Regional Centre for Neurosciences, Newcastle General Hospital, Newcastle upon Tyne, UK.
J Clin Sleep Med. 2009 Jun 15;5(3):235-9.
REM sleep behavior disorder (RBD) is characterized by loss of the normal muscle atonia during REM sleep associated with disruptive motor activity related to the acting out of dreams. There is frequently injury to the patient or bed partner, and treatment is usually required. Clonazepam has been the first-line therapy for many years, with 2 large case series reporting efficacy with few side effects in the majority of patients. However, long-acting hypnotics in the elderly or those with cognitive impairment can be associated with adverse events especially unacceptable daytime sedation, confusion, and exacerbation of existing sleep apnea.
We reviewed 39 patients with confirmed RBD who were treated within our regional sleep center, assessing both efficacy and side effects of drug therapies.
Adverse effects were reported by 58% of the patients using clonazepam, with 50% either discontinuing the drug or reducing the dose. This prompted us review the side effects of clonazepam in detail and to look for alternative therapies. We report several novel and effective therapies, in particular zopiclone, in a series of patients under long-term follow-up for RBD.
There are alternatives to clonazepam therapy for RBD which can be as effective and may be better tolerated.
快速眼动睡眠行为障碍（RBD）的特征是 REM 睡眠期间正常肌肉弛缓丧失，与梦境表现相关的破坏性行为有关的运动活动。患者或床伴经常受伤，通常需要治疗。氯硝西泮多年来一直是一线治疗药物，有 2 项大型病例系列报告称，大多数患者的疗效好，副作用少。然而，在老年人或认知功能障碍者中使用长效催眠药可能会出现不良事件，尤其是无法接受的日间镇静、意识混乱和现有的睡眠呼吸暂停加重。
我们回顾了在我们的区域睡眠中心接受治疗的 39 例确诊 RBD 患者，评估了药物治疗的疗效和副作用。
使用氯硝西泮的患者有 58%报告了不良反应，其中 50%的患者停止或减少了用药剂量。这促使我们详细审查氯硝西泮的副作用，并寻找替代疗法。我们报告了一些新的和有效的治疗方法，特别是佐匹克隆，在一系列接受 RBD 长期随访的患者中。
RBD 的氯硝西泮治疗有替代方法，可能同样有效，且耐受性更好。
