パーキンソン病の睡眠覚醒障害

Sleep-Wake Disturbances in Advanced Parkinson's Disease

パーキンソン病（Parkinson's disease：PD）の非運動症状の1つに不眠があり，進行期においては80％の患者にみられる。PD進行期における不眠は，PDの運動症状を含め併存する病態／疾患，治療薬の副作用や合併症，原発性睡眠障害の併存など多様な原因があることを念頭に評価し治療を進める必要がある。治療の原則は，睡眠衛生指導とともに，持続ドパミン受容体刺激（CDS）を意識した抗PD薬の調整による夜間の運動症状のコントロール，睡眠を妨げる非運動症状への治療，睡眠を妨げる薬物の中止，原発性睡眠障害の治療がある。PDにおける不眠は，患者の生活の質のみならず，運動機能にも影響を及ぼし得るため，個別に適切な評価と対応が必要である。

Abstract

Insomnia, one of the non-motor symptoms of Parkinson's disease (PD), affects approximately 80% of patients with advanced-stage PD. In such cases, it is necessary to evaluate and treat the condition with the understanding that various factors may be involved, such as side effects or complications of medications and comorbid conditions and diseases, including primary sleep disorders and motor symptoms of PD. The principles of treatment include sleep hygiene education, control of nocturnal motor symptoms through adjustment of anti-parkinsonian medications with consideration of continuous dopaminergic stimulation (CDS), treatment of non-motor symptoms that interfere with sleep, discontinuation of medications that disturb sleep, and management of primary sleep-related disorders. Insomnia in PD can affect not only patient quality of life but also motor functions, making individualized and appropriate assessment and management essential.