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帕金森病 REM 睡眠行为障碍的临床意义。

Clinical significance of REM sleep behavior disorder in Parkinson's disease.

机构信息

Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan.

出版信息

Sleep Med. 2013 Feb;14(2):131-5. doi: 10.1016/j.sleep.2012.10.011. Epub 2012 Dec 3.

DOI:10.1016/j.sleep.2012.10.011

PMID:23218532

Abstract

OBJECTIVE

Rapid eye movement (REM) sleep behavior disorder (RBD) may be a risk factor for dementia development in patients with Parkinson's disease (PD); however, the role of subclinical RBD remains unknown. Patients with PD and clinical RBD, subclinical RBD, or with normal REM sleep were examined in a cross sectional study and a longitudinal follow-up.

METHODS

Interviews regarding RBD symptoms and polysomnographies were performed on 82 PD patients divided into RBD subcategories based on the presence/absence of REM sleep without atonia (RWA) and/or RBD symptoms. Descriptive variables were compared and patients were followed-up longitudinally for 21.4±10.8months.

RESULTS

The existence of RBD, but not subclinical RBD, was associated with orthostatic hypotension and levodopa dose equivalents (LDEs) in patients with PD. Kaplan-Myer curves indicated that the occurrence of dementia in the PD group with clinical RBD was significantly faster than in the PD group with normal REM sleep (p=0.013). A Cox hazard regression analysis revealed that development to PD with dementia was only significantly associated with the presence of clinical RBD (hazard ratio: 14.1, p=0.017).

CONCLUSION

Clinical RBD symptoms, but not subclinical RBD, were associated with the development of dementia in PD.

摘要

目的

快速眼动（REM）睡眠行为障碍（RBD）可能是帕金森病（PD）患者痴呆发展的一个危险因素；然而，亚临床 RBD 的作用尚不清楚。在一项横断面研究和纵向随访中，检查了具有临床 RBD、亚临床 RBD 或正常 REM 睡眠的 PD 患者。

方法

对 82 名 PD 患者进行了 REM 睡眠行为障碍症状和多导睡眠图检查，根据是否存在 REM 睡眠无张力（RWA）和/或 RBD 症状将患者分为 RBD 亚组。比较了描述性变量，并对患者进行了 21.4±10.8 个月的纵向随访。

结果

RBD 的存在，而不是亚临床 RBD 的存在，与 PD 患者的直立性低血压和左旋多巴等效剂量（LDEs）有关。Kaplan-Meier 曲线表明，具有临床 RBD 的 PD 组发生痴呆的速度明显快于具有正常 REM 睡眠的 PD 组（p=0.013）。Cox 风险回归分析表明，向具有痴呆的 PD 发展仅与临床 RBD 的存在显著相关（风险比：14.1，p=0.017）。