帕金森病 REM 睡眠行为障碍的相关因素。

Associated factors for REM sleep behavior disorder in Parkinson disease.

机构信息

Paracelsus-Elena-Klinik, Center of Parkinsonism and Movement Disorders, Klinikstr. 16, 34128 Kassel, Germany.

出版信息

Neurology. 2011 Sep 13;77(11):1048-54. doi: 10.1212/WNL.0b013e31822e560e. Epub 2011 Aug 10.

DOI:10.1212/WNL.0b013e31822e560e

PMID:21832215

Abstract

OBJECTIVE

To investigate the frequency, phenomenology, and associated risk factors of REM sleep behavior disorder (RBD) in Parkinson disease (PD).

METHODS

An unselected cohort of sleep-disturbed patients with PD (n=457) was investigated with video-supported polysomnography. We determined the frequency of RBD and analyzed the influence of age, clinical disease features, disease duration, cognitive and physical impairment, medication, comorbidity, and sleep architecture.

RESULTS

The overall frequency of RBD was 46%. According to our cohort and modified definition, there was no preferred PD subtype for RBD (p=0.142). There was no gender preference (p=0.770). RBD was associated with older age (p=0.000). Adjusted for age and gender, patients with PD and RBD had longer disease duration (p=0.024), higher Hoehn & Yahr stages (p=0.002), more falls (p=0.018), more fluctuations (p=0.005), more psychiatric comorbidity (p=0.026), and a higher dose of levodopa (p=0.002). The presence of RBD was related to slightly increased sleep efficiency (p=0.007), a higher amount of REM sleep (p=0.000), and more periodic leg movements during sleep (p=0.019).

CONCLUSION

RBD is a frequent and clinically relevant nocturnal disturbance for all stages of PD. It increases with age and disease duration and may contribute to the nocturnal problems of patients with PD and their bed partners.

摘要

目的

研究帕金森病（PD）患者 REM 睡眠行为障碍（RBD）的频率、表现和相关风险因素。

方法

对睡眠障碍的 PD 患者（n=457）进行了未选择的队列研究，采用视频支持的多导睡眠图进行研究。我们确定了 RBD 的频率，并分析了年龄、临床疾病特征、疾病持续时间、认知和身体损伤、药物、合并症和睡眠结构的影响。

结果

RBD 的总体频率为 46%。根据我们的队列和修正定义，RBD 没有首选的 PD 亚型（p=0.142）。没有性别偏好（p=0.770）。RBD 与年龄较大有关（p=0.000）。调整年龄和性别后，有 RBD 的 PD 患者疾病持续时间更长（p=0.024），Hoehn & Yahr 分期更高（p=0.002），跌倒更多（p=0.018），波动更多（p=0.005），合并症更多（p=0.026），左旋多巴剂量更高（p=0.002）。RBD 的存在与睡眠效率略有增加有关（p=0.007），REM 睡眠时间增加（p=0.000），以及睡眠期间周期性腿部运动增加（p=0.019）。