Clinical Research Department, The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA.
Mov Disord. 2010 Oct 30;25(14):2296-303. doi: 10.1002/mds.23348.
The aim of this study was to test the hypothesis that patients with REM sleep behavior disorder, many of whom will develop Parkinson's disease (PD) or a related synucleinopathy, will demonstrate decreased heart rate variability (HRV) compared with a group of age-matched controls as measured by an electrocardiogram during wakefulness. We compared HRV in 11 untreated idiopathic REM sleep behavior disorder patients (9 men and 2 women; mean age, 63.3 years; SD, 7.5 years) and 11 control subjects with idiopathic insomnia without REM sleep behavior disorder (7 men and 4 women; mean age, 59.5 years; SD, 8.7 years). Subjects with other causes of reduced HRV were excluded. HRV was determined from 5-minute presleep segments of a single channel electrocardiogram recorded during polysomnographic evaluations, using R-R intervals during wakefulness. Time domain, geometric measures, and spectral analysis of the R-R intervals were significantly different between cases and controls. A discriminant function analysis correctly classified 95.5% of subjects (overall model fit, P = 0.016). Leave-one-out cross-validation correctly classified 77.3% of subjects. HRV during wakefulness is significantly decreased in patients with idiopathic REM sleep behavior disorder compared with control subjects, suggesting abnormalities of both sympathetic and parasympathetic function. Patients with RBD may later develop motor and cognitive features of a Lewy body disorder, such as PD. Cardiac autonomic dysfunction is also impaired in PD, suggesting that impaired HRV may be an early sign of PD. HRV measured by routine electrocardiograms could be used to screen for Lewy body disorders such as PD.
这项研究的目的是检验 REM 睡眠行为障碍患者（其中许多人将发展为帕金森病 (PD) 或相关的突触核蛋白病）的心率变异性 (HRV) 会降低的假设，与一组年龄匹配的对照组相比，通过清醒时的心电图进行测量。我们比较了 11 名未经治疗的特发性 REM 睡眠行为障碍患者（9 名男性和 2 名女性；平均年龄 63.3 岁；SD 为 7.5 岁）和 11 名无 REM 睡眠行为障碍的特发性失眠对照组患者（7 名男性和 4 名女性；平均年龄 59.5 岁；SD 为 8.7 岁）的 HRV。排除了其他导致 HRV 降低的原因。HRV 是从多导睡眠图评估期间记录的单个通道心电图的 5 分钟睡前段中确定的，使用清醒期间的 R-R 间隔。病例组和对照组之间的时域、几何测量和 R-R 间隔的频谱分析有显著差异。判别函数分析正确分类了 95.5%的受试者（总体模型拟合，P=0.016）。留一法交叉验证正确分类了 77.3%的受试者。与对照组相比，特发性 REM 睡眠行为障碍患者清醒时的 HRV 明显降低，表明交感和副交感功能均异常。RBD 患者可能随后出现 PD 等路易体障碍的运动和认知特征。PD 患者的心脏自主神经功能也受损，表明 HRV 受损可能是 PD 的早期迹象。通过常规心电图测量的 HRV 可用于筛查 PD 等路易体障碍。
