703 例睡眠障碍患者的 REM 睡眠行为障碍：全面睡眠史采集的重要性。

REM sleep behavior disorder in 703 sleep-disorder patients: the importance of eliciting a comprehensive sleep history.

机构信息

Innsbruck Medical University, Department of Neurology, Anichstrasse 35, A-6020 Innsbruck, Austria.

出版信息

Sleep Med. 2010 Feb;11(2):167-71. doi: 10.1016/j.sleep.2009.03.011.

DOI:10.1016/j.sleep.2009.03.011

PMID:20022299

Abstract

OBJECTIVES

The aim of our study was to evaluate the frequency of REM sleep behavior disorder (RBD) in a mixed sleep laboratory population and to assess potential associations. Moreover, we investigated referral diagnoses of patients subsequently diagnosed with RBD and assessed the frequency of incidental RBD.

METHODS

Charts and polysomnographic reports of 703 consecutive patients comprising the full spectrum of ICSD-2 sleep disorders [501 males, 202 females; mean age, 51.0+/-14.1 years (range: 10-82 years)] were carefully reviewed. The vast majority of patients were adults (98.7%). Patients were categorized into those with and without RBD. For associations, all concomitant sleep and neurological diagnoses and medications were evaluated.

RESULTS

Thirty-four patients (4.8%) were diagnosed with RBD (27 men; 7 women, mean age, 57.7+/-12.3 years). RBD was idiopathic in 11 patients (1.6%; 9 men) and symptomatic in 23 patients (3.3%; 18 men) secondary to Parkinsonian syndromes (n=11), use of antidepressants (n=7), narcolepsy with cataplexy (n=4), and pontine infarction (n=1). Six out of 34 patients were referred for suspected RBD, 20 reported RBD symptoms only on specific questioning, and 8 patients had no history of RBD but showed typical RBD behavioral manifestations in the video-polysomnography. Logistic regression analysis revealed significant associations between RBD and the presence of Parkinsonian syndromes (odds ratio [OR] 16.8, 95%CI: 6.4-44.1; P<0.001), narcolepsy with cataplexy (OR 10.7, 95%CI: 2.9-40.2; P<0.001), SSRI use (OR 3.9, 95%CI: 1.6-9.8; P=0.003), and age (OR 1.5/10-year increase, 95%CI: 1.0-2.0; P=0.039).

CONCLUSION

In this population of 703 consecutive sleep-disorder patients, RBD was uncommon. Its etiology was predominantly symptomatic. The majority of RBD patients reported RBD symptoms on specific questioning only, underlining the importance of eliciting a comprehensive sleep history for the diagnosis of RBD.

摘要

目的

我们的研究旨在评估混合睡眠实验室人群中 REM 睡眠行为障碍（RBD）的频率，并评估潜在的关联。此外，我们还调查了随后被诊断为 RBD 的患者的转诊诊断，并评估了偶发性 RBD 的频率。

方法

对包含 ICSD-2 睡眠障碍全部谱的 703 例连续患者的图表和多导睡眠图报告[501 例男性，202 例女性；平均年龄 51.0±14.1 岁（范围：10-82 岁）]进行了仔细审查。绝大多数患者为成年人（98.7%）。患者分为有和无 RBD 两组。对于关联，评估了所有伴随的睡眠和神经诊断以及药物。

结果

34 例患者（4.8%）被诊断为 RBD（27 例男性；7 例女性，平均年龄 57.7±12.3 岁）。11 例（1.6%；9 例男性）为特发性 RBD，23 例（3.3%；18 例男性）为症状性 RBD，继发于帕金森综合征（n=11）、使用抗抑郁药（n=7）、伴有猝倒的发作性睡病（n=4）和脑桥梗死（n=1）。34 例患者中有 6 例因疑似 RBD 被转介，20 例仅在特定询问时报告 RBD 症状，8 例无 RBD 病史，但在视频多导睡眠图中表现出典型的 RBD 行为表现。逻辑回归分析显示 RBD 与帕金森综合征（比值比[OR] 16.8，95%CI：6.4-44.1；P<0.001）、伴有猝倒的发作性睡病（OR 10.7，95%CI：2.9-40.2；P<0.001）、SSRIs 使用（OR 3.9，95%CI：1.6-9.8；P=0.003）和年龄（OR 每增加 10 岁 1.5，95%CI：1.0-2.0；P=0.039）之间存在显著关联。