Sunwoo Jun Sang, Kim Young Ji, Byun Jung Ick, Kim Tae Joon, Jun Jin Sun, Lee Soon Tae, Jung Keun Hwa, Park Kyung Il, Chu Kon, Kim Manho, Lee Sang Kun, Kim Han Joon, Schenck Carlos H, Jung Ki Young
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Department of Neurology, Seoul National University Hospital, Seoul, Korea.
J Clin Neurol. 2020 Apr;16(2):261-269. doi: 10.3988/jcn.2020.16.2.261.
The first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD).
We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0±7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25-0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment.
Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15-12.32, =0.029).
We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.
快速眼动睡眠行为障碍（RBD）症状治疗的一线药物是睡前服用的氯硝西泮和褪黑素。我们旨在确定特发性RBD（iRBD）患者中抑郁症与治疗反应之间的关联。
我们回顾了123例连续接受氯硝西泮和/或褪黑素治疗的iRBD患者的病历（76例男性；年龄66.0±7.7岁；症状持续时间4.1±4.0年）。氯硝西泮和褪黑素最初分别于睡前以0.25 - 0.50mg/天和2mg/天的剂量给药，随后根据个体患者的反应调整剂量。治疗反应根据治疗后梦境行为或不愉快梦境是否有任何改善来定义。
40例（32.5%）患者接受氯硝西泮治疗，56例（45.5%）接受褪黑素治疗，27例（22.0%）接受联合治疗。随访时氯硝西泮和褪黑素的剂量分别为0.5±0.3mg和2.3±0.7mg。96例（78.0%）患者在平均17.7个月的随访期内报告RBD症状有所改善。在调整潜在混杂因素后，抑郁症与治疗反应不良显著相关（优势比 = 3.76，95%置信区间 = 1.15 - 12.32，P = 0.029）。
我们发现，合并抑郁症与iRBD患者对氯硝西泮和/或褪黑素的反应不良显著相关。需要更多患者的进一步研究来验证我们的观察结果，并确定合并抑郁症在iRBD病理生理学中的临床意义。
