Učestalost poremećaja REM faze sna kod bolesnika sa Parkinsonovom bolesti
Sažetak
U
Uvod/Cilj. San je izazvan prirodnim ciklusima aktivnosti u mozgu i sastoji se od dva osnovna stanja: sna sa brzim kretanjem očiju (REM faza) i sna bez brzog kretanja očiju (NREM faza). Poremećaj REM faze sna (RBD) karakteriše se izraženim motornim i vokalnim manifestacijama u toku REM faze sna koje predstavljaju 'odigravanje' događaja u snovima. Normalan gubitak mišićnog tonusa, sa izuzetkom respiratornih, ekstraokularnih, sfinkternih mišića i mišića srednjeg uva odsutan je kod bolesnika sa RBD. Poreklo RBD često je nepoznato, ali se dovodi u vezu sa degenerativnim neurološkim poremećajima kao što je Parkinsonova bolest (PB). Bolesnici sa PB ne moraju uvek ispoljiti odlike koje prate RBD, koji se identifikuje kod približno jedne trećine do jedne polovine ovih bolesnika. Metode. U periodu od decembra 2010. do septembra 2011. ambulantno smo pregledali 97 bolesnika sa PB, lečenih u Institutu za neurologiju Kliničkog Centra Srbije u Beogradu. Nakon što je ustanovljena dijagnoza, svi bolesnici popunili su posebno konstruisani upitnik sa sledećim varijablama: starost, pol, godine života na početku bolesti, dužina trajanja bolesti od pojave simptoma, forma bolesti, način lečenja, dužina trajanja lečenja, prisustvo opstipacije, smanjenje čula mirisa i porodična anamneza PB. Na početku pregleda, motorna sposobnost bolesnika ocenjivana je pomoću skale Unified Parkinson’s Disease Rating Scale (motor part) (UPDRS). Kognitivne sposobnosti procenjivane su pomoću skale Mini Mental Status Examination (MMSE) (Mini mental test), a simptomi depresije bodovani su uz pomoć skale Hamilton-ove Depression Rating Scale (HDRS). Bolesnici sa PB podeljeni su na one sa i bez RBD koristeći RBD Questionnaire – Hong Kong (RBDQ-HK) upitnik u vidu intervjua. Forma PB, način lečenja, pol, opstipacija i porodična anamneza PD su statistički računate Fišerovim χ2 testom. Dužina trajanja simptoma i lečenja, prisustvo olfaktivnih promena, MMSE skor, UPDRS skor i HDRS skor analizirani su primenom Z-testa. Starost i godine života na početku bolesti procenjene su neuparenim t-testom. Rezultati. RBD pozitivnu grupu činilo je 15 (15,5%) bolesnika, dok kod ostalih (82/97) RBD nije bio identifikovan. Između RBD pozitivne i negativne grupe kada je u pitanju pol (p = 0,847), starost (p = 0,577), uzrast na početku bolesti (p = 0,141), dužine trajanja bolesti od pojave simptoma (p = 0,069), porodična anamneza (p = 0,591), forma bolesti (p = 0,899), prisustva opstipacije (p = 0,353), smanjenje čula mirisa (p = 0,32) i MMSE skor (p = 0,217) nije bilo razlike. Dužina trajanja lečenja u grupi RBD pozitivnih bila je značajno duža nego u grupi RBD negativnih (9,4 ± 5,3 i 6,3 ± 3,9 godina, respektivno; p = 0,029), što je utvrđeno i za UPDRS motorni skor (19,1 ± 9,4 i 12,7 ± 8,2, respektivno; p = 0,013). Takođe, HDRS skor bio je viši kod bolesnika kod kojih je utvrđen RBD, za razliku od bolesnika u grupi u kojoj je ovo oboljenje bilo odsutno (10,1 ± 6,0 i 6,4 ± 4,5, respektivno; p = 0,019). Zaključak. Dobijeni rezultati pokazuju da 15,5% bolesnika sa PB ima i RBD, kao i da se bolesnici sa RBD razlikuju od onih bez tog oboljenja po dužini trajanja lečenja, težini bolesti (utvrđenoj UPDRS skorom) i težini depresivnih simptoma.
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