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首页> 外文期刊>Annals of Indian Academy of Neurology >Sleep disturbances in drug na?ve Parkinson's disease (PD) patients and effect of levodopa on sleep
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Sleep disturbances in drug na?ve Parkinson's disease (PD) patients and effect of levodopa on sleep

机译：单纯药物帕金森病（PD）患者的睡眠障碍和左旋多巴对睡眠的影响

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Context: Parkinson's disease (PD) is associated with sleep disturbances, attributed to the neurodegenerative process and therapeutic drugs. Studies have found levodopa to increase wakefulness in some patients while increasing sleepiness in others. Aims: To confirm sleep disturbances in drug na?ve PD patients and understand the impact of levodopa on their sleep. Materials and Methods: Twenty-three drug na?ve PD patients and 31 age-gender matched controls were compared using the Parkinson's Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS). A polysomnogram objectively compared sleep quality. Of the 23 patients, the 12 initiated on levodopa were reassessed subjectively and through polysomnography after 2 months of therapy. Statistical Analysis: Data was expressed as mean ± standard deviation, median, and range. Continuous variables were analyzed by Student's T test for normally distributed data and Mann–Whitney U test for skewed data. Discrete variables were compared by Chi Square tests (Pearson Chi square Test or Fisher's Exact Test). Wilcoxon signed ranks test was applied in the analysis of paired data pre- and post-levodopa. A P value < 0.05 was considered as statistically significant. Statistical analysis of the data was done using the Statistical Package for the Social Sciences (SPSS) version 12. Results: Drug na?ve PD patients had lower PDSS scores than controls. The sleep architecture changes observed on polysomnogram were reduced NREM Stage III and REM sleep and increased sleep latency and wake after sleep onset time. Following levodopa, improved sleep efficiency with reduced sleep latency and wake after sleep onset time was noted, coupled with improved PDSS scores. However, NREM Stage III and REM sleep duration did not increase. Discussion: PD patients take longer to fall asleep and have difficulty in sleep maintenance. Sleep maintenance is affected by nocturia, REM behavioral disorder, nocturnal cramps, akinesia, and tremors, as observed in PDSS scores. Levodopa improves sleep efficiency by improving motor scores without altering sleep architecture. Conclusions: Poor sleep quality and sleep architecture changes occur secondary to the neurodegenerative process in PD patients. Though levodopa improves sleep quality by reducing rigidity and tremor, it does not reverse sleep architecture changes.
机译：背景：帕金森氏病（PD）与睡眠障碍有关，这归因于神经退行性过程和治疗药物。研究发现左旋多巴可以提高某些患者的清醒性，同时增加其他患者的嗜睡性。目的：确定未使用过药物的PD患者的睡眠障碍，并了解左旋多巴对他们睡眠的影响。资料和方法：使用帕金森氏病睡眠量表（PDSS）和爱普沃思嗜睡量表（ESS）比较了23名未使用过药物的PD患者和31位年龄性别匹配的对照组。多导睡眠图客观地比较了睡眠质量。在23例患者中，治疗2个月后，对12例左旋多巴开始的患者进行了主观评估，并通过多导睡眠图进行了重新评估。统计分析：数据表示为平均值±标准偏差，中位数和范围。通过学生的T检验对正态分布的数据进行了分析，对连续变量进行了分析，对Mann-Whitney U检验对偏斜的数据进行了分析。通过卡方检验（Pearson卡方检验或Fisher精确检验）比较离散变量。 Wilcoxon带符号秩检验用于左旋多巴前后的配对数据分析。 P <0.05被认为具有统计学意义。使用社会科学统计软件包（SPSS）版本12对数据进行统计分析。结果：药物纯净的PD患者的PDSS得分低于对照组。在多导睡眠图上观察到的睡眠结构变化减少了NREM III期和REM睡眠，并增加了睡眠潜伏期和睡眠开始后的苏醒时间。左旋多巴后，注意到改善的睡眠效率，减少的睡眠潜伏期和入睡时间后的苏醒，以及改善的PDSS评分。但是，NREM III期和REM睡眠时间并未增加。讨论：PD患者入睡时间更长，并且难以维持睡眠。睡眠维持受夜尿症，REM行为障碍，夜间痉挛，运动障碍和震颤的影响，如PDSS评分所观察到的。左旋多巴通过改善运动评分而不改变睡眠结构来改善睡眠效率。结论：PD患者的神经变性过程继发于不良的睡眠质量和睡眠结构变化。尽管左旋多巴通过降低僵硬度和震颤来改善睡眠质量，但并不能逆转睡眠结构的变化。

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