Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
J Clin Sleep Med. 2013 Jan 15;9(1):55-9A. doi: 10.5664/jcsm.2340.
REM sleep behavior disorder (RBD) is reported in up to 50% of patients with Parkinson's disease (PD). Only a few systematic, large-scale studies have addressed the characteristics of RBD in PD. The aim of the present study is to assess the frequency of RBD in patients with PD and the association with PD characteristics.
We sent a questionnaire including items on sleep quality, sleep disorders, and PD characteristics and severity to the members of the national PD patients' organization in Switzerland. To assess and characterize RBD, we used a validated 10-item questionnaire (the RBD screening questionnaire, RBDSQ).
Four hundred seventeen PD patients returned the questionnaire, with RBD scores ≥ 6 in 172 patients. These patients had longer disease duration and lower activity of daily living scores, as well as more frequent nighttime awakenings and hallucinations than PD patients with RBDSQ scores < 6. Age, gender, sleep-wake disorders such as excessive daytime sleepiness, sleep apnea, and insomnia, as well as levodopa equivalent dose did not differ between the 2 groups. Patients with RBDSQ score ≥ 6 were more often treated with antidepressants.
We confirm a frequent (42.6%) history of RBD in PD. Probable RBD in PD is associated with more advanced disease as suggested by the longer disease duration and higher impairment of daily living. It is also linked to sleep fragmentation with significantly more nighttime awakenings and with hallucinations. Hallucinations might be linked to emotional disinhibition and probably to activation of limbic structures. Both sleep fragmentation and limbic activation might facilitate the occurrence of RBD in PD.
据报道，50%的帕金森病（PD）患者存在 REM 睡眠行为障碍（RBD）。仅有少数系统的大规模研究探讨了 PD 中 RBD 的特征。本研究旨在评估 PD 患者 RBD 的频率及其与 PD 特征的相关性。
我们向瑞士全国 PD 患者组织的成员发送了一份包括睡眠质量、睡眠障碍和 PD 特征和严重程度的问卷。为了评估和描述 RBD，我们使用了经过验证的 10 项问卷（RBD 筛查问卷，RBDSQ）。
417 名 PD 患者返回了问卷，其中 172 名患者的 RBD 评分≥6。这些患者的疾病持续时间更长，日常生活活动评分更低，夜间觉醒和幻觉的频率也更高，而 RBDSQ 评分<6 的 PD 患者则没有。两组患者的年龄、性别、睡眠-觉醒障碍（如日间过度嗜睡、睡眠呼吸暂停和失眠）以及左旋多巴等效剂量无差异。RBDSQ 评分≥6 的患者更常使用抗抑郁药。
我们证实 PD 中 RBD 的发生率很高（42.6%）。PD 中可能的 RBD 与疾病持续时间更长和日常生活活动受损程度更高有关，提示疾病更严重。它还与睡眠碎片化有关，夜间觉醒和幻觉明显增多。幻觉可能与情绪抑制和边缘结构的激活有关。睡眠碎片化和边缘结构的激活都可能促进 PD 中 RBD 的发生。
