Nodel M R, Ukraintseva Yu V, Yakhno N N
Sechenov First Moscow State Medical University, Moscow, Russia.
Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(9):15-20. doi: 10.17116/jnevro20171179115-20.
Parasomnia, a syndrome of rapid eye movement sleep behavior disorder (RBD), is a common non-motor impairment in patients with Parkinson's disease (PD). The relationship between RBD with other symptoms of PD affecting night sleep, in particular, nocturia, is understudied. An aim of the study was to determine the symptoms related to night sleep disturbances in PD patients with RBD and assess the dynamics of these disturbances with the disease progression taking into account RBD onset.
One hundred and forty patients (72 male and 68 female) with PD without dementia (mean age 61.98±0.79 years, PD stage - 2.35±0.05, duration 5.82±90.65 years) were examined. Motor disorders were assessed with the unified Parkinson's disease rating scale (UPDRS), sleep disturbances and frequent night urinations were evaluated with the Parkinson's Disease Sleep Scale (PDSS). The diagnosis of probable RBD was based on reports of patients or their relatives on the dream-related motor activity and vocalization. Quality-of-life was evaluated with the Parkinson's Disease Questionnaire (PDQ-39). Patients were followed up after 2.5 years.
Probable RBD was diagnosed in 46.43% of patients, including 30.77%, who developed the syndrome before the manifestation of motor symptoms, 16.92% patients with simultaneous development of RBD and motor symptoms and 52.31% with RBD development >2 years after motor disorders. Patients with RBD differed from those without parasomnia by the higher severity of nocturia. After 2.5 years of follow-up, the severity of disease was greater in patients with RBD assessed by UPDRS, quality-of-life indices, severity of nocturia and episodes of nocturia. The highest frequency of episodes of nocturia was noted in patients with early onset of RBD before the manifestation of motor symptoms.
RBD in patients with PD is associated with the rapid progress of nocturia, higher degree of worsening of daily activities and deterioration of quality of life. The relationship between RBD and progression of nighttime urination suggests common pathophysiological mechanisms of their development, which include the structural changes in the brain stem nuclei. The diagnosis of RBD is one of the markers of spreading of neurodegenerative pathology into the brain stem that resulted in the unfavorable disease course.
异态睡眠是快速眼动睡眠行为障碍（RBD）的一种综合征，是帕金森病（PD）患者常见的非运动障碍。RBD与影响夜间睡眠的PD其他症状，尤其是夜尿症之间的关系研究较少。本研究的目的是确定RBD的PD患者夜间睡眠障碍相关症状，并考虑RBD发病情况，评估这些障碍随疾病进展的动态变化。
对140例无痴呆的PD患者（72例男性和68例女性）进行检查（平均年龄61.98±0.79岁，PD分期 - 2.35±0.05，病程5.82±90.65年）。用统一帕金森病评定量表（UPDRS）评估运动障碍，用帕金森病睡眠量表（PDSS）评估睡眠障碍和夜间尿频。可能的RBD诊断基于患者或其亲属关于梦相关运动活动和发声的报告。用帕金森病问卷（PDQ-39）评估生活质量。对患者进行2.5年的随访。
46.43%的患者被诊断为可能的RBD，其中30.77%在运动症状出现前就出现了该综合征，16.92%的患者RBD与运动症状同时出现，52.31%的患者在运动障碍发生2年后出现RBD。RBD患者与无异态睡眠的患者相比，夜尿症严重程度更高。随访2.5年后，通过UPDRS评估，RBD患者的疾病严重程度更高，生活质量指标、夜尿症严重程度和夜尿发作次数也更高。夜尿发作频率最高的是在运动症状出现前RBD早发的患者。
PD患者的RBD与夜尿症快速进展、日常活动恶化程度更高和生活质量下降有关。RBD与夜间排尿进展之间的关系表明它们发展的共同病理生理机制，其中包括脑干核团的结构变化。RBD的诊断是神经退行性病变扩散到脑干导致疾病进程不利的标志物之一。
