多导睡眠监测在帕金森病中的作用：客观睡眠评估与临床指征

文献信息

中文摘要

睡眠障碍（SDs）在帕金森病（PD）中高度流行，在疾病过程中影响高达80%的患者，并显著导致生活质量受损、认知下降、运动恶化、跌倒风险增加以及照护者负担加重。多导睡眠监测（PSG）仍是PD中客观睡眠评估的金标准，并在鉴别诊断和治疗规划中发挥核心作用。本综述探讨了PSG可识别的SDs谱系，包括快速眼动（REM）睡眠行为障碍（RBD）、阻塞性睡眠呼吸暂停（OSA）、睡眠期周期性肢体运动以及睡眠结构改变。视频多导睡眠监测（v-PSG）对于确认REM睡眠期无肌张力（RWA）至关重要，RWA是RBD的电生理标志，也是公认的突触核蛋白病前驱标志物。此外，PSG可量化呼吸暂停低通气指数（AHI）、氧饱和度下降负荷和睡眠碎片化，这些参数与认知障碍和疾病进展相关。虽然家庭睡眠呼吸暂停检测（HSAT，3型）可能对高度怀疑OSA的选定病例有用，但全面的实验室（1型）PSG提供更优的诊断准确性，尤其是在复杂或重叠睡眠障碍的患者中。将客观睡眠评估整合到常规PD管理中对于识别可治疗的合并症、改善预后分层以及优化运动和非运动结局至关重要。

英文摘要

Sleep disorders (SDs) are highly prevalent in Parkinson's disease (PD), affecting up to 80% of patients during the disease and significantly contributing to impaired quality of life, cognitive decline, motor worsening, fall risk, and increased caregiver burden. Polysomnography (PSG) remains the gold standard for objective sleep assessment in PD and plays a central role in differential diagnosis and therapeutic planning. This review examines the spectrum of SDs identifiable by PSG, including rapid eye movement (REM) sleep behavior disorder (RBD), obstructive sleep apnea (OSA), periodic limb movements in sleep, and alterations in sleep architecture. Video-polysomnography (v-PSG) is essential for confirming REM sleep without atonia (RWA), which is the electrophysiological hallmark of RBD and a recognized prodromal marker of synucleinopathies. Also, PSG quantifies the apnea-hypopnea index (AHI), oxygen desaturation burden, and sleep fragmentation, parameters associated with cognitive impairment and disease progression. While home sleep apnea testing (HSAT, type 3) may be useful for selected cases with high suspicion of OSA, comprehensive in-laboratory (type 1) PSG provides superior diagnostic accuracy, particularly in patients with complex or overlapping sleep disturbances. Integrating objective sleep evaluation into routine PD management is crucial to identify treatable comorbidities, improve prognostic stratification, and optimize motor and non-motor outcomes.