Paparrigopoulos Thomas J
Athens University Medical School, Department of Psychiatry, Greece.
Int Rev Psychiatry. 2005 Aug;17(4):293-300. doi: 10.1080/09540260500104540.
Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterized by the intermittent loss of electromyographic atonia normally present during REM sleep and the emergence of purposeful complex motor activity associated with vivid dreams. Rapid eye movement sleep behaviour disorder usually affects older males and can be either idiopathic or symptomatic of various underlying disorders, in particular neurodegenerative diseases; in the latter case, RBD may be a prodromal symptom of the neurological disease. Several brainstem regions have been implicated in RBD pathophysiology, although the exact mechanism of the disorder in humans remains to be clarified. On clinical grounds, differentiation of RBD should be made from several non-REM parasomnias and other aberrant behaviours occurring during sleep. Rapid eye movement sleep behaviour disorder can be diagnosed on the basis of a systematic medical, neurological and psychiatric evaluation of the patient, assisted by a standard polysomnographic recording that includes continuous overnight videotaping; a brain imaging study is mandatory when an underlying brain disease is being suspected. Clonazepam at bedtime is the treatment of choice for RBD; alternatively, melatonin or pramipexole can be administered when clonazepam is contraindicated.
快速眼动（REM）睡眠行为障碍（RBD）是一种异态睡眠，其特征是在快速眼动睡眠期间通常出现的肌电图失张力间歇性丧失，以及与生动梦境相关的有目的的复杂运动活动的出现。快速眼动睡眠行为障碍通常影响老年男性，可为特发性或各种潜在疾病的症状性表现，尤其是神经退行性疾病；在后一种情况下，RBD可能是神经疾病的前驱症状。尽管该疾病在人类中的确切机制仍有待阐明，但几个脑干区域已被认为与RBD的病理生理学有关。基于临床情况，RBD应与几种非快速眼动异态睡眠以及睡眠期间出现的其他异常行为相鉴别。快速眼动睡眠行为障碍可根据对患者进行的系统医学、神经学和精神病学评估进行诊断，并辅以包括连续通宵录像的标准多导睡眠图记录；当怀疑存在潜在脑部疾病时，必须进行脑部影像学检查。睡前服用氯硝西泮是RBD的首选治疗方法；或者，当氯硝西泮禁忌时，可给予褪黑素或普拉克索。
