From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea.
Neurology. 2023 Dec 4;101(23):e2364-e2375. doi: 10.1212/WNL.0000000000207947.
To evaluate the prevalence of REM sleep behavior disorder (RBD) and its possible prodromal conditions, isolated dream enactment behavior (DEB) and isolated REM without atonia (RWA), in a general population sample, and the factors associated with diagnosis and symptom frequency.
From a population-based prospective cohort in Korea, 1,075 participants (age 60.1 ± 7.0 years; range 50-80 years; men 53.7%) completed the RBD screening questionnaire (RBDSQ), a structured telephone interview for the presence and characteristics of repeated DEB, and home polysomnography (PSG). RWA was measured on submentalis EMG, including 30-second epoch-based tonic and phasic activity as well as 3-second mini-epoch-based phasic and any EMG activities. Based on the presence of repeated DEB and any EMG activity of ≥22.3%, we categorized the participants into no RBD, isolated RWA, isolated DEB, and RBD groups.
RBD was diagnosed in 20 participants, isolated RWA in 133 participants, and isolated DEB in 48 participants. Sex and DEB frequency-adjusted prevalence of RBD was 1.4% (95% CI 1.0%-1.8%), isolated RWA was 12.5% (95% CI 11.3%-13.6%), and isolated DEB was 3.4% (95% CI 2.7%-4.1%). Total RBDSQ score was higher in the RBD and isolated DEB groups than in the isolated RWA and no RBD group (median 5 [interquartile range (IQR) 4-6] for RBD, median 4 [IQR 3-6] for isolated DEB, median 2 [IQR 1-3] for isolated RWA, and median 2 [IQR 1-4] for no RBD groups, < 0.001). RBDSQ score of ≥5 had good specificity but poor positive predictive value (PPV) for RBD (specificity 84.1% and PPV 7.7%) and its prodromal conditions (specificity 85.2% and PPV 29.1%). Among the RWA parameters, any EMG activity showed the best association with the RBD and its possible prodromes (area under the curve, 0.917). Three-second mini-epoch-based EMG activity and phasic EMG activity were correlated with the frequency of DEB (standardized Jonckheere-Terpstra statistic [std. J-T static] for trend = 0.488, < 0.001, and std. J-T static = 3.265, = 0.001, respectively).
This study provides prevalence estimates of RBD and its possible prodromal conditions based on a structured telephone interview and RWA measurement on PSG from the general population.
评估 REM 睡眠行为障碍（RBD）及其可能的前驱症状，孤立性梦境行为（DEB）和孤立性 REM 无动（RWA），在一般人群样本中的患病率，以及与诊断和症状频率相关的因素。
来自韩国一项基于人群的前瞻性队列研究，1075 名参与者（年龄 60.1±7.0 岁；范围 50-80 岁；男性 53.7%）完成了 RBD 筛查问卷（RBDSQ）、一项关于重复 DEB 存在和特征的结构化电话访谈，以及家庭多导睡眠图（PSG）。RWA 通过颏下肌 EMG 进行测量，包括 30 秒时基紧张和相位活动以及 3 秒微时基相位和任何 EMG 活动。根据重复 DEB 和任何 EMG 活动≥22.3%，我们将参与者分为无 RBD、孤立 RWA、孤立 DEB 和 RBD 组。
20 名参与者被诊断为 RBD，133 名参与者为孤立性 RWA，48 名参与者为孤立性 DEB。经性别和 DEB 频率调整后的 RBD 患病率为 1.4%（95%CI 1.0%-1.8%），孤立性 RWA 为 12.5%（95%CI 11.3%-13.6%），孤立性 DEB 为 3.4%（95%CI 2.7%-4.1%）。RBD 和孤立性 DEB 组的总 RBDSQ 评分高于孤立性 RWA 和无 RBD 组（RBD 组中位数 5[四分位距（IQR）4-6]，孤立性 DEB 组中位数 4[IQR 3-6]，孤立性 RWA 组中位数 2[IQR 1-3]，无 RBD 组中位数 2[IQR 1-4]， < 0.001）。RBDSQ 评分≥5 对 RBD（特异性 84.1%和阳性预测值（PPV）7.7%）及其前驱症状（特异性 85.2%和 PPV 29.1%）具有良好的特异性，但 PPV 较低。在 RWA 参数中，任何 EMG 活动与 RBD 和其可能的前驱症状相关性最好（曲线下面积，0.917）。3 秒微时基 EMG 活动和相位 EMG 活动与 DEB 的频率相关（趋势的标准化 Jonckheere-Terpstra 统计量[std. J-T 统计量]为 0.488，<0.001，和 std. J-T 统计量为 3.265，=0.001，分别）。
本研究基于一项结构电话访谈和 PSG 上的 RWA 测量，提供了一般人群中 RBD 及其可能前驱症状的患病率估计。
