Sleep Unit, IRCCS C. Mondino National Institute of Neurology Foundation, Pavia, Italy.
Sleep Med. 2012 Aug;13(7):926-32. doi: 10.1016/j.sleep.2012.04.015. Epub 2012 Jun 15.
BACKGROUND/OBJECTIVE: Nocturnal sleep enactment behaviors (SEBs) are common in patients affected by Parkinson's disease (PD), dementia associated with Parkinson's disease (PDD), and dementia with Lewy bodies (DLB). We investigated the occurrence and neurobiological significance of abnormal SEBs in the context of PD without cognitive decline compared to PDD/DLB patients.
We evaluated a sample of 139 patients with PD, PDD, or DLB in a cross-sectional survey. One hundred and seventeen patients showing either no cognitive impairment (PD group) or meeting the diagnostic requirements for dementia (PDD/DLB group) underwent video-polysomnography. Seventy subjects (42 males) in whom a clear-cut diagnosis of abnormal sleep-related motor-behavioral episodes was possible were included in the final analysis.
SEBs consisting of RBD or occurring on arousal from NREM or REM sleep were globally more frequent in the dementia group (PDD/DLB) than in the PD group (p=0.001), the difference being statistically significant for arousal-related episodes (p=0.002), while a trend emerged for RBD (p=0.07). Male sex, daytime sleepiness, higher motor impairment, and lower mini-mental score were significantly more frequent with the occurrence of abnormal sleep-related motor-behavioral episodes.
SEBs in PD, PDD, and DLB may consist of RBD episodes or of arousal-related NREM and REM episodes. These latter are more frequent in patients with PDD/DLB and seem to be mainly related to more advanced stages of disease with a higher degree of cognitive decline.
背景/目的：夜间睡眠行为障碍（SEBs）在帕金森病（PD）、帕金森病相关痴呆（PDD）和路易体痴呆（DLB）患者中很常见。我们研究了与无认知能力下降的 PD 患者相比，PDD/DLB 患者中异常 SEB 的发生及其神经生物学意义。
我们在一项横断面研究中对 139 例 PD、PDD 或 DLB 患者进行了评估。117 例患者表现出无认知障碍（PD 组）或符合痴呆诊断标准（PDD/DLB 组），进行了视频多导睡眠图检查。70 名受试者（42 名男性）可明确诊断为异常睡眠相关运动行为事件，被纳入最终分析。
在痴呆组（PDD/DLB）中，包括 RBD 或从 NREM 或 REM 睡眠中觉醒时发生的 SEBs 总体上比 PD 组更频繁（p=0.001），觉醒相关事件的差异具有统计学意义（p=0.002），而 RBD 则呈现出趋势（p=0.07）。异常睡眠相关运动行为事件发生时，男性、日间嗜睡、更高的运动障碍和更低的迷你精神状态评分更常见。
PD、PDD 和 DLB 中的 SEBs 可能包括 RBD 发作或与觉醒相关的 NREM 和 REM 发作。这些在 PDD/DLB 患者中更为常见，似乎主要与疾病的更晚期阶段相关，认知能力下降程度更高。
