Retrospektive Analyse der Herzratenvariabilität von gesunden Kontrollen, Patienten mit REM-Schlafverhaltensstörungen, Parkinson-Krankheit, Multisystematrophie und Progressiver supranukleärer Blickparese im Schlaf

Dysfunctions of the autonomic nervous system appear frequently in Parkinson-syndromes and their pre-stages, i.e. in REM-sleep-behaviour-disorder (RBD). Previous studies were able to show that Parkinson-syndromes such as Parkinsons disease (PD), Multiple System-Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) can be distinguished from each other in respect of their extent of autonomic dysfunctions and particularly concerning cardial sympathic denervation. The analysis of heart-rate-variability (HRV) can be used to examine the influence of the autonomic nervous system. Earlier studies were able to show an impaired HRV in Parkinson-syndromes. However, the data obtained for HRV in subjects with Parkinson-syndromes still cannot be clearly interpreted due to non-unity between different approaches and results of the previous studies. Retrospectively, we investigated the new HRV-parameter, i.e. the deceleration capacity (DC), in comparison with well established HRV-Parameters, such as SDNN, SDANN, LF/HF and pNN50, in patients with PD, MSA, PSP, RBD and healthy controls (HC) during sleep. For calculation of the HRV-parameters, electrocardiogramms from stationary polysomnographies were used. Furthermore, we tried to identify possible confounders such as secondary diagnosis and medication. We also examined a correlation between DC and motoric symptoms (UPDRS, Hoehn and Yahr-Stadium) or non-motoric symptoms (PD NMS, score of autonomic dysfunctions), and common diagnostics for Parkinson-syndromes (FDG-PET, DaTScan, IBZM-Scintigraphy, TCS, MIBG-Scintigraphy). In our studies, we were able to show a significantly lower DC in patients with MSA or PSP than in patients with HC, PD or RBD. Significant differences could especially be demonstrated in the DC values during the total recording time and in the parasympathically dominated non-REM-Sleep 1. We were not able to differentiate between PD, HC and RBD via DC in any stage of the sleep. Actually, patients with PD showed an even higher DC in nearly all stages of the sleep than HC or patients with RBD. Furthermore, we could not show significant differences of DC between patients with PSP and MSA. A longitudinal display of the DC and the significant negative correlation between DC and Hoehn and Yahr-Stadium both indicate a decreasing DC with progession of the disease. Our findings suggest that PD and atypical Parkinson-syndroms can be differentiated via parasympathic cardial denervation, as shown by the DC. Since the DC is known to show the parasympathic influence on the heart, we postulate a pattern of exclusively parasympathic cardial denervation in patients with atypical Parkinson-syndromes, such as MSA or PSP and not in patients with PD. The long-term goal is to establish the DC as a parameter being able to differentiate between PD and atypical Parkinson-syndromes and to evaluate the DC as a potential parameter for predicting a conversion of the prodromal stage of an α-synucleinopathy, i.e. RBD, to manifest MSA or PD.