that in ageing population. Subjective daytime sleepiness is common in Pakinson’s disease but can not be explained by OSAH. Despite this, oxygen desaturation is significantly associated with impairment of attention, abstract thinking and physical component of health-related quality of life.