Department of Neurology, University of Michigan, Ann Arbor, Michigan.
Veterans Affairs Ann Arbor Healthcare System and Veterans Affairs Ann Arbor Healthcare System Geriatric Research Education and Clinical Center, Ann Arbor, Michigan.
J Clin Sleep Med. 2022 Sep 1;18(9):2173-2178. doi: 10.5664/jcsm.10066.
Identifying individuals with isolated rapid eye movement sleep behavioral disorder (iRBD) is an important clinical research priority for future synucleinopathy trials. Nevertheless, little is known about the breadth of clinical settings where diagnoses of iRBD are initially made.
We conducted a retrospective cohort study using the electronic medical record system at the University of Michigan to identify patients aged ≥ 60 years with new diagnoses of iRBD between 2015 and 2020. We focused specifically on patients receiving primary care at the University of Michigan so that we might use the university's electronic medical record system to capture the full scope of their multispecialty care interactions and diagnoses in this integrated health care system. We used Ninth Revision and Tenth Revision, diagnosis codes to identify the time of initial clinical diagnosis.
We found that 62/105 (59.0%) diagnoses were made by a sleep specialist, 9 (8.6%) by neurologists, and 30 (29.5%) by generalists or primary care (29.5%) providers. In addition, 67/105 (63.8%) diagnoses were made in the context of having available polysomnography results, while the remainder was made on the basis of clinical symptoms alone. The prognostic implications of iRBD were documented in 40/105 (38.1%) encounter notes and were more likely to occur in sleep clinic settings (chi-square = 12.74; < .001) than in other contexts.
Initial iRBD diagnoses occur in varied clinical settings in an integrated health care system and are often made without a confirmatory polysomnogram. Documented prognostic counseling is seen most often in sleep medicine clinics. Synucleinopathy prevention trials may be best designed around a sleep clinic-focused recruitment approach.
Havis I, Coates T, Wyant KJ, Spears CC, Garwood M, Kotagal V. Isolated REM sleep behavior disorder in North American older adults in an integrated health care system. 2022;18(9):2173-2178.
识别孤立性快速眼动睡眠行为障碍（iRBD）患者是未来研究突触核蛋白病的重要临床研究重点。然而，人们对最初做出 iRBD 诊断的临床环境的广泛程度知之甚少。
我们使用密歇根大学的电子病历系统进行了一项回顾性队列研究，以确定 2015 年至 2020 年间≥60 岁的新发 iRBD 患者。我们特别关注在密歇根大学接受初级保健的患者，以便我们可以使用该大学的电子病历系统在这个综合医疗保健系统中捕捉他们多专科治疗互动和诊断的全部范围。我们使用第九版和第十版诊断代码来识别初始临床诊断的时间。
我们发现，62/105（59.0%）例诊断由睡眠专家做出，9/105（8.6%）例由神经科医生做出，30/105（29.5%）例由全科医生或初级保健提供者做出。此外，67/105（63.8%）例诊断是在有可用多导睡眠图结果的情况下做出的，而其余的则是根据临床症状做出的。105 次就诊中有 40/105（38.1%）次记录了 iRBD 的预后意义，并且更有可能发生在睡眠诊所环境中（卡方=12.74；<.001）而不是其他环境中。
在一个综合医疗保健系统中，初始 iRBD 诊断出现在不同的临床环境中，并且通常在没有确认性多导睡眠图的情况下做出。记录的预后咨询最常见于睡眠医学诊所。突触核蛋白病预防试验可能最好围绕睡眠诊所为重点的招募方法进行设计。
Havis I, Coates T, Wyant KJ, Spears CC, Garwood M, Kotagal V. 北美老年人群中综合医疗保健系统中的孤立 REM 睡眠行为障碍。 2022;18(9):2173-2178.
