帕金森病患者睡眠障碍评估与护理干预的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.15.016

摘要/Abstract

摘要：

目的总结帕金森患者睡眠障碍评估与护理干预的最佳证据，帮助帕金森病患者改善睡眠障碍，为临床护理工作提供参考。方法系统检索国内外数据及相关网站中关于帕金森病患者睡眠障碍的所有证据，检索文献类型包括指南、专家共识、临床决策、证据总结、系统评价及最新的基础研究。检索时限为建库至2022年11月。由2名研究者对纳入文献的质量进行评价，对符合标准的文献进行资料提取与证据汇总。结果共纳入10篇文献，包括临床决策3篇、指南2篇、系统评价3篇、专家共识2篇。总结了包括睡眠障碍筛查与评估、护理干预、教育和支持系统4个类别的23条证据。结论该研究全面、科学地总结了帕金森病患者睡眠障碍评估与护理干预的最佳证据，可为临床医护人员提供循证依据，从而以科学的方法管理帕金森病患者的睡眠障碍，提高患者的生活质量。

关键词: 帕金森病, 睡眠障碍, 证据总结, 循证护理学

Abstract:

Objective To summarize the best evidence of sleep disorder assessment and nursing intervention in patients with Parkinson’s disease，and to provide references for clinical work to help improve sleep disorders in patients with Parkinson’s disease. Methods All evidence on Parkinson’s sleep disorder from domestic and foreign data and related websites were systematically searched，including guidelines，expert consensuses，clinical decision-making，evidence summaries and systematic reviews. The retrieval period is from the establishment of databases to November 1，2022. There were 2 researchers who evaluated the quality of the literature，extracted and summarized the evidence according to the subject. Results A total of 10 pieces of literature were included，involving 3 clinical decisions，2 guidelines，3 systematic reviews and 2 expert consensuses. 23 pieces of evidence covering 4 categories of sleep disorder screening and assessment，care interventions，and education and support systems were summarized. Conclusion This study comprehensively and scientifically summarizes the best evidence for the assessment and nursing interventions of sleep disorders in patients with Parkinson’s disease，which can provide evidence-based evidence for clinicians to manage sleep disorders in a scientific way and improve patients’ quality of life.

Key words: Parkinson’s Disease, Sleep Disorders, Evidence Summary, Evidence-Based Nursing

周兰兰, 徐群利, 沈蓝君, 李婷婷, 应钰皑, 洪思思. 帕金森病患者睡眠障碍评估与护理干预的最佳证据总结[J]. 中华护理杂志, 2023, 58(15): 1885-1891.

ZHOU Lanlan, XU Qunli, SHEN Lanjun, LI Tingting, YING Yuai, HONG Sisi. Evidence summary of assessing sleep disorders and nursing interventions in patients with Parkinson’s disease[J]. Chinese Journal of Nursing, 2023, 58(15): 1885-1891.

图/表 4

图1 文献筛选流程注：NICE为英国国家卫生和临床优化研究所。

Figure 1 Literature screening process

表1 纳入文献的一般特征（n=10）

Table 1 General characteristics of the literature（n=10）

表2 纳入指南的质量评价结果（n=2）

Table 2 Results of quality evaluation included in the guidelines（n=2）

表3 帕金森病患者睡眠障碍评估与护理干预的最佳证据总结

Table 3 Summary of the best evidence for the assessment of sleep disorders and nursing interventions in patients with Parkinson’s disease

参考文献 32

[1]	Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease[J]. Nat Rev Neurosci, 2017, 18(8):509. DOI PMID
[2]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病睡眠障碍管理专家共识[J]. 中华神经科杂志, 2022, 55(5):441-451.
	Parkinson’s Disease and Movement Disorders Group, Chinese Society of Neurology,Parkinson’s Disease and Movement Disorders Branch of Neurology,Chinese Medical Doctor Association. Consensus on the clinical management of sleep disturbance of patients with Parkinson’s disease in China[J]. Chin J Neurol, 2022, 55(5):441-451.
[3]	桂小红, 王黎萍, 吴承龙, 等. 早期与中晚期帕金森病非运动症状的比较以及对生活质量的影响[J]. 临床神经病学杂志, 2019, 32(1):13-16.
	Gui XH, Wang LP, Wu CL, et al. Comparative study of nonmotor symptoms and the effects on health-related quality of life of patients with Parkinson’s disease between early and middle and late stages[J]. J Clin Neurol, 2019, 32(1):13-16.
[4]	Maggi G, Trojano L, Barone P, et al. Sleep disorders and co-gnitive dysfunctions in Parkinson’s disease:a meta-analytic study[J]. Neuropsychol Rev, 2021, 31(4):643-682. DOI
[5]	Schütz L, Sixel-Döring F, Hermann W. Management of sleep disturbances in Parkinson’s disease[J]. J Park Dis, 2022, 12(7):2029-2058.
[6]	Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treat-ments for nonmotor symptoms of Parkinson’s disease:an evidence-based medicine review[J]. Mov Disord, 2019, 34(2):180-198. DOI URL
[7]	Foster MJ, Shurtz S. Making the critical appraisal for summa-ries of evidence(CASE)for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198. DOI URL
[8]	Brouwers MC, Lavis JN, Spithoff K, et al. Assessment of health systems guidance using the Appraisal of Guidelines for Research and Evaluation-Health Systems(AGREE-HS) instru-ment[J]. Health Policy, 2019, 123(7):646-651. DOI PMID
[9]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[10]	Lennaerts H, Groot M, Rood B, et al. A guideline for Parkin-son’s disease nurse specialists,with recommendations for clinical practice[J]. J Parkinsons Dis, 2017, 7(4):749-754.
[11]	Rajan R, Brennan L, Bloem BR, et al. Integrated care in Par-kinson’s disease:a systematic review and meta-analysis[J]. Mov Disord, 2020, 35(9):1509-1531. DOI URL
[12]	Chahine L. Evaluation and treatment of insomnia,daytime slee-piness,and other sleep disorders in Parkinson disease[EB/OL].(2022-10-24)[2022-11-08]. http://www.uptodate.com/con-tents/Evaluation-and-treatment-of-insomnia-daytime-sleepiness-and-other-sleep-disorders-in-Parkinson-disease.
[13]	Lee J, Kim Y, Kim YL. Non-pharmacological therapies for sleep disturbances in people with Parkinson’s disease:a systematic review[J]. J Adv Nurs, 2018, 74(8):1741-1751. DOI URL
[14]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[15]	Maski S. Insufficient sleep:evaluation and management[EB/OL].(2022-05-23)[2022-11-08]. http://www.uptodate.com/con-tents/Insufficient-sleep-Evaluation-and-management.
[16]	Chahine L, Tarsy D. Management of nonmotor symptoms in Parkinson disease[EB/OL].(2022-10-25)[2022-11-08]. http://www.uptodate.com/contents/Management-of-nonmotor-symptoms-in-Parkinson-disease.
[17]	Grimes D, Fitzpatrick M, Gordon J, et al. Canadian guideline for Parkinson disease[J]. J De L’association Med Can, 2019, 191(36):E989-E1004.
[18]	Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015[J]. Sleep Med Rev, 2017, 35:33-50. DOI PMID
[19]	Liu CF, Wang T, Zhan SQ, et al. Management recommenda-tions on sleep disturbance of patients with Parkinson’s di-sease[J]. Chin Med J (Engl), 2018, 131(24):2976-2985.
[20]	刘春风, 徐兴, 沈赟. 多导睡眠监测在帕金森病伴发睡眠障碍诊断中的应用[J]. 诊断学理论与实践, 2018, 17(4):377-381.
	Liu CF, Xu X, Shen Y. Application of polysomnography in diagnosis of Parkinson’s disease accompanied with sleep disorder[J]. J Diagn Concepts & Pract, 2018, 17(4):377-381.
[21]	Thomas SJ, Gamble K. Actigraphy in the evaluation of sleep disorders[EB/OL].(2022-03-23)[2022-11-08]. http://www.upto-date.com/contents/Actigraphy-in-the-evaluation-of-sleep-disorders.
[22]	刘春风, 沈赟. 重视帕金森病睡眠障碍的规范管理[J]. 中华神经科杂志, 2019, 52(5):361-363.
	Liu CF, Shen Y. Pay attention to the standardized manage-ment of sleep disorders in Parkinson’s disease[J]. Chin J Ne-urol, 2019, 52(5):361-363.
[23]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病治疗指南(第四版)[J]. 中华神经科杂志, 2020, 53(12):973-986.
	Parkinson’s Disease and Movement Disorders Group, Chinese Society of Neurology,Parkinson’s Disease and Movement Disorders Branch of Neurology,Chinese Medical Doctor Asso-ciation. Chinese guidelines for the treatment of Parkinson’s disease(fourth edition)[J]. Chin J Neurol, 2020, 53(12):973-986.
[24]	Luo FY, Ye MF, Lv TT, et al. Efficacy of cognitive behavioral therapy on mood disorders,sleep,fatigue,and quality of life in Parkinson’s disease:a systematic review and meta-analysis[J]. Front Psychiatry, 2021, 12:793804. DOI URL
[25]	Cristini J, Weiss M, De Las Heras B, et al. The effects of exercise on sleep quality in persons with Parkinson’s disease:a systematic review with meta-analysis[J]. Sleep Med Rev, 2021, 55:101384. DOI URL
[26]	Gurubhagavatula I. Drowsy driving:risks,evaluation,and mana-ge-ment[EB/OL].(2022-10-25)[2022-11-08]. http://www.upto-date.com/contents/Drowsy-driving-Risks-evaluation-and-manage-ment.
[27]	Lidstone SC, Bayley M, Lang AE. The evidence for multidis-ciplinary care in Parkinson’s disease[J]. Expert Rev Neuro-ther, 2020, 20(6):539-549.
[28]	吴玉芙, 郝单单, 王浩然, 等. 帕金森病多学科全程管理模式的构建及运行[J]. 北京医学, 2021, 43(10):994-996.
	Wu YF, Hao DD, Wang HR, et al. Construction and operation of multidisciplinary whole-course management model for Par-kinson’s disease[J]. Beijing Med J, 2021, 43(10):994-996.
[29]	陈一萍, 张茹, 杨辉. 国外帕金森病高级实践护士发展现状与启示[J]. 护理研究, 2022, 36(7):1210-1214.
	Chen YP, Zhang R, Yang H. Development status and enligh-tenment of advanced practice nurse of Parkinson’s disease abroad[J]. Chin Nurs Res, 2022, 36(7):1210-1214.
[30]	李遥, 郭珍珍, 胡双, 等. 帕金森病照顾者负担量表的汉化及信效度检验[J]. 护理研究, 2022, 36(8):1370-1374.
	Li Y, Guo ZZ, Hu S, et al. Sinicization and reliability and validity test of the Parkinson’s Disease Caregiver Burden Questionnaire[J]. Chin Nurs Res, 2022, 36(8):1370-1374.
[31]	李琴, 宋彩萍, 陈雨露, 等. 中晚期帕金森病患者社区护理需求量表的制订及信效度检验[J]. 中华护理杂志, 2022, 57(11):1351-1358. DOI URL
	Li Q, Song CP, Chen YL, et al. Development and reliability and validity tests of the tool of community nursing needs scale for patients with middle and advanced Parkinson’s disease[J]. Chin J Nurs, 2022, 57(11):1351-1358.
[32]	何月月, 刘思雨, 尹安春, 等. 帕金森病患者姑息照护的研究进展[J]. 中华护理杂志, 2020, 55(5):786-790. DOI URL