McGrane Ian R, Leung Jonathan G, St Louis Erik K, Boeve Bradley F
Department of Pharmacy, Shodair Children's Hospital, 2755 Colonial Dr, Helena, MT 59601, USA.
Department of Pharmacy, Mayo Clinic College of Medicine, Mayo Clinic, 1216 2nd Street Southwest, Rochester, MN 55902, USA.
Sleep Med. 2015 Jan;16(1):19-26. doi: 10.1016/j.sleep.2014.09.011. Epub 2014 Oct 13.
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with dream enactment often involving violent or potentially injurious behaviors during REM sleep that is strongly associated with synucleinopathy neurodegeneration. Clonazepam has long been suggested as the first-line treatment option for RBD. However, evidence supporting melatonin therapy is expanding. Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioral outcomes and decrease in muscle tonicity during REM sleep. Melatonin also has a favorable safety and tolerability profile over clonazepam with limited potential for drug-drug interactions, an important consideration especially in elderly individuals with RBD receiving polypharmacy. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies.
快速眼动（REM）睡眠行为障碍（RBD）是一种与梦境演绎相关的异态睡眠，通常在快速眼动睡眠期间涉及暴力或潜在伤害行为，与突触核蛋白病神经变性密切相关。长期以来，氯硝西泮一直被建议作为RBD的一线治疗选择。然而，支持褪黑素治疗的证据正在不断增加。褪黑素似乎对RBD的管理有益，可改善临床行为结果，并降低快速眼动睡眠期间的肌肉张力。与氯硝西泮相比，褪黑素还具有良好的安全性和耐受性，药物相互作用的可能性有限，这在接受多种药物治疗的老年RBD患者中是一个重要的考虑因素。有必要进行前瞻性临床试验，以确立褪黑素和氯硝西泮作为RBD治疗方法的证据基础。
