Figorilli Michela, Ferri Raffaele, Zibetti Maurizio, Beudin Patricia, Puligheddu Monica, Lopiano Leonardo, Cicolin Alessandro, Durif Frank, Marques Ana, Fantini Maria Livia
EA 7280, Université Clermont Auvergne, Clermont-Ferrand, France.
Sleep Disorders Center - Neurophysiology Unit, University of Cagliari, Cagliari, Italy.
Sleep. 2017 Feb 1;40(2). doi: 10.1093/sleep/zsw060.
To compare three different methods, two visual and one automatic, for the quantification of rapid eye movement (REM) sleep without atonia (RSWA) in the diagnosis of REM sleep behavior disorder (RBD) in Parkinson's disease (PD) patients.
Sixty-two consecutive patients with idiopathic PD underwent video-polysomnographic recording and showed more than 5 minutes of REM sleep. The electromyogram during REM sleep was analyzed by means of two visual methods (Montréal and SINBAR) and one automatic analysis (REM Atonia Index or RAI). RBD was diagnosed according to standard criteria and a series of diagnostic accuracy measures were calculated for each method, as well as the agreement between them.
RBD was diagnosed in 59.7% of patients. The accuracy (85.5%), receiver operating characteristic (ROC) area (0.833) and Cohen's K coefficient (0.688) obtained with RAI were similar to those of the visual parameters. Visual tonic parameters, alone or in combination with phasic activity, showed high values of accuracy (93.5-95.2%), ROC area (0.92-0.94), and Cohen's K (0.862-0.933). Similarly, the agreement between the two visual methods was very high, and the agreement between each visual methods and RAI was substantial. Visual phasic measures alone performed worse than all the other measures.
The diagnostic accuracy of RSWA obtained with both visual and automatic methods was high and there was a general agreement between methods. RAI may be used as the first line method to detect RSWA in the diagnosis of RBD in PD, together with the visual inspection of video-recorded behaviors, while the visual analysis of RSWA might be used in doubtful cases.
比较三种不同方法（两种视觉方法和一种自动方法）用于量化帕金森病（PD）患者快速眼动（REM）睡眠无张力（RSWA），以诊断REM睡眠行为障碍（RBD）。
62例连续的特发性PD患者接受了视频多导睡眠图记录，且REM睡眠时间超过5分钟。通过两种视觉方法（蒙特利尔法和SINBAR法）和一种自动分析方法（REM无张力指数或RAI）对REM睡眠期间的肌电图进行分析。根据标准标准诊断RBD，并计算每种方法的一系列诊断准确性指标以及它们之间的一致性。
59.7%的患者被诊断为RBD。RAI获得的准确性（85.5%）、受试者工作特征（ROC）曲线下面积（0.833）和科恩K系数（0.688）与视觉参数相似。视觉紧张性参数单独或与相位活动相结合时，显示出高准确性值（93.5 - 95.2%）、ROC曲线下面积（0.92 - 0.94）和科恩K系数（0.862 - 0.933）。同样，两种视觉方法之间的一致性非常高，每种视觉方法与RAI之间的一致性也很高。单独的视觉相位测量比所有其他测量表现更差。
视觉和自动方法获得的RSWA诊断准确性都很高，且方法之间总体一致。在PD患者RBD诊断中，RAI可作为检测RSWA的一线方法，同时结合对视频记录行为的视觉检查，而在可疑病例中可使用RSWA的视觉分析。
