REM 睡眠无肌肉弛缓且步态无损害的轻至中度帕金森病患者。
REM Sleep Without Atonia and Gait Impairment in People with Mild-to-Moderate Parkinson's Disease.
机构信息
University of Minnesota, Department of Neurology, Minneapolis, MN, USA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Parkinsons Dis. 2021;11(2):767-778. doi: 10.3233/JPD-202098.
BACKGROUND
Subtle gait deficits can be seen in people with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD), a prodromal stage of Parkinson's disease (PD) and related alpha-synucleinopathies. It is unknown if the presence and level of REM sleep without atonia (RSWA, the electromyographic hallmark of RBD) is related to the severity of gait disturbances in people with PD.
OBJECTIVE
We hypothesized that gait disturbances in people with mild-to-moderate PD would be greater in participants with RSWA compared to those without RSWA and matched controls, and that gait impairment would correlate with measures of RSWA.
METHODS
Spatiotemporal characteristics of gait were obtained from 41 people with PD and 21 age-matched controls. Overnight sleep studies were used to quantify muscle activity during REM sleep and group participants with PD into those with RSWA (PD-RSWA+, n = 22) and normal REM sleep muscle tone (PD-RSWA-, n = 19). Gait characteristics were compared between groups and correlated to RSWA.
RESULTS
The PD-RSWA+ group demonstrated significantly reduced gait speed and step lengths and increased stance and double support times compared to controls, and decreased speed and cadence and increased stride velocity variability compared to PD-RSWA- group. Larger RSWA scores were correlated with worse gait impairment in the PD group.
CONCLUSION
The presence and level of muscle tone during REM sleep is associated with the severity of gait disturbances in PD. Pathophysiological processes contributing to disordered gait may occur earlier and/or progress more rapidly in people with PD and RBD.
背景
在特发性快速眼动（REM）睡眠行为障碍（RBD）患者中可以观察到细微的步态缺陷，这是帕金森病（PD）和相关的α-突触核蛋白病的前驱阶段。目前尚不清楚 REM 睡眠无张力（RSWA，RBD 的肌电图标志）的存在和水平是否与 PD 患者步态障碍的严重程度有关。
目的
我们假设，与无 RSWA 的参与者和匹配的对照组相比，轻度至中度 PD 患者的步态障碍在有 RSWA 的参与者中更为严重，并且步态障碍与 RSWA 的测量值相关。
方法
从 41 名 PD 患者和 21 名年龄匹配的对照组中获得步态的时空特征。使用整夜睡眠研究来量化 REM 睡眠期间的肌肉活动，并将 PD 患者分为有 RSWA（PD-RSWA+，n = 22）和正常 REM 睡眠肌肉张力（PD-RSWA-，n = 19）的患者。比较组间的步态特征，并与 RSWA 相关。
结果
与对照组相比，PD-RSWA+组的步态速度和步长明显降低，支撑和双支撑时间增加，与 PD-RSWA-组相比，速度和步频降低，步速变异性增加。较大的 RSWA 评分与 PD 组的步态障碍严重程度相关。
结论
REM 睡眠期间肌肉张力的存在和水平与 PD 患者步态障碍的严重程度相关。导致步态障碍的病理生理过程可能在 PD 和 RBD 患者中更早发生和/或更快进展。
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