Sleep and EEG Unit, Centre Hospitalier Universitaire, Clermont-Ferrand, France.
EA7820 UFR Medecine, Universite Clermont Auvergne, Clermont-Ferrand, France.
J Neurol Neurosurg Psychiatry. 2018 Mar;89(3):305-310. doi: 10.1136/jnnp-2017-316576. Epub 2017 Oct 24.
Because the association between rapid eye movement sleep behaviour disorder (RBD) and impulse control disorders (ICDs) in Parkinson's disease (PD) has been debated, we assessed the sleep characteristics and the frequency of RBD using video-polysomnography (v-PSG) in patients with PD with versus without ICDs.
Eighty non-demented patients with PD consecutively identified during routine evaluation at three movement disorders centres were enrolled in a case-control study. Forty patients (22 men; mean age: 62.6±9.7 years, Hoehn & Yahr: 2.1±0.6) with one or more current ICDs were age-matched and sex-matched with 40 patients with no history of ICDs (22 men, mean age: 64.9±7.8 years, Hoehn & Yahr: 2.2±0.6). They underwent a detailed sleep interview followed by a full-night in-lab v-PSG. Sleep was scored blindly to ICDs condition and RBD diagnosis included a clinical complaint of enacted dreams and/or documented behaviour during rapid eye movement (REM) sleep, with the presence of quantified REM sleep without atonia (RSWA).
Patients with ICDs had a higher arousal index and higher RSWA than those without ICDs (51.9%±28.2%vs 32.2±27.1%, p=0.004). In addition, RBD was more frequent in the ICD group (85%vs53%, p=0.0001). RBD was still associated with ICDs in a multivariate regression analysis including age of onset, PD duration and severity, treatment duration, levodopa-equivalent and dopamine agonist-equivalent daily doses and antidepressant use (OR: 4.9 (95% CI 1.3 to 18.5), p=0.02).
This large, controlled series of patients with PD with ICDs assessed by v-PSG confirms the association between ICDs and RBD. Increased surveillance of symptoms of ICDs should be recommended in patients with PD with RBD.
由于快速眼动睡眠行为障碍（RBD）与帕金森病（PD）中的冲动控制障碍（ICD）之间的关联存在争议，我们使用视频多导睡眠图（v-PSG）评估了 PD 患者中存在和不存在 ICD 的患者的睡眠特征和 RBD 发生频率。
我们在三个运动障碍中心的常规评估中连续招募了 80 名非痴呆 PD 患者进行病例对照研究。40 名患者（22 名男性；平均年龄：62.6±9.7 岁，Hoehn & Yahr：2.1±0.6）存在一种或多种当前 ICD，与 40 名无 ICD 病史的患者年龄和性别匹配（22 名男性，平均年龄：64.9±7.8 岁，Hoehn & Yahr：2.2±0.6）。他们接受了详细的睡眠访谈，然后进行了整夜的实验室 v-PSG。睡眠评分对 ICD 状态进行盲法评估，RBD 诊断包括有梦境行为和/或 REM 睡眠期间有记录的行为的临床主诉，同时存在 REM 睡眠期间无动性（RSWA）的量化。
与无 ICD 组相比，ICD 组的觉醒指数和 RSWA 更高（51.9%±28.2%vs 32.2±27.1%，p=0.004）。此外，ICD 组的 RBD 更常见（85%vs 53%，p=0.0001）。在包括发病年龄、PD 持续时间和严重程度、治疗持续时间、左旋多巴等效和多巴胺激动剂等效日剂量以及抗抑郁药使用在内的多变量回归分析中，RBD 仍与 ICD 相关（OR：4.9（95%CI 1.3 至 18.5），p=0.02）。
这项使用 v-PSG 评估的、具有 ICD 的大型对照 PD 患者系列研究证实了 ICD 与 RBD 之间的关联。在存在 RBD 的 PD 患者中，应建议更密切监测 ICD 症状。
