快速眼动睡眠行为障碍中强直性和阵挛性肌肉活动的量化
Quantification of tonic and phasic muscle activity in REM sleep behavior disorder.
作者信息
Mayer Geert, Kesper Karl, Ploch Thomas, Canisius Sebastian, Penzel Thomas, Oertel Wolfgang, Stiasny-Kolster Karin
机构信息
Department of Neurology, Hephata Klinik, Schwalmstadt-Treysa, Germany.
出版信息
J Clin Neurophysiol. 2008 Feb;25(1):48-55. doi: 10.1097/WNP.0b013e318162acd7.
REM sleep behavior disorder (RBD) is characterized by excessive tone of the chin muscle and limb movement during sleep. In the past, quantification of increased muscle tone in REM sleep has been performed visually, using no stringent criteria. The aim of this study was to develop an automatic analysis, allowing the quantification of muscle activity and its amplitude for all sleep stages, with a focus on REM sleep in patients with RBD. Forty-eight patients (27 male, 21 female) with RBD were included in the analysis. Twenty-one had idiopathic RBD; 28 had narcolepsy plus RBD. Twenty-five patients without confirmed sleep disorder served as control subjects. The amplitude of the EMG was generated from the difference of the upper and lower envelope of the mentalis muscle recordings. By smoothing the amplitude curve, a threshold curve was defined. Any muscle activity beyond the threshold curve was defined as motor activity. The means of the motor activity per second were summarized statistically and calculated for each sleep stage. Due to variable distribution of REM sleep, the latter was assigned to respective quartiles of the recorded night. Muscle activity was defined according to a histogram as short-lasting (<0.5 second) and long-lasting (>0.5 second) activity. No difference in the distribution of REM sleep/quartile and mean muscle tone throughout the sleep cycle could be found within the RBD groups and control subjects. Muscle activity was in the range of 200 ms. No clusters or regular distribution of muscle activity were found. Long muscle activity in the group with manifest clinical RBD was significantly higher than in control subjects, whereas it was nonsignificantly higher in subclinical RBD. The correlation between the frequency of long muscle activity in REM sleep and age was highly significant only for patients with idiopathic RBD. Automatic analysis of muscle activity in sleep is a reliable, easy method that may easily be used in the evaluation for REM sleep behavior disorder, creating indices of muscle activity similar to the indices for sleep apnea or PLMS. Together with the overt behavior, the analyses provides an important tool to get a deeper insight into the pathophysiology of RBD. Long movements appear to represent the motor disinhibition in REM sleep more distinct than short movements. The positive correlation of age and increased motor activity in REM sleep in idiopathic RBD highlights the idea of age dependant motor disinhibition as a continuum of a neurodegenerative disorder, which in narcolepsy patients with RBD only seems to happen as a single temporal event at onset of the disorder.
快速眼动睡眠行为障碍(RBD)的特征是睡眠期间颏肌和肢体运动张力过高。过去,快速眼动睡眠中肌张力增加的量化是通过视觉进行的,没有严格的标准。本研究的目的是开发一种自动分析方法,能够量化所有睡眠阶段的肌肉活动及其幅度,重点是RBD患者的快速眼动睡眠。48例RBD患者(27例男性,21例女性)纳入分析。21例为特发性RBD;28例为发作性睡病合并RBD。25例未确诊睡眠障碍的患者作为对照。肌电图的幅度由颏肌记录的上下包络线差值产生。通过平滑幅度曲线,定义了一条阈值曲线。任何超过阈值曲线的肌肉活动都被定义为运动活动。对每个睡眠阶段每秒的运动活动平均值进行统计学总结和计算。由于快速眼动睡眠分布不均,将其分配到记录夜晚的相应四分位数中。根据直方图将肌肉活动定义为短暂(<0.5秒)和持久(>0.5秒)活动。在RBD组和对照受试者中,整个睡眠周期的快速眼动睡眠/四分位数分布和平均肌张力均无差异。肌肉活动范围为200毫秒。未发现肌肉活动的聚集或规律分布。有明显临床RBD的组中持久肌肉活动明显高于对照组,而亚临床RBD组中则无明显升高。仅特发性RBD患者快速眼动睡眠中持久肌肉活动频率与年龄之间的相关性高度显著。睡眠中肌肉活动的自动分析是一种可靠、简便的方法,可轻松用于快速眼动睡眠行为障碍的评估,创建类似于睡眠呼吸暂停或周期性肢体运动指数的肌肉活动指数。结合明显行为,这些分析为深入了解RBD的病理生理学提供了重要工具。长时间运动似乎比短时间运动更能代表快速眼动睡眠中的运动去抑制。特发性RBD中年龄与快速眼动睡眠中运动活动增加的正相关性突出了年龄依赖性运动去抑制作为神经退行性疾病连续体的概念,而在发作性睡病合并RBD患者中,这似乎仅在疾病发作时作为单个时间事件发生。