Cesari Matteo, Heidbreder Anna, St Louis Erik K, Sixel-Döring Friederike, Bliwise Donald L, Baldelli Luca, Bes Frederik, Fantini Maria Livia, Iranzo Alex, Knudsen-Heier Stine, Mayer Geert, McCarter Stuart, Nepozitek Jiri, Pavlova Milena, Provini Federica, Santamaria Joan, Sunwoo Jun-Sang, Videnovic Aleksandar, Högl Birgit, Jennum Poul, Christensen Julie A E, Stefani Ambra
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Sleep. 2022 Mar 14;45(3). doi: 10.1093/sleep/zsab257.
Video-polysomnography (v-PSG) is essential for diagnosing rapid eye movement (REM) sleep behavior disorder (RBD). Although there are current American Academy of Sleep Medicine standards to diagnose RBD, several aspects need to be addressed to achieve harmonization across sleep centers. Prodromal RBD is a stage in which symptoms and signs of evolving RBD are present, but do not yet meet established diagnostic criteria for RBD. However, the boundary between prodromal and definite RBD is still unclear. As a common effort of the Neurophysiology Working Group of the International RBD Study Group, this manuscript addresses the need for comprehensive and unambiguous v-PSG recommendations to diagnose RBD and identify prodromal RBD. These include: (1) standardized v-PSG technical settings; (2) specific considerations for REM sleep scoring; (3) harmonized methods for scoring REM sleep without atonia; (4) consistent methods to analyze video and audio recorded during v-PSGs and to classify movements and vocalizations; (5) clear v-PSG guidelines to diagnose RBD and identify prodromal RBD. Each section follows a common template: The current recommendations and methods are presented, their limitations are outlined, and new recommendations are described. Finally, future directions are presented. These v-PSG recommendations are intended for both practicing clinicians and researchers. Classification and quantification of motor events, RBD episodes, and vocalizations are however intended for research purposes only. These v-PSG guidelines will allow collection of homogeneous data, providing objective v-PSG measures and making future harmonized multicentric studies and clinical trials possible.
视频多导睡眠图（v-PSG）对于诊断快速眼动（REM）睡眠行为障碍（RBD）至关重要。尽管目前美国睡眠医学学会有诊断RBD的标准，但为了在各睡眠中心实现统一，仍有几个方面需要解决。前驱性RBD是RBD症状和体征已出现，但尚未达到既定RBD诊断标准的阶段。然而，前驱性RBD与确诊RBD之间的界限仍不明确。作为国际RBD研究组神经生理学工作组的共同努力，本手稿阐述了对全面且明确的v-PSG建议的需求，以诊断RBD并识别前驱性RBD。这些建议包括：（1）标准化的v-PSG技术设置；（2）REM睡眠评分的特殊考量；（3）无张力性REM睡眠评分的统一方法；（4）分析v-PSG期间录制的视频和音频以及对动作和发声进行分类的一致方法；（5）诊断RBD和识别前驱性RBD的明确v-PSG指南。每个部分都遵循一个通用模板：介绍当前的建议和方法，概述其局限性，并描述新的建议。最后，阐述未来的方向。这些v-PSG建议适用于临床执业医生和研究人员。然而，运动事件、RBD发作和发声的分类与量化仅用于研究目的。这些v-PSG指南将允许收集同质数据，提供客观的v-PSG测量结果，并使未来统一的多中心研究和临床试验成为可能。
