Gagnon Jean-François, Postuma Ronald B, Montplaisir Jacques
Centre d'Etude du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
Neurology. 2006 Sep 12;67(5):742-7. doi: 10.1212/01.wnl.0000233926.47469.73.
REM sleep behavior disorder (RBD) is characterized by complex behavioral manifestations in response to dream content that may cause sleep disruption or injuries to the patient or the bed partner. In this case, the patients need treatment to control their symptoms. Pharmacologic agents have been reported to have positive and negative impacts on REM sleep muscle atonia and the motor behaviors associated with RBD. Clonazepam is efficacious and well tolerated by the majority of patients afflicted by RBD and should be considered as initial treatment. In patients at risk of falls who have cognitive impairment or who have obstructive sleep apneas, melatonin may be a good alternative to clonazepam. Anticholinesterase inhibitors and dopaminergic agents are not of clear benefit. Monoamine oxidase inhibitors, tricyclic antidepressants, serotonergic synaptic reuptake inhibitors, and noradrenergic antagonists can induce or aggravate RBD symptoms and should be avoided in patients with RBD. When these agents are prescribed to patients with neurodegenerative disorders or narcolepsy who are at risk of developing RBD, systematic follow-up may be warranted to detect the emergence of RBD symptoms.
快速眼动睡眠行为障碍（RBD）的特征是对梦境内容产生复杂的行为表现，这可能会导致睡眠中断或患者自身或同床伴侣受伤。在这种情况下，患者需要接受治疗以控制症状。据报道，药物对快速眼动睡眠期肌肉张力缺失及与RBD相关的运动行为有正面和负面影响。氯硝西泮对大多数RBD患者有效且耐受性良好，应被视为初始治疗药物。对于有认知障碍或阻塞性睡眠呼吸暂停且有跌倒风险的患者，褪黑素可能是氯硝西泮的良好替代药物。抗胆碱酯酶抑制剂和多巴胺能药物的益处不明确。单胺氧化酶抑制剂、三环类抗抑郁药、血清素能突触再摄取抑制剂和去甲肾上腺素能拮抗剂可诱发或加重RBD症状，RBD患者应避免使用。当给有患RBD风险的神经退行性疾病或发作性睡病患者开这些药物时，可能需要进行系统随访以检测RBD症状的出现。
