Service des Pathologies du Sommeil, Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France; Paris Brain Institute (ICM), Sorbonne University, Inserm U1227, CNRS 7225, Paris, France.
Rev Neurol (Paris). 2023 Oct;179(7):667-674. doi: 10.1016/j.neurol.2023.08.005. Epub 2023 Aug 17.
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by the absence of normal muscle atonia during REM sleep, resulting in excessive motor activity while dreaming. RBD can be classified as isolated which is the strongest clinical marker of prodromal synucleinopathy, or secondary, associated with other neurological diseases, mainly Parkinson's disease (PD) and dementia with Lewy bodies. The diagnosis of RBD must be systematically documented by a video polysomnography in the case of isolated RBD. PD associated with RBD may represent a distinct phenotype compared to PD without RBD, indicating a more severe and widespread synucleinopathy. Clinically, it is associated with poorer motor and cognitive performance, more severe non-motor symptoms, and faster disease progression. Imaging studies have revealed broader brain damage and significant alterations in cerebral metabolism and neurotransmission in PD patients with RBD. The management of RBD involves safety precautions and pharmacotherapy. Safety measures aim to minimize the risk of injury during RBD episodes and include creating a safe sleeping environment and separating the patient from their bed partner if necessary. Pharmacotherapy options include clonazepam and melatonin. Clonazepam must be cautiously prescribed in older patients due to potential side effects.
快速眼动（REM）睡眠行为障碍（RBD）是一种睡眠障碍，其特征是 REM 睡眠期间正常的肌肉弛缓消失，导致做梦时过度的运动活动。RBD 可以分为孤立型，这是前驱性突触核蛋白病的最强临床标志物，或继发性，与其他神经疾病相关，主要是帕金森病（PD）和路易体痴呆。孤立型 RBD 的诊断必须通过视频多导睡眠图系统记录。与无 RBD 的 PD 相比，伴 RBD 的 PD 可能代表一种不同的表型，表明更严重和广泛的突触核蛋白病。临床上，它与较差的运动和认知表现、更严重的非运动症状和更快的疾病进展相关。影像学研究显示，伴 RBD 的 PD 患者的大脑损伤更广泛，大脑代谢和神经传递发生显著改变。RBD 的管理包括安全预防措施和药物治疗。安全措施旨在降低 RBD 发作期间受伤的风险，包括创造安全的睡眠环境，如果需要，将患者与床伴分开。药物治疗选择包括氯硝西泮和褪黑素。由于潜在的副作用，氯硝西泮必须谨慎地用于老年患者。
