Avaliação dos distúrbios de sono em indivíduos com doença de Parkinson submetidos à polissonografia

Abstract

Introduction: Sleep disorders are prevalent symptoms in Parkinson's disease (PD) and are predictors of disability and worsening quality of life. Therefore, studies aimed at understanding the physiological variations of sleep architecture in PD, as well as identifying the most prevalent disorders and their characteristics, can guide clinical decision-making and improve the quality of life of these individuals. Objectives: To describe the physiological variations of sleep and to investigate the most prevalent sleep disorders in individuals with PD undergoing polysomnography (PSG). Materials and methods: This is a cross-sectional, descriptive and exploratory study, developed from the analysis of data from electronic medical records of individuals treated at The Sarah Network Rehabilitation Hospitals from 2015 to 2021. They were selected from patients with and without a diagnosis of PD with clinical complaints of sleep disorders and undergoing PSG. Medical records of individuals with other neurological and psychiatric diseases and those undergoing deep brain stimulation surgery were excluded. For statistical analysis, the SPSS program was used. Results: The medical records of 313 individuals with PD (187 men, 64±9.7 years) and 56 individuals without the disease (25 men, 51 ± 9.5 years) were analyzed. There was a decrease in sleep efficiency, total sleep time, percentage in stages N3 and REM, index of microarousals and microarousals related to breathing, in addition to the average index of O2 saturation in individuals with PD. In turn, the wake time after sleep, percentage in stage N2 and awakening index were higher. In the PD group, obstructive sleep apnea (OSA) was the most prevalent disorder (77.9%), followed by REM sleep behavior disorder (RBD) (26.8%) and periodic limb movements (PLM) (17 .6%). There was a correlation between disease duration and percentage in stage N3;REM stage and Unified Parkinson´s Disease Rating Scale (UPDRS III) and Modified Hoehn and Yahr Scale (HY). When considering individuals with PD, with and without OSA, those presented more changes in sleep parameters: higher apnea and hypopnea indexes (AHI), AHI in NREM, AHI in REM, micro-arousal index related to breathing, microarousal index related to limb movement, longer oxygen saturation time less than 90% and lower minimum oxygen saturation values, even with less disease severity. Conclusion: Individuals with PD have many physiological changes in sleep, with a higher prevalence of disorders when compared to the control group. OSA was the most common disorder in the PD group. The percentage in stage N3 was associated with disease duration, the REM stage was associated with UPDRS and HY. Sleep assessment, mainly based on PSG, which is considered the gold standard, should be encouraged in the clinical follow-up of these individuals. Therefore, the identification of physiological alterations in the sleep architecture of this population can guide the therapeutic approach, minimizing the possible complications that may arise with the evolution of the disease.