Terzaghi Michele, Pilati Laura, Ghiotto Natascia, Arnaldi Dario, Versino Maurizio, Rustioni Valter, Rustioni Gianluca, Sartori Ivana, Manni Raffaele
Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Sleep. 2022 Feb 14;45(2). doi: 10.1093/sleep/zsab239.
To determine whether autonomic dysfunction in idiopathic REM sleep behavior disorder (iRBD) affects circadian blood pressure (BP) profile.
Twenty-one iRBD (mean age 68.8 ± 6.4, mean age at onset 62.2 ± 9.3), 21 drug-free de novo Parkinson's disease (PD) and 21 control participants (HCs), comparable for age and sex, underwent 24-h ambulatory BP monitoring. A prospective follow-up study was performed to evaluate the occurrence of neurodegenerative disorders in the iRBD cohort.
In the iRBD group, nighttime systolic BP (SBP) was higher (124.0 ± 20.0, p = .026), nocturnal BP decrease lower (4.0 ± 8.7% for SBP and 8.7 ± 8.0% for diastolic BP [DBP], p = .001), and nondipping status more frequent (71.4% for SBP and 52.4% for DBP; p = .001 and p = .01, respectively) than in the HCs. Reverse dipping of SBP was found in 23.8% (p = .048) of the iRBD participants. Nondipping status was not associated with differences in gender, age, disease duration, age at disease onset, UPDRS score, presence of antihypertensive therapy, or polysomnographic measures. Patients with PD showed daytime and nighttime BP profiles comparable to those observed in iRBD. A subgroup analysis considering only the participants without antihypertensive therapy (12 iRBD, 12 PD) showed results superimposable on those of the whole iRBD and PD groups. Longitudinal follow-up (mean 5.1 ± 1.9 years) showed no differences in BP profile at baseline between converters (n = 6) and nonconverters.
Twenty-four-hour BP control was impaired in iRBD. This impairment, similar to patterns observed in de novo PD, consisted of reduced amplitude of nocturnal dipping and increased frequency of nondipping status. These findings could have implications for cardiovascular morbidity and mortality in iRBD.
确定特发性快速眼动睡眠行为障碍（iRBD）中的自主神经功能障碍是否会影响昼夜血压（BP）曲线。
21例iRBD患者（平均年龄68.8±6.4岁，平均发病年龄62.2±9.3岁）、21例未经药物治疗的新发帕金森病（PD）患者和21名对照参与者（健康对照者），年龄和性别相匹配，均接受了24小时动态血压监测。进行了一项前瞻性随访研究，以评估iRBD队列中神经退行性疾病的发生情况。
在iRBD组中，夜间收缩压（SBP）较高（124.0±20.0，p = 0.026），夜间血压下降幅度较低（SBP为4.0±8.7%，舒张压[DBP]为8.7±8.0%，p = 0.001），非勺型血压状态更为常见（SBP为71.4%，DBP为52.4%；p分别为0.001和0.01），均高于健康对照者。23.8%的iRBD参与者出现SBP反勺型（p = 0.048）。非勺型血压状态与性别、年龄、病程、发病年龄、统一帕金森病评定量表（UPDRS）评分、是否接受降压治疗或多导睡眠图测量结果的差异无关。PD患者的白天和夜间血压曲线与iRBD患者观察到的相似。仅考虑未接受降压治疗的参与者（12例iRBD，12例PD）的亚组分析结果与整个iRBD和PD组的结果重叠。纵向随访（平均5.1±1.9年）显示，病情转变者（n = 6）和未转变者在基线时的血压曲线无差异。
iRBD患者的24小时血压控制受损。这种损害与新发PD中观察到的模式相似，包括夜间血压下降幅度减小和非勺型血压状态频率增加。这些发现可能对iRBD患者的心血管发病率和死亡率产生影响。
