Esaki Yuichi, Kitajima Tsuyoshi, Koike Shigefumi, Fujishiro Hiroshige, Iwata Yasuyo, Tsuchiya Akiko, Hirose Marina, Iwata Nakao
Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan.
Department of Sleep Medicine, Toyohashi Mates Sleep Disorders Center, Aichi, Japan.
J Clin Sleep Med. 2016 May 15;12(5):689-93. doi: 10.5664/jcsm.5796.
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by REM sleep without atonia and elaborate motor activity in association with dream mentation. The melatonin receptor agonist ramelteon has been documented as being effective in two patients with secondary RBD. However, there are no reports on ramelteon treatment for idiopathic RBD.
In an open-labeled trial, we treated 12 consecutive patients with idiopathic RBD for at least 4 w with 8 mg ramelteon given within 30 min before bedtime.
Ramelteon treatment did not have a clear effect on REM sleep without atonia or an RBD severity scale measured by video-supported polysomnography. However, clinical assessment using a visual analog scale showed a trend toward significance and there were also definitely positive changes in some individual cases. Ramelteon was well tolerated in most patients, with minor side effects.
Considering that ramelteon is associated with few side effects, further study may ascertain whether patients with RBD could be effectively treated by ramelteon, especially when clonazepam may not be suitable due to its side effects.
A commentary on this article appears in this issue on page 643.
快速眼动（REM）睡眠行为障碍（RBD）是一种异态睡眠，其特征为REM睡眠时肌张力缺乏以及与梦境相关的复杂运动行为。褪黑素受体激动剂雷美替胺已被证明对两名继发性RBD患者有效。然而，尚无雷美替胺治疗特发性RBD的相关报道。
在一项开放标签试验中，我们对12例连续的特发性RBD患者进行治疗，睡前30分钟内给予8毫克雷美替胺，治疗至少4周。
雷美替胺治疗对REM睡眠时肌张力缺乏或通过视频辅助多导睡眠图测量的RBD严重程度量表没有明显影响。然而，使用视觉模拟量表进行的临床评估显示有显著趋势，并且在一些个体病例中也有明确的积极变化。大多数患者对雷美替胺耐受性良好，副作用较小。
鉴于雷美替胺副作用较少，进一步研究可能确定雷美替胺是否能有效治疗RBD患者，尤其是当氯硝西泮因其副作用而不适用时。
关于本文的一篇评论发表在本期第643页。
