Fujii Yoko, Okura Mutsumi, Uemori Hidekazu, Taniguchi Mitsutaka, Ohi Motoharu
Sleep Medical Center, Osaka Kaisei Hospital.
Sleep Disordered Breathing Center, Saiseikai Nara Hospital.
Rinsho Shinkeigaku. 2018 Feb 28;58(2):88-92. doi: 10.5692/clinicalneurol.cn-001051. Epub 2018 Jan 31.
The rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream-enacting behaviors related to the loss of the normal generalized skeletal muscle atonia during REM sleep, and shows REM sleep without atonia (RWA) during polysomnography (PSG). Patients with idiopathic RBD have been known to have a siginificantly increased risk of developing one of the α-synucleiopathies later in life, therefore the diagnosis of RBD is very important and must be dealt with carefully. A 51-year-old man was identified presenting dream-enacting behaviors and unpleasant dreams suggesting the diagnosis of RBD, in addition to snoring and excessive daytime sleepiness. Attended video-PSG excluded RBD showing REM sleep with atonia and without increased phasic EMG activity, and diagnosed with severe obstructive sleep apnea (OSA) with an apnea-hypopnea index of 30.1 demonstrating that the reported abnormal sleep behaviors occurred only during respiratory event-induced arousals. Continuous positive airway pressure therapy eliminated the abnormal behaviors, unpleasant dreams, snoring and daytime hypersomnolence. This case shows that severe OSA mimic the symptoms of RBD and that attended video-PSG is necessary to establish the diagnosis of RBD, and identify or exclude other causes of dream-enacting behaviors.
快速眼动（REM）睡眠行为障碍（RBD）是一种异态睡眠，其特征是在REM睡眠期间与正常全身骨骼肌失张力相关的梦境演绎行为，在多导睡眠图（PSG）检查中表现为REM睡眠无失张力（RWA）。已知特发性RBD患者在晚年发生α-突触核蛋白病的风险显著增加，因此RBD的诊断非常重要，必须谨慎处理。一名51岁男性被发现存在梦境演绎行为和不愉快的梦境，提示RBD诊断，此外还有打鼾和日间过度嗜睡。视频PSG检查排除了RBD，显示REM睡眠时有失张力且无肌电活动增加，并诊断为重度阻塞性睡眠呼吸暂停（OSA），呼吸暂停低通气指数为30.1，表明所报告的异常睡眠行为仅在呼吸事件诱发的觉醒期间出现。持续气道正压通气治疗消除了异常行为、不愉快的梦境、打鼾和日间嗜睡。该病例表明，重度OSA可模拟RBD症状，视频PSG检查对于确立RBD诊断以及识别或排除梦境演绎行为的其他原因是必要的。
