Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Mov Disord. 2020 Nov;35(11):2077-2085. doi: 10.1002/mds.28210. Epub 2020 Aug 3.
The risk of neurodegenerative disorders in idiopathic rapid eye movement sleep behavior disorder (iRBD) patients with residual injurious symptoms (RIS) after symptomatic treatment with clonazepam and/or melatonin is unclear.
The objective of this study was to determine the rate and correlates of RIS and its association with the risk of neurodegenerative diseases in patients with iRBD.
This was a retrospective cohort study. RIS was defined by the RBD Questionnaire-Hong Kong (RBDQ-HK) as the presence of residual sleep-related injuries or potential injurious behaviors for at least once a month after at least 1 year of treatment.
A total of 15 out of 133 (11.3%) patients with iRBD (age at diagnosis = 66.5 ± 7.3 years, 77.4% male) had RIS after 2.7 years of treatment. Patients with RIS were younger at both onset and polysomnography-confirmed diagnosis of iRBD (years, mean ± standard deviation, 56.3 ± 6.9 vs. 61.8 ± 7.6, P = 0.01; 61.2 ± 4.2 vs. 67.2 ± 7.4, P < 0.001, respectively), had more severe behavioral symptoms at diagnosis (both RBDQ-HK total score and behavioral subscore, P = 0.01), and used a higher maximum dose of clonazepam (mg; median [interquartile range], 1.5 [1.0] vs. 1.0 [1.0], P = 0.01). RIS was probably associated with a higher risk of developing dementia with Lewy bodies (adjusted hazard ratio [95% confidence interval], 5.47 [1.71-17.46], adjusted for onset age of RBD), but not Parkinsons's disease in the follow-up.
RIS is not uncommon in patients with iRBD despite long-term medication treatment. An earlier onset and more severe clinical profile are associated with RIS. The prediction of RIS toward dementia with Lewy bodies but not PD suggests that RIS may probably help to identify the specific risk of different subtypes of α-synucleinopathy. © 2020 International Parkinson and Movement Disorder Society.
尽管使用氯硝西泮和/或褪黑素进行症状治疗后，特发性快速眼动睡眠行为障碍（iRBD）患者仍存在残余损伤性症状（RIS），但其发生神经退行性疾病的风险尚不清楚。
本研究旨在确定 iRBD 患者 RIS 的发生率和相关因素，及其与神经退行性疾病风险的关系。
这是一项回顾性队列研究。RIS 采用香港 RBD 问卷（RBDQ-HK）定义，即经过至少 1 年的治疗后，每月至少出现 1 次睡眠相关损伤或潜在的损伤性行为。
在 133 例 iRBD 患者（诊断时年龄=66.5±7.3 岁，77.4%为男性）中，共有 15 例（11.3%）在 2.7 年后的治疗中出现 RIS。RIS 患者的起病年龄和多导睡眠图确诊 iRBD 的年龄更小（年，均值±标准差，56.3±6.9 岁 vs. 61.8±7.6 岁，P=0.01；61.2±4.2 岁 vs. 67.2±7.4 岁，P<0.001），诊断时的行为症状更严重（RBDQ-HK 总分和行为子评分均为 P=0.01），且使用的氯硝西泮最高剂量更高（mg；中位数[四分位间距]，1.5[1.0]mg vs. 1.0[1.0]mg，P=0.01）。RIS 可能与较高的路易体痴呆发病风险相关（调整后的风险比[95%置信区间]，5.47[1.71-17.46]，调整了 RBD 的起病年龄），但在随访中与帕金森病无关。
尽管进行了长期药物治疗，iRBD 患者 RIS 仍不少见。更早的起病和更严重的临床特征与 RIS 相关。RIS 对路易体痴呆的预测而不是对帕金森病的预测提示，RIS 可能有助于识别不同 α-突触核蛋白病亚型的特定风险。
