Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
J Neurol Neurosurg Psychiatry. 2022 Sep;93(9):1010-1017. doi: 10.1136/jnnp-2021-327460. Epub 2021 Nov 11.
To investigate the prevalence and clinical correlates of video polysomnography (vPSG)-confirmed rapid eye movement sleep behaviour disorder (RBD) in patients with major depressive disorder (MDD).
This is a clinic-based two-phase epidemiological study. In phase 1, patients with MDD were screened by a validated questionnaire, RBD Questionnaire-Hong Kong (RBDQ-HK). In phase 2, a subsample of both the screen-positive (RBDQ-HK >20) and screen-negative patients with MDD underwent further clinical and sleep assessment (vPSG) to confirm the diagnosis of RBD (MDD+RBD). Poststratification weighting method was used to estimate the prevalence of MDD+RBD. The total likelihood ratio and the probability of prodromal Parkinson's disease (PD) were calculated from prodromal markers and risk factors, as per the Movement Disorder Society research criteria.
A total of 455 patients with MDD were screened (median age (IQR)=52.66 (15.35) years, 77.58% woman, 43.74% positive). Eighty-one patients underwent vPSG and 12 of them were confirmed MDD+RBD. The prevalence of MDD+RBD was estimated to be 8.77% (95% CI: 4.33% to 16.93%), with possibly male predominance. MDD+RBD were associated with colour vision and olfaction deficit and a higher probability for prodromal PD.
Almost 9% of patients with MDD in the psychiatric outpatient clinic has vPSG-confirmed RBD. Comorbid MDD+RBD may represent a subtype of MDD with underlying α-synucleinopathy neurodegeneration. Systematic screening of RBD symptoms and necessity of vPSG confirmation should be highlighted for capturing this MDD subtype with a view to enhance personalised treatment and future neuroprotection to prevent neurodegeneration.
调查经视频多导睡眠图（vPSG）确诊的伴有 REM 睡眠行为障碍（RBD）的重性抑郁障碍（MDD）患者的患病率和临床相关性。
这是一项基于诊所的两阶段流行病学研究。在第 1 阶段，通过经过验证的问卷，即香港 RBD 问卷（RBDQ-HK）对 MDD 患者进行筛查。在第 2 阶段，对 MDD 患者的筛查阳性（RBDQ-HK＞20）和筛查阴性患者的亚组进行进一步的临床和睡眠评估（vPSG），以确认 RBD 的诊断（MDD+RBD）。采用后分层加权法来估计 MDD+RBD 的患病率。根据运动障碍协会的研究标准，从前驱标志物和危险因素中计算总似然比和前驱帕金森病（PD）的概率。
共对 455 例 MDD 患者进行了筛查（中位数年龄（IQR）=52.66（15.35）岁，77.58%为女性，43.74%阳性）。81 例患者进行了 vPSG，其中 12 例确诊为 MDD+RBD。MDD+RBD 的患病率估计为 8.77%（95%CI：4.33%至 16.93%），可能男性居多。MDD+RBD 与色觉和嗅觉缺陷有关，并且前驱 PD 的可能性更高。
精神科门诊中近 9%的 MDD 患者存在 vPSG 确诊的 RBD。共患 MDD+RBD 可能代表一种具有潜在α-突触核蛋白神经退行性变的 MDD 亚型。应该强调对 RBD 症状进行系统筛查和 vPSG 确诊的必要性，以发现这种 MDD 亚型，从而增强个性化治疗和未来的神经保护，以防止神经退行性变。
