Olson E J, Boeve B F, Silber M H
Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Brain. 2000 Feb;123 ( Pt 2):331-9. doi: 10.1093/brain/123.2.331.
We describe demographic, clinical, laboratory and aetiological findings in 93 consecutive patients with rapid eye movement (REM) sleep behaviour disorder (RBD), which consists of excessive motor activity during dreaming in association with loss of skeletal muscle atonia of REM sleep. The patients were seen at the Mayo Sleep Disorders Center between January 1, 1991 and July 31, 1995. Eighty-one patients (87%) were male. The mean age of RBD onset was 60.9 years (range 36-84 years) and the mean age at presentation was 64.4 years (37-85 years). Thirty-two per cent of patients had injured themselves and 64% had assaulted their spouses. Subdural haematomas occurred in two patients. Dream content was altered and involved defence of the sleeper against attack in 87%. The frequency of nocturnal events decreased with time in seven untreated patients with neurodegenerative disease. MRI or CT head scans were performed in 56% of patients. Although four scans showed brainstem pathology, all of these patients had apparently unrelated neurodegenerative diseases known to be associated with RBD. Neurological disorders were present in 57% of patients; Parkinson's disease, dementia without parkinsonism and multiple system atrophy accounted for all but 14% of these. RBD developed before parkinsonism in 52% of the patients with Parkinson's disease. Five of the 14 patients with multiple system atrophy were female, and thus the strong male predominance in RBD is less evident in this condition. Psychiatric disorders, drug use or drug withdrawal were rarely causally related to RBD. Clonazepam treatment of RBD was completely or partially successful in 87% of the patients who used the drug. We conclude that RBD is a well-defined condition and that descriptions from different centres are fairly consistent. It is commonest in elderly males and may result in serious morbidity to patients and bed partners. There is a strong relationship to neurodegenerative disease, especially Parkinson's disease, multiple system atrophy and dementia, and neurologists should explore the possibility of RBD in patients with these conditions. RBD symptoms may be the first manifestations of these disorders and careful follow-up is needed. Neuroimaging is unlikely to reveal underlying disorders not suspected clinically. We confirm the effectiveness of clonazepam, but note that attention to the safety of the bed environment may be sufficient for patients with contraindications to the drug.
我们描述了93例连续性快速眼动（REM）睡眠行为障碍（RBD）患者的人口统计学、临床、实验室及病因学特征，该疾病表现为梦境中出现过度运动行为并伴有REM睡眠期骨骼肌弛缓消失。这些患者于1991年1月1日至1995年7月31日期间在梅奥睡眠障碍中心就诊。81例（87%）患者为男性。RBD发病的平均年龄为60.9岁（范围36 - 84岁），就诊时的平均年龄为64.4岁（37 - 85岁）。32%的患者曾有过自我伤害行为，64%的患者曾攻击过配偶。2例患者发生了硬膜下血肿。87%的患者梦境内容发生改变，涉及睡眠者抵御攻击。7例未经治疗的神经退行性疾病患者的夜间事件频率随时间下降。56%的患者进行了头颅MRI或CT扫描。尽管4次扫描显示脑干病变，但所有这些患者均患有明显无关的已知与RBD相关的神经退行性疾病。57%的患者存在神经系统疾病；帕金森病、无帕金森综合征的痴呆以及多系统萎缩占这些疾病的94%。52%的帕金森病患者RBD在帕金森综合征之前出现。14例多系统萎缩患者中有5例为女性，因此在这种情况下RBD中男性占主导的情况不太明显。精神障碍、药物使用或药物戒断很少与RBD有因果关系。使用氯硝西泮治疗RBD的患者中，87%获得了完全或部分成功。我们得出结论，RBD是一种明确的疾病，不同中心的描述相当一致。它在老年男性中最为常见，可能给患者及其同床伴侣带来严重的发病风险。与神经退行性疾病密切相关，尤其是帕金森病、多系统萎缩和痴呆，神经科医生应探究患有这些疾病的患者发生RBD的可能性。RBD症状可能是这些疾病的首发表现，需要密切随访。神经影像学检查不太可能揭示临床上未怀疑的潜在疾病。我们证实了氯硝西泮的有效性，但注意到对于有药物禁忌证的患者，关注床环境的安全性可能就足够了。
