伴有和不伴有共病阻塞性睡眠呼吸暂停的快速眼动睡眠行为障碍中，定量快速眼动睡眠时相性爆发持续时间、时相性和紧张性肌肉活动以及快速眼动失张力指数的诊断阈值。
Diagnostic thresholds for quantitative REM sleep phasic burst duration, phasic and tonic muscle activity, and REM atonia index in REM sleep behavior disorder with and without comorbid obstructive sleep apnea.
作者信息
McCarter Stuart J, St Louis Erik K, Duwell Ethan J, Timm Paul C, Sandness David J, Boeve Bradley F, Silber Michael H
机构信息
Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.
出版信息
Sleep. 2014 Oct 1;37(10):1649-62. doi: 10.5665/sleep.4074.
OBJECTIVES
We aimed to determine whether phasic burst duration and conventional REM sleep without atonia (RSWA) methods could accurately diagnose REM sleep behavior disorder (RBD) patients with comorbid OSA.
DESIGN
We visually analyzed RSWA phasic burst durations, phasic, "any," and tonic muscle activity by 3-s mini-epochs, phasic activity by 30-s (AASM rules) epochs, and conducted automated REM atonia index (RAI) analysis. Group RSWA metrics were analyzed and regression models fit, with receiver operating characteristic (ROC) curves determining the best diagnostic cutoff thresholds for RBD. Both split-night and full-night polysomnographic studies were analyzed.
SETTING
N/A.
PARTICIPANTS
Parkinson disease (PD)-RBD (n = 20) and matched controls with (n = 20) and without (n = 20) OSA.
INTERVENTIONS
N/A.
MEASUREMENTS AND RESULTS
All mean RSWA phasic burst durations and muscle activities were higher in PD-RBD patients than controls (P < 0.0001), and RSWA associations with PD-RBD remained significant when adjusting for age, gender, and REM AHI (P < 0.0001). RSWA muscle activity (phasic, "any") cutoffs for 3-s mini-epoch scorings were submentalis (SM) (15.5%, 21.6%), anterior tibialis (AT) (30.2%, 30.2%), and combined SM/AT (37.9%, 43.4%). Diagnostic cutoffs for 30-s epochs (AASM criteria) were SM 2.8%, AT 11.3%, and combined SM/AT 34.7%. Tonic muscle activity cutoff of 1.2% was 100% sensitive and specific, while RAI (SM) cutoff was 0.88. Phasic muscle burst duration cutoffs were: SM (0.65) and AT (0.79) seconds. Combining phasic burst durations with RSWA muscle activity improved sensitivity and specificity of RBD diagnosis.
CONCLUSIONS
This study provides evidence for REM sleep without atonia diagnostic thresholds applicable in Parkinson disease-REM sleep behavior disorder (PD-RBD) patient populations with comorbid OSA that may be useful toward distinguishing PD-RBD in typical outpatient populations.
目的
我们旨在确定阶段性爆发持续时间和传统的快速眼动睡眠无张力（RSWA）方法能否准确诊断合并阻塞性睡眠呼吸暂停（OSA）的快速眼动睡眠行为障碍（RBD）患者。
设计
我们通过3秒的微时段直观分析RSWA的阶段性爆发持续时间、阶段性、“任何”和紧张性肌肉活动，通过30秒（美国睡眠医学学会规则）时段分析阶段性活动，并进行自动快速眼动无张力指数（RAI）分析。分析组RSWA指标并拟合回归模型，通过受试者操作特征（ROC）曲线确定RBD的最佳诊断临界阈值。分析了分夜和全夜多导睡眠图研究。
设置
无。
参与者
帕金森病（PD）-RBD患者（n = 20）以及匹配的有（n = 20）和无（n = 20）OSA的对照组。
干预措施
无。
测量和结果
PD-RBD患者的所有平均RSWA阶段性爆发持续时间和肌肉活动均高于对照组（P < 0.0001），在调整年龄、性别和快速眼动睡眠呼吸暂停低通气指数（REM AHI）后，RSWA与PD-RBD的关联仍具有显著性（P < 0.0001）。3秒微时段评分的RSWA肌肉活动（阶段性、“任何”）临界值为颏下肌（SM）（15.5%，21.6%）、胫前肌（AT）（30.2%，30.2%）以及联合SM/AT（总肌肉活动）（37.9%，43.4%）。30秒时段（美国睡眠医学学会标准）的诊断临界值为SM 2.8%、AT 11.3%以及联合SM/AT 34.7%。紧张性肌肉活动临界值为1.2%，其敏感性和特异性均为100%，而RAI（SM）临界值为0.88。阶段性肌肉爆发持续时间临界值为：SM（0.65）秒和AT（0.79）秒。将阶段性爆发持续时间与RSWA肌肉活动相结合可提高RBD诊断的敏感性和特异性。
结论
本研究为适用于合并OSA的帕金森病-快速眼动睡眠行为障碍（PD-RBD）患者群体的快速眼动睡眠无张力诊断阈值提供了证据，这可能有助于在典型门诊患者群体中鉴别PD-RBD。
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