Zhou Junying, Zhang Jihui, Du Lina, Li Zhe, Li Yun, Lei Fei, Wing Yun-Kwok, Kushida Clete A, Zhou Dong, Tang Xiangdong
Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
Sleep Med. 2014 Jun;15(6):654-60. doi: 10.1016/j.sleep.2013.12.020. Epub 2014 Mar 6.
To investigate demography and clinic and polysomnographic characteristics in Chinese rapid eye movement (REM) sleep behavior disorder (RBD) patients across onset ages.
Ninety consecutive patients fulfilling the criteria for RBD were recruited for study in our sleep center. Patients were separated into early- and late-onset groups according to age when symptoms began (< or =50 and >50 years, respectively). Ninety age- and gender-matched healthy subjects served as controls. All subjects were interviewed for their clinical history, completed an RBD questionnaire, and underwent an overnight video polysomnography assessment. Demographics, comorbidities, scores on the RBD questionnaire, sleep architecture, and EMG activity were compared between the patients and controls and between the early- and late-onset groups.
Of all RBD patients, 63 were male, and mean age of RBD onset was 54.3±15.7 years. In 25 patients (28%), RBD was secondary and associated with neurodegenerative disease, narcolepsy or antidepressant use. Twenty-three patients (26%) had early-onset RBD and 67 (74%) were in the late-onset group. RBD patients had significantly more comorbidities, dreams and dream-enacting behaviors, and poorer sleep quality than did controls. The early-onset group had a high proportion of females (48%) and an increased proportion of cases associated with narcolepsy. The early-onset group also had fewer movements, lower EMG activity during REM sleep, and better sleep quality when compared to the late-onset group. EMG activity was positively correlated with age of onset. The mean follow-up time was 1.57±0.82 years, and four patients in the late-onset group were subsequently diagnosed with neurodegenerative diseases.
Stratifying patients into early and late-onset RBD revealed different characteristics from those previously described as typical for RBD. EMG activity during REM sleep was positively correlated with age of onset. We suggest that it will be valuable to explore the relationship between age of onset conversion and neurodegenerative diseases.
研究中国快速眼动（REM）睡眠行为障碍（RBD）患者在不同发病年龄阶段的人口统计学、临床及多导睡眠图特征。
连续纳入90例符合RBD诊断标准的患者于我院睡眠中心进行研究。根据症状起始年龄将患者分为早发组和晚发组（分别为≤50岁和＞50岁）。90例年龄及性别匹配的健康受试者作为对照。所有受试者均接受临床病史访谈，完成RBD问卷，并进行整夜视频多导睡眠图评估。比较患者与对照以及早发组和晚发组之间的人口统计学、合并症、RBD问卷得分、睡眠结构及肌电图（EMG）活动情况。
所有RBD患者中，男性63例，RBD平均发病年龄为54.3±15.7岁。25例患者（28%）的RBD为继发性，与神经退行性疾病、发作性睡病或使用抗抑郁药有关。23例患者（26%）为早发型RBD，67例（74%）为晚发型RBD。RBD患者的合并症、梦境及梦呓行为显著多于对照，睡眠质量也更差。早发组女性比例较高（48%），与发作性睡病相关的病例比例增加。与晚发组相比，早发组的运动次数更少，REM睡眠期EMG活动更低，睡眠质量更好。EMG活动与发病年龄呈正相关。平均随访时间为1.57±0.82年，晚发组中有4例患者随后被诊断为神经退行性疾病。
将RBD患者分为早发和晚发组后发现了与既往描述的典型RBD不同的特征。REM睡眠期EMG活动与发病年龄呈正相关。我们认为探索发病年龄转变与神经退行性疾病之间的关系将具有重要价值。
