Relação entre os distúrbios do sono no equilíbrio, destreza manual, mobilidade e qualidade de vida em indivíduos com Doença de Parkinson
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2021-10-06
Autores
Silva, Luane Moraes
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Universidade Estadual Paulista (Unesp)
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Introdução: A Doença de Parkinson (DP) é uma doença neurodegenerativa, progressiva e multissistêmica que gera comprometimentos motores e não motores.Os distúrbios do sono estão entre os sintomas não motores mais prevalentes na DP que parecem estar associados com a progressão dos comprometimentos da marcha, deterioração rápida do controle postural, equilíbrio e prejuízo da destreza manual dos indivíduos. Objetivo: verificar a relação dos distúrbios do sono com: a destreza manual, o equilíbrio, a mobilidade e a qualidade de vida em indivíduos com a DP.Material e Método: Participaram do estudo, idosos com e sem DP do sexo feminino e masculino divididos em dois grupos: grupo controle (GC) e grupo de idosos com DP (GIDP). Os dois grupos foram avaliados quanto a Qualidade de vida (Questionário Short-Form Health Survey - SF-36), função cognitiva (Montreal Cognitive Assessment- Moca Test), equilíbrio e mobilidade (Timed Up and Go – TUG e Four square step test - FSST), destreza manual (Annett PegBoard), qualidade do sono (Índice de Qualidade de Sono de Pittsburgh - PSQI – BR)).O GIDP também foi avaliado por meio da Escala Unificada de Avaliação da Doença de Parkinson – Parte III (Unified Parkinson’s Disease Rating Scale – UPDRS). A análise estatística foi realizada por meio do software GraphPad Prism 7. A normalidade dos dados foi analisada pelo teste de Shapiro-Wilk. Para comparação entre os grupos quanto às médias ± desvio padrão da média dos dados referentes à caracterização da amostra foi aplicado o teste Mann-Whitney. A análise da correlação entre as variáveis foi feita por meio do teste de correlação de Spearman. Em todos os testes estatísticos foi adotado o nível de significância de p < 0.05.Resultados: No PSQI- BR, o GIDP apresentou maior indicativo de distúrbios do sono e pior qualidade subjetiva do sono do que o GC. Na actigrafia o GC apresentou maior amplitude do ritmo ciclo sono- vigília do que o GIDP e verificou-se que no GC aproximadamente 56% dos participantes apresentaram ritmo sincronizado com o claroescuro ambiental, enquanto que no GIDP, 92% apresentaram se dessincronizados. Quanto à parte motora notamos diferenças entre os grupos no TUG (p=0,0001), no Pegboard mão direita (p=0,001) e na mão esquerda (p=0,033).Na qualidade de vida observamos diferenças nos domínios: capacidade funcional (p=0,02), limitações por aspectos físicos (p=0,008) e estado geral de saúde (p=0,01) entre os grupos. Observamos correlações entre a amplitude do ritmo do ciclo sono-vigília com o pegboard direito (p=0,0028) e esquerdo (p=0,0426), com o domínio de limitação física (p=0,0013 ) e com o estado emocional (p=0,018). Notamos correlação entre a latência do sono e o estado cognitivo. Nas possíveis correlações entre os escores do PSQI e as variáveis motoras verificamos correlação entre qualidade subjetiva do sono QSS e TUG (R=0,45 e p= 0,026) e entre DD e TUG (R=0,505 e p=0,010). Notamos correlação negativa (R=-0,563 e p=0,003) entre o Estado Geral de Saúde e o QSS, resultados semelhantes foram observados em relação ao domínio vitalidade e DDS (R= -0,497, p=0,10), e entre os domínios estado Geral de saúde (R=-0,559, p=0,003) e vitalidade (R=-0,421, p=0,032) com a DD.Conclusão: Concluímos que os indivíduos com DP apresentam uma qualidade do sono ruim, assim como diminuição na amplitude do ciclo sono vigília e que essas alterações do ciclo sono vigília impactaram negativamente na destreza manual de ambas as mãos, na cognição e nos domínios de limitação física e estado emocional na qualidade de vida.
Introduction: Parkinson's Disease (PD) is a neurodegenerative, progressive and multisystemic disease that generates motor and non-motor impairments. Sleep disorders are among the most prevalent non-motor symptoms in PD that seem to be associated with the progression of gait impairments. , rapid deterioration of postural control, balance and impairment of individuals' manual dexterity. Objective: to verify the relationship of sleep disorders with: manual dexterity, balance, mobility and quality of life in individuals with PD. Material and Method: The study included female and male elderly with and without PD, divided into two groups: control group (CG) and elderly group with PD (GIDP). Both groups were assessed for quality of life (ShortForm Health Survey - SF-36), cognitive function (Montreal Cognitive AssessmentMoca Test), balance and mobility (Timed Up and Go - TUG and Four square step test - FSST), manual dexterity (Annett PegBoard), sleep quality (Pittsburgh Sleep Quality Index - PSQI - BR)). The GIDP was also assessed using the Unified Parkinson's Disease Rating Scale - Part III (Unified Parkinson's Disease Rating Scale – UPDRS). Statistical analysis was performed using the GraphPad Prism 7 software. Data normality was analyzed using the Shapiro-Wilk test. For comparison between groups regarding the means ± standard deviation of the mean of the data referring to the characterization of the sample, the Mann-Whitney test was applied. The analysis of the correlation between the variables was performed using the Spearman correlation test. In all statistical tests, the significance level of p < 0.05 was adopted.Results: In the PSQI-BR, the GIDP had a higher indicative of sleep disorders and worse subjective sleep quality than the CG. In the actigraphy, the CG showed greater amplitude of the sleep-wake cycle rhythm than the GIDP and it was found that in the CG approximately 56% of the participants presented a rhythm synchronized with the ambient light-dark, while in the GIDP, 92% were out of sync. As for the motor part, we noticed differences between the groups in the TUG (p=0.0001), in the right hand pegboard (p=0.001) and in the left hand (p=0.033). In terms of quality of life, we observed differences in the domains: functional capacity ( p=0.02), limitations due to physical aspects (p=0.008) and general health status (p=0.01) between groups. We observed correlations between the amplitude of the sleep-wake cycle rhythm with the right (p=0.0028) and left (p=0.0426) pegboard, with the physical limitation domain (p=0.0013 ) and with the state emotional (p=0.018). We noted a correlation between sleep latency and cognitive status. In the possible correlations between PSQI scores and motor variables, we verified a correlation between the subjective quality of sleep QSS and TUG (R=0.45 and p=0.026) and between DD and TUG (R=0.505 and p=0.010). We noted a negative correlation (R=-0.563 and p=0.003) between the General Health Status and the QSS, similar results were observed in relation to the vitality and DDS domain (R= -0.497, p=0.10), and between the domains General health status (R=-0.559, p=0.003) and vitality (R=-0.421, p=0.032) with DD.Conclusion: We conclude that individuals with PD have poor sleep quality, as well as decreased amplitude the sleep-wake cycle and that these changes in the sleep-wake cycle negatively impacted the manual dexterity of both hands, cognition and the domains of physical limitation and emotional state in quality of life.
Introduction: Parkinson's Disease (PD) is a neurodegenerative, progressive and multisystemic disease that generates motor and non-motor impairments. Sleep disorders are among the most prevalent non-motor symptoms in PD that seem to be associated with the progression of gait impairments. , rapid deterioration of postural control, balance and impairment of individuals' manual dexterity. Objective: to verify the relationship of sleep disorders with: manual dexterity, balance, mobility and quality of life in individuals with PD. Material and Method: The study included female and male elderly with and without PD, divided into two groups: control group (CG) and elderly group with PD (GIDP). Both groups were assessed for quality of life (ShortForm Health Survey - SF-36), cognitive function (Montreal Cognitive AssessmentMoca Test), balance and mobility (Timed Up and Go - TUG and Four square step test - FSST), manual dexterity (Annett PegBoard), sleep quality (Pittsburgh Sleep Quality Index - PSQI - BR)). The GIDP was also assessed using the Unified Parkinson's Disease Rating Scale - Part III (Unified Parkinson's Disease Rating Scale – UPDRS). Statistical analysis was performed using the GraphPad Prism 7 software. Data normality was analyzed using the Shapiro-Wilk test. For comparison between groups regarding the means ± standard deviation of the mean of the data referring to the characterization of the sample, the Mann-Whitney test was applied. The analysis of the correlation between the variables was performed using the Spearman correlation test. In all statistical tests, the significance level of p < 0.05 was adopted.Results: In the PSQI-BR, the GIDP had a higher indicative of sleep disorders and worse subjective sleep quality than the CG. In the actigraphy, the CG showed greater amplitude of the sleep-wake cycle rhythm than the GIDP and it was found that in the CG approximately 56% of the participants presented a rhythm synchronized with the ambient light-dark, while in the GIDP, 92% were out of sync. As for the motor part, we noticed differences between the groups in the TUG (p=0.0001), in the right hand pegboard (p=0.001) and in the left hand (p=0.033). In terms of quality of life, we observed differences in the domains: functional capacity ( p=0.02), limitations due to physical aspects (p=0.008) and general health status (p=0.01) between groups. We observed correlations between the amplitude of the sleep-wake cycle rhythm with the right (p=0.0028) and left (p=0.0426) pegboard, with the physical limitation domain (p=0.0013 ) and with the state emotional (p=0.018). We noted a correlation between sleep latency and cognitive status. In the possible correlations between PSQI scores and motor variables, we verified a correlation between the subjective quality of sleep QSS and TUG (R=0.45 and p=0.026) and between DD and TUG (R=0.505 and p=0.010). We noted a negative correlation (R=-0.563 and p=0.003) between the General Health Status and the QSS, similar results were observed in relation to the vitality and DDS domain (R= -0.497, p=0.10), and between the domains General health status (R=-0.559, p=0.003) and vitality (R=-0.421, p=0.032) with DD.Conclusion: We conclude that individuals with PD have poor sleep quality, as well as decreased amplitude the sleep-wake cycle and that these changes in the sleep-wake cycle negatively impacted the manual dexterity of both hands, cognition and the domains of physical limitation and emotional state in quality of life.
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Doença de parkinson, Distúrbios do sono, Equilíbrio, Destreza manual, Qualidade de vida, Parkinson's disease, Sleep disorders, Balance, Manual dexterity, Quality of life