Department of Neurology, University Hospital Bern (Inselspital), 3010, Bern, Switzerland.
Department of Neurosurgery, University Hospital Bern (Inselspital), 3010, Bern, Switzerland.
Sleep Med. 2021 Jan;77:170-176. doi: 10.1016/j.sleep.2020.11.025. Epub 2020 Nov 29.
REM-sleep behavior disorder (RBD) is a parasomnia and a common sleep disorder in Parkinson's disease (PD). While deep brain stimulation (DBS) is an established treatment for advanced PD with beneficial effects on cardinal PD motor symptoms, the data on the impact of DBS on RBD are limited and often controversial. We reviewed published articles that reported on RBD in the context of DBS surgery via systematic PubMed search. We identified 75 studies and included 12 studies, involving a total of 320 subjects, in our review. Results in respect to EMG activity outcome after subthalamic stimulation are inconsistent. We found no study that reported on RBD outcome after pallidal DBS and no DBS study quantified complex behavior during REM sleep. We also added data on RBD outcome after subthalamic (N = 4 patients) or pallidal (N = 3 patients) DBS from patients with PD with RBD, obtained as part of a prospective DBS study in our centre. Our case series showed an increase of complex behavior during REM (CB-REM) after surgery, independent of DBS target. Conversely, we found a trend towards increasing REM sleep without atonia (RSWA) in subthalamic-stimulated patients and a trend towards decreased RSWA in pallidal stimulated patients. We conclude that CB-REM and RSWA might represent two distinct elements in RBD and should be assessed separately, especially in studies that report on RBD outcome after treatment interventions. Further, larger, prospective, controlled studies in different DBS targets, reporting separately on the different RBD modalities, are needed.
快速眼动睡眠行为障碍（RBD）是一种睡眠障碍，也是帕金森病（PD）的常见病症。尽管深部脑刺激（DBS）是治疗晚期 PD 的一种既定方法，对 PD 的主要运动症状有有益的影响，但关于 DBS 对 RBD 的影响的数据有限，且往往存在争议。我们通过系统的 PubMed 搜索，对报道 DBS 手术背景下 RBD 的已发表文章进行了综述。我们确定了 75 项研究，并纳入了 12 项研究，共涉及 320 名受试者。关于丘脑下刺激后肌电图活动结果的研究结果不一致。我们没有发现报告苍白球 DBS 后 RBD 结果的研究，也没有 DBS 研究对 REM 睡眠期间的复杂行为进行量化。我们还添加了我们中心一项前瞻性 DBS 研究中 4 名 PD 伴 RBD 患者（丘脑下刺激）或 3 名 PD 伴 RBD 患者（苍白球刺激）手术后 RBD 结果的数据。我们的病例系列研究表明，手术后 REM 期间的复杂行为（CB-REM）增加，与 DBS 靶点无关。相反，我们发现丘脑下刺激患者的 REM 睡眠无张力（RSWA）有增加趋势，而苍白球刺激患者的 RSWA 有减少趋势。我们的结论是，CB-REM 和 RSWA 可能代表 RBD 的两个不同元素，应分别进行评估，特别是在报告治疗干预后 RBD 结果的研究中。此外，需要在不同的 DBS 靶点进行更大规模、前瞻性、对照研究，分别报告不同的 RBD 模式。
