Study on the correlation between two common sleep disorders in Parkinson's disease

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.

DOI: 10.3969/j.issn.1672-6731.2017.01.007