Schaefer Carolin, Kunz Dieter, Bes Frederik
Institute of Physiology, Charité-Universitätsmedizin Berlin (CBF), in St. Hedwig-Krankenhaus, Grosse Hamburger Str. 5-7, 10115 Berlin. Germany.
Klinik Schlaf-und Chronomedizin, St Hedwig Hospital, Berlin. Germany.
Curr Alzheimer Res. 2017;14(10):1084-1089. doi: 10.2174/1567205014666170523094938.
REM sleep behavior disorder (RBD), with its main clinical symptoms of nightmares with dream-enacting behavior, is considered as a possible precursor of neurodegenerative disease. Obstructive Sleep Apnea Syndrome (OSAS) is known to be capable of provoking RBD-like symptoms by apneic event related arousals. The two sleep related pathologies must coincide in a relevant number of individuals because of overlapping prevalence in similar age groups. Until now RBD symptoms coexisting with OSAS are rarely described in scientific literature and in fact considered as OSAS mimicking RBD.
We report four cases with a severe clinical RBD syndrome which were polysomnographically also diagnosed with concomitant OSAS (AHI range: 10.1 -53.2/h).
Treatment with 2 mg prolonged release melatonin led to a relevant clinical improvement of RBD symptoms in all patients, so far untreated for the sleep related breathing disorder. Measure of REM sleep without atonia (RSWA) in polysomnography showed values ranging from 5.1 to 20.4% determined with the Montplaisir method. Surprisingly, RSWA values in PSG with melatonin were high, probably because of the still untreated OSAS.
We presume that in patients with RBD and OSAS both pathologies contribute in varying degrees to the emergence of RBD symptoms by a destabilization of REM sleep. We suggest by consequence to consider a therapeutic strategy including the treatment of both disorders for an optimal therapeutic response.
快速眼动睡眠行为障碍（RBD），其主要临床症状为伴有梦境行为的噩梦，被认为是神经退行性疾病的一种可能先兆。阻塞性睡眠呼吸暂停综合征（OSAS）已知可通过与呼吸暂停事件相关的觉醒引发类似RBD的症状。由于在相似年龄组中患病率重叠，这两种与睡眠相关的病理情况必然在相当数量的个体中同时存在。到目前为止，科学文献中很少描述与OSAS共存的RBD症状，实际上被认为是模仿RBD的OSAS。
我们报告了4例严重临床RBD综合征患者，经多导睡眠图检查也诊断为合并OSAS（呼吸暂停低通气指数范围：10.1 - 53.2次/小时）。
2毫克缓释褪黑素治疗使所有患者的RBD症状有了显著临床改善，这些患者此前未接受过与睡眠相关呼吸障碍的治疗。多导睡眠图中无张力快速眼动睡眠（RSWA）的测量值经蒙特普莱西尔方法测定范围为5.1%至20.4%。令人惊讶的是，服用褪黑素时多导睡眠图中的RSWA值很高，可能是因为OSAS仍未得到治疗。
我们推测，在RBD和OSAS患者中，这两种病理情况均通过快速眼动睡眠的不稳定在不同程度上促成了RBD症状的出现。因此，我们建议考虑一种包括治疗这两种疾病的治疗策略，以获得最佳治疗效果。
