Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China.
Parkinsonism Relat Disord. 2017 Nov;44:66-72. doi: 10.1016/j.parkreldis.2017.09.003. Epub 2017 Sep 5.
Loss of REM sleep muscle atonia (RWA) and dream-enactment behavior (DEB) are two associated features of REM sleep behavior disorder (RBD), which is frequently associated with Parkinson's disease (PD). Few studies have examined both DEB and RWA simultaneously in patients with PD. This study aimed to evaluate relationships between RWA, DEB and clinical characteristics of PD.
We conducted overnight polysomnography in 145 patients with PD. DEB (motor behaviors and/or vocalizations during REM) and increased RWA (IRWA; tonic and phasic chin EMG density ≥ 30% and ≥15%, respectively) were identified. Patients were categorized as clinical RBD (DEB and IRWA), sub-DEB positive (DEB only), subclinical RBD (IRWA only), or normal REM sleep.
Patients with DEB had higher Hoehn and Yahr (H&Y) stage, Unified Parkinson's Disease Rating Scale (UPDRS) III score, levodopa equivalent dose(LEDs), and worse cognition. RWA was associated with H&Y stage, LEDs, cognition, and sleep structure in all patients. PD duration was associated with RWA, but not DEB. The PD patients who exhibited clinical or subclinical RBD, compared to sub-DEB positive, had higher H&Y stage, UPDRS III score and LEDs, lower cognitive score, worse sleep structure than the PD + cREM group.
Both DEB and RWA were associated with severity of PD illness. Subclinical RBD might have different disease progression from sub-DEB positive. DEB symptoms may fluctuate or disappear whereas RWA may continue to develop as PD progresses. Differences in the course of DEB and RWA may reflect the difference in the degeneration process of neurodegenerative disorders.
快速眼动（REM）睡眠肌肉弛缓丧失（RWA）和梦境行为（DEB）是 REM 睡眠行为障碍（RBD）的两个相关特征，RBD 常与帕金森病（PD）相关。少数研究同时检查了 PD 患者的 DEB 和 RWA。本研究旨在评估 RWA、DEB 与 PD 临床特征之间的关系。
我们对 145 例 PD 患者进行了整夜多导睡眠图检查。确定了 DEB（REM 期间的运动行为和/或发声）和增加的 RWA（IRWA；分别为 30%和 15%以上的紧张性和阶段性颏肌 EMG 密度）。患者被分为临床 RBD（DEB 和 IRWA）、亚 DEB 阳性（仅 DEB）、亚临床 RBD（仅 IRWA）或正常 REM 睡眠。
有 DEB 的患者 H&Y 分期更高，统一帕金森病评定量表（UPDRS）III 评分、左旋多巴等效剂量（LEDS）更高，认知功能更差。在所有患者中，RWA 与 H&Y 分期、LEDS、认知和睡眠结构相关。PD 病程与 RWA 相关，但与 DEB 无关。与亚 DEB 阳性相比，表现出临床或亚临床 RBD 的 PD 患者，H&Y 分期、UPDRS III 评分和 LEDS 更高，认知评分更低，睡眠结构更差。
DEB 和 RWA 均与 PD 疾病严重程度相关。亚临床 RBD 可能与亚 DEB 阳性的疾病进展不同。DEB 症状可能波动或消失，而 RWA 可能随着 PD 的进展继续发展。DEB 和 RWA 病程的差异可能反映了神经退行性疾病变性过程的差异。
