Scaglione C, Vignatelli L, Plazzi G, Marchese R, Negrotti A, Rizzo G, Lopane G, Bassein L, Maestri M, Bernardini S, Martinelli P, Abbruzzese G, Calzetti S, Bonuccelli U, Provini F, Coccagna G
Department of Neurological Sciences, University of Bologna, Ugo Foscolo 7, I-40123, Bologna, Italy.
Neurol Sci. 2005 Feb;25(6):316-21. doi: 10.1007/s10072-004-0364-7.
The aim of the study was to determine the clinical frequency and features of REM sleep behaviour disorder (RBD) in a large population of Parkinson's disease (PD) patients using defined diagnostic criteria both for RBD and PD. Six trained neurologists used a semistructured questionnaire based on ICSD-R diagnostic criteria for RBD to evaluate 200 PD patients and their caregivers. Interobserver reliability for the diagnosis of RBD was "substantial" (Kappa 0.65). Five patients were excluded from the study because of an MMSE lower than 25. The demographic and PD clinical features were compared in the clinically defined RBD group and in those without RBD (NRBD). Then the RBD features during the last year were analysed in the affected group. Out of 195 patients, 66 fulfilled the ICSD-R criteria for RBD; 62 patients reported RBD during the last year (frequency 31.8%). RBD features: two or more episodes per week in 35.5%; upper limb movements in 87%; lower limb movements in 79%; vocalisations during events in 85%. RBD onset was before PD in 27% of patients; 69% of the RBD group had injured themselves or their caregivers during sleep. According to multivariate analysis, RBD was associated with male gender, age and PD duration. Brief training and the use of a semistructured questionnaire may help the neurologist in dealing with sleep disturbances in PD patients. The search for RBD symptoms in PD is highly recommended, especially in patients with a long disease duration, the risk of sleep-related injuries being high.
本研究的目的是使用针对快速眼动睡眠行为障碍（RBD）和帕金森病（PD）的既定诊断标准，确定一大群帕金森病患者中RBD的临床发生率和特征。六位经过培训的神经科医生使用基于国际睡眠障碍分类修订版（ICSD-R）RBD诊断标准的半结构化问卷，对200名帕金森病患者及其照料者进行评估。RBD诊断的观察者间信度为“高度一致”（kappa值0.65）。由于简易精神状态检查表（MMSE）得分低于25分，五名患者被排除在研究之外。对临床确诊的RBD组和无RBD（NRBD）组的人口统计学和帕金森病临床特征进行比较。然后分析患病组过去一年中的RBD特征。在195名患者中，66名符合ICSD-R的RBD标准；62名患者在过去一年中报告有RBD（发生率31.8%）。RBD特征：每周发作两次或更多次的占35.5%；上肢运动的占87%；下肢运动的占79%；发作时有发声的占85%。27%的患者RBD发作先于帕金森病；RBD组中69%的患者在睡眠期间曾伤害过自己或其照料者。多变量分析显示，RBD与男性、年龄和帕金森病病程有关。简短培训和使用半结构化问卷可能有助于神经科医生处理帕金森病患者的睡眠障碍问题。强烈建议在帕金森病患者中筛查RBD症状，尤其是病程较长的患者，因为其睡眠相关伤害风险较高。
