Neurology Service, Hospital Clinic, Barcelona, Spain.
J Neurol Sci. 2011 Nov 15;310(1-2):283-5. doi: 10.1016/j.jns.2011.07.049. Epub 2011 Aug 30.
Longitudinal studies in Parkinson disease (PD) have shown that the prevalence of sleep disorders increases with advanced disease. However, two sleep disorders, namely excessive daytime sleepiness (EDS) and REM sleep behavior disorder (RBD) have been described to antedate the development of the classical motor signs and symptoms of PD. One epidemiological study from the Honolulu-Asia Aging Study showed that aging men who reported "being sleepy most of the daily" had a threefold excess risk for developing PD after a seven-year follow-up. The origin and nature of EDS were not investigated. This study needs to be replicated. More robust data exist regarding RBD as the first manifestation of PD. RBD subjects commonly develop parkinsonism and cognitive impairment with time. Patients with the idiopathic form of RBD with decreased striatal dopamine transporters imaging, substantia nigra hyperechogenicity and hyposmia have an increased short-term risk for developing the classical motor, dysautonomic and cognitive symptoms of a synucleinopathy. Patients with idiopathic RBD, particularly those with abnormal subclinical features seen in the synucleinopathies such as decreased striatal dopamine transporters uptake, are the ideal population to be tested with disease-modifying agents in order to stop or slow down neurodegeneration in the brain.
帕金森病（PD）的纵向研究表明，随着疾病的进展，睡眠障碍的患病率会增加。然而，有两种睡眠障碍，即日间过度嗜睡（EDS）和 REM 睡眠行为障碍（RBD），已被描述为早于 PD 的典型运动体征和症状的出现。一项来自檀香山-亚洲老龄化研究的流行病学研究表明，报告“大部分时间都感到困倦”的老年男性在七年的随访后，患 PD 的风险增加了三倍。EDS 的起源和性质尚未被研究。这项研究需要重复。关于 RBD 作为 PD 的首发表现，有更可靠的数据。随着时间的推移，RBD 患者通常会发展为帕金森病和认知障碍。伴有纹状体多巴胺转运体成像减少、黑质高回声和嗅觉减退的特发性 RBD 患者，在短期内出现典型运动、自主神经和认知症状的突触核蛋白病的风险增加。特发性 RBD 患者，尤其是那些具有与突触核蛋白病相关的亚临床异常特征（如纹状体多巴胺转运体摄取减少）的患者，是最适合用疾病修饰药物进行测试的人群，以便阻止或减缓大脑的神经退行性变。
