Bhidayasiri Roongroj, Sringean Jirada, Rattanachaisit Watchara, Truong Daniel D
Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Bangkok, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Bangkok, Thailand.
J Neurol Sci. 2017 Mar 15;374:32-37. doi: 10.1016/j.jns.2017.01.018. Epub 2017 Jan 7.
Sleep disorders are identified as common non-motor symptoms of Parkinson's disease (PD) and recently this recognition has been expanded to include parasomnias, encompassing not only REM sleep behaviour disorder (RBD), but also other non-REM forms. RBD, a prototypical parasomnia in PD, exists even in the prodromal stage of the disease, and is characterized by the presence of dream enactment behaviours occurring alongside a loss of normal skeletal muscle atonia during REM sleep. In contrast, non-REM parasomnias are more frequently observed in the late stage PD. However, the development of these disorders often overlaps and it is not uncommon for PD patients to meet the criteria for more than one type of parasomnias, thus making a clinical distinction challenging for practicing neurologists who are not sleep specialists. Indeed, clinical recognition of the predominant form of parasomnia does not just depend on video-polysomnography, but also on an individual physician's clinical acumen in delineating pertinent clinical history to determine the most likely diagnosis and proceed accordingly. In this review article, we highlight the various forms of parasomnias that have been reported in PD, including, but not limited to, RBD, with a focus on clinical symptomatology and implications for clinical practice. In addition, we review the differences in PD-related parasomnias compared to those seen in general populations. With advances in sleep research and better technology for ambulatory home monitoring, it is likely that many unanswered questions on PD-related parasomnias will soon be resolved resulting in better management of this nocturnal challenge in PD.
睡眠障碍被认为是帕金森病（PD）常见的非运动症状，最近这一认识已扩展到包括异态睡眠，不仅涵盖快速眼动睡眠行为障碍（RBD），还包括其他非快速眼动形式。RBD是PD中的典型异态睡眠，甚至在疾病的前驱期就已存在，其特征是在快速眼动睡眠期间出现梦境行为的同时伴有正常骨骼肌张力缺失。相比之下，非快速眼动异态睡眠在PD晚期更为常见。然而，这些障碍的发展往往相互重叠，PD患者符合不止一种异态睡眠类型标准的情况并不少见，这使得对于非睡眠专科的神经科医生来说，进行临床区分具有挑战性。事实上，异态睡眠主要形式的临床识别不仅取决于视频多导睡眠图，还取决于个体医生在描述相关临床病史以确定最可能诊断并据此进行处理方面的临床敏锐度。在这篇综述文章中，我们重点介绍了PD中报告的各种异态睡眠形式，包括但不限于RBD，重点关注临床症状及对临床实践的影响。此外，我们还回顾了与一般人群相比，PD相关异态睡眠的差异。随着睡眠研究的进展以及用于家庭动态监测的更好技术的出现，关于PD相关异态睡眠的许多未解决问题可能很快会得到解决，从而更好地应对PD中的这种夜间挑战。
