Paracelsus-Elena-Klinik, Center of Parkinsonism and Movement Disorders, Kassel, Germany.
J Clin Sleep Med. 2011 Feb 15;7(1):75-80.
To develop a polysomnographic video-based scale for rating the severity of REM sleep behavior disorder (RBD), to classify the severity of RBD and to determine the intraindividual variability of RBD in patients with Parkinson disease (PD).
Twenty PD patients identified with RBD were investigated with video-supported polysomnography (PSG). Seventy-three motor behavior events during REM sleep were graded visually and polysomnographically on an event-to-event basis according to categorical location of movements: "0" = no visible movement; "1" = slight movements or jerks "2" = movements involving proximal extremities, including violent behavior; "3" = axial involvement including bed falls. Vocalizations were rated as "1" for present or "0" for absent. Ratings were performed by 2 blinded raters. Reliability was calculated with Cohen's κ. Final RBD severity was determined by the highest score given. This rating scale was then used to compare RBD severity and density, calculated as RBD episodes per REM sleep minute over 2 consecutive nights in 10 additional PD patients with RBD. Statistical significance was determined by effect size (Hedges' g) and calculation of the confidence interval.
Interrater reliability of the scale was 0.8 for movement data and 0.89 for vocalization data. Intraindividual RBD density varied significantly (effect size 0.5 ± 0.22; confidence interval 0.2 to 0.79) by factor 2.5 between the 2 PSG nights. Final RBD severity score differed in 60% of patients between nights 1 and 2. Forty percent of patients showed violent behavior, but only on one night. All patients had severely disturbed sleep with reduced sleep efficiency, loss of slow wave sleep, sleep fragmentation, and an increased periodic limb movement (PLM) index.
The RBD severity scale (RBDSS) is a reliable, easy-to-use tool for assessing motor events during REM sleep with PSG. Severity and phenomenology of RBD shows a significant variability in the individual PD patient.
开发一种基于多导睡眠图（PSG）的 REM 睡眠行为障碍（RBD）严重程度评定量表，对 RBD 的严重程度进行分类，并确定帕金森病（PD）患者 RBD 的个体内变异性。
对 20 例经视频支持的 PSG 证实的 RBD 患者进行研究。73 例 REM 睡眠期间的运动行为事件根据运动的位置进行分类，逐个事件进行视觉和 PSG 评分：“0”=无可见运动；“1”=轻微运动或抽搐；“2”=涉及近端肢体的运动，包括暴力行为；“3”=包括床坠落的轴性参与。发声被评为“1”（存在）或“0”（不存在）。评分由 2 名盲法评分者进行。可靠性用 Cohen's κ 计算。最终 RBD 严重程度由给出的最高分确定。然后，使用该评分量表比较 10 例额外 RBD 患者的 RBD 严重程度和密度，这是在连续两个晚上的 REM 睡眠分钟内计算的 RBD 发作次数。通过效应量（Hedges'g）和置信区间的计算确定统计学意义。
该量表的运动数据的组内信度为 0.8，发声数据的组内信度为 0.89。个体内 RBD 密度在两个 PSG 晚上之间差异显著（效应量 0.5±0.22；置信区间 0.2 至 0.79），差异倍数为 2.5。在第 1 天和第 2 天之间，60%的患者的最终 RBD 严重程度评分不同。40%的患者出现暴力行为，但仅在一个晚上。所有患者均存在严重的睡眠障碍，表现为睡眠效率降低、慢波睡眠丧失、睡眠片段化和周期性肢体运动（PLM）指数增加。
RBD 严重程度评分量表（RBDSS）是一种可靠、易于使用的工具，可用于评估 PSG 期间 REM 睡眠期间的运动事件。个体 PD 患者的 RBD 严重程度和表现具有显著的可变性。
