Background: Rapid eye movement (REM) sleep behavior disorder (RBD) and obstructive sleep apnea (OSA) are the most common sleep disorders in Parkinson's disease (PD). The aim of this study was to identify whether RBD could alleviate OSA severity in PD patients and its effect on cognitive impairment.
Methods: From February 2014 to May 2017, we recruited 174 PD patients from the Second Affiliated Hospital of Soochow University, all of whom underwent polysomnography (PSG). We collected clinical data, PSG results, and compared information between patients with and without RBD or OSA by analysis of covariance. We also investigated the effect of these sleep disorders on cognitive impairment using linear regression.
Results: We grouped participants as follows: PD only (n = 53), PD + OSA (n = 29), PD + RBD (n = 61), and PD + RBD + OSA (n = 31). Minimum oxygen saturation (SaO2) during whole sleep and in REM sleep was higher in PD + RBD + OSA patients than that in PD + OSA patients. PD + RBD patients had worse Mini-Mental Status Examination and Montreal Cognitive Assessment (MoCA) scores than those in the PD group (P < 0.001), especially in visuospatial/executive, attention, and memory functions. The PD + OSA group performed worse than the PD group in the delayed recall domain. After adjusting for age, sex, body mass index, education, disease severity, and other sleep disorders, MoCA was negatively associated with OSA (β = -0.736, P = 0.043) and RBD (β = -2.575,P < 0.001). The severity of RBD (tonic/phasic electromyography activity) and OSA (apnea-hypopnea index/oxygen desaturation index/minimum SaO2) were also associated with MoCA. The adjusted β values of RBD-related parameters were higher than that for OSA.
Conclusions: We found that RBD alleviated OSA severity; however, RBD and OSA together exacerbated PD cognitive impairment. Further studies are needed to evaluate whether OSA treatment can improve cognition in PD.
快速眼动睡眠期行为障碍及睡眠呼吸暂停对帕金森病患者认知功能的影响摘要背景：快速眼动睡眠期行为障碍（Rapid eye movement sleep behavior disorder, RBD）和睡眠呼吸暂停（obstructive sleep apnea, OSA）是帕金森病（Parkinson's disease, PD）患者常见的两种睡眠障碍。本研究旨在研究RBD是否可以改善PD患者OSA严重程度及两者对PD患者认知功能的影响。 方法: 纳入2014年2月至2017年5月之间就诊于苏州大学附属第二医院的174例PD患者，所有患者均进行多导睡眠监测（polysomnography, PSG）。评估其临床症状、PSG结果，对PD合并RBD或OSA患者的临床特点及睡眠参数进行对比。另外，我们还利用线性回归分析研究RBD及OSA对其认知功能障碍的影响。 结果: 所有PD患者分为四组：PD组（不合并RBD及OSA, n = 53），PD + OSA组（PD合并OSA组，n = 29），PD + RBD 组（PD合并RBD， n = 61）及PD + RBD + OSA组 (PD同时合并RBD及OSA， n = 31）。PD + RBD + OSA 组患者夜间最低脉氧及REM期最低脉氧较PD + OSA高。PD + RBD组患者的认知功能较差 (P＜0.001)，主要表现为视空间/执行功能、注意及记忆功能障碍。PD + OSA组则主要表现为延迟记忆功能障碍。在校正年龄、性别、BMI、教育程度、病程及其他睡眠障碍后，蒙特利尔认知评价量表分数与OSA （β = -0.736, P = 0.043）及RBD （β = -2.575, P＜0.001 ）呈负相关。且RBD（紧张性及时相性下颏肌电）及OSA（呼吸暂停低通气指数/氧饱和度指数/最低脉氧饱和度）严重程度与MoCA相关。校正β值说明RBD对PD患者认知功能的影响更严重。 结论: RBD可减轻PD患者OSA严重程度，但合并RBD及OSA加重PD患者认知功能障碍。.
Keywords: Cognitive Dysfunction; Sleep Apnea; Obstructive; Parkinson's Disease; Rapid Eye Movement Sleep Behavior Disorder.