From the Cleo Roberts Memory and Movement Clinic (D.S., P.C.), Banner Sun Health Research Institute, Sun City; Division of Neurology (J.K.L.-I.) and Division of Neurology, Sleep Disorders Center (P.R.), Banner University Medical Center, Phoenix; College of Medicine (A.O.B.), University of Arizona, Tucson; Neurophysiology Unit (M.L.F.), Neurology Department, Clermont-Ferrand University Hospital, Institut Pascal, CNRS, Université Clermont Auvergne, France; Department of Neurology (A.Y.A.), University of California Los Angeles; Department of Neurology (D.L.B., D.E.H.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (S.R.C., J.M., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Department of Neurology (E.H.D., M.G.M.), Stanford University; Department of Neurology (J.E.E., M.M.L.), VA Portland Health Care System and Oregon Health & Science University; Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Psychology (J.-F.G.), Université du Québec à Montréal, Canada; Department of Neurology (M.J.H., C.H.S.), University of Minnesota Medical Center, Minneapolis; Center of Sleep Sciences (E.M.), Stanford University, CA; Research Institute of the McGill University Health Centre (A.P.), Montréal; Center for Advanced Research in Sleep Medicine (A.P.), Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Neurology (E.K.S.L., B.F.B.), Mayo Clinic, Rochester, NY; Department of Neurology (A.V.), Harvard Medical School, Boston, MA; and Department of Neurology (R.P.), McGill University, Montréal, Canada.
Neurology. 2024 Feb 13;102(3):e208008. doi: 10.1212/WNL.0000000000208008. Epub 2024 Jan 5.
BACKGROUND AND OBJECTIVES: REM sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment. The International RBD Study Group developed the RBD Symptom Severity Scale (RBDSSS) to assess symptom severity for clinical or research use. We assessed the psychometric and clinimetric properties of the RBDSSS in participants enrolled in the North American Prodromal Synucleinopathy (NAPS) Consortium for RBD. METHODS: NAPS participants, who have polysomnogram-confirmed RBD, and their bedpartners completed the RBDSSS (participant and bedpartner versions). The RBDSSS contains 8 questions to assess the frequency and severity/impact of (1) dream content, (2) vocalizations, (3) movements, and (4) injuries associated with RBD. Total scores for participant (maximum score = 54) and bedpartner (maximum score = 38) questionnaires were derived by multiplying frequency and severity scores for each question. The Clinical Global Impression Scale of Severity (CGI-S) and RBD symptom frequency were assessed by a physician during a semistructured clinical interview with participants and, if available, bedpartners. Descriptive analyses, correlations between overall scores, and subitems were assessed, and item response analysis was performed to determine the scale's validity. RESULTS: Among 261 study participants, the median (interquartile range) score for the RBDSSS-PT (participant) was 10 (4-18) and that for the RBDSSS-BP (bedpartner) was 8 (4-15). The median CGI-S was 3 (3-4), indicating moderate severity. RBDSSS-BP scores were significantly lower in women with RBD (6 vs 9, = 0.02), while there were no sex differences in RBDSSS-PT scores (8 vs 10.5, = 0.615). Positive correlations were found between RBDSSS-PT vs RBDSSS-BP (Spearman = 0.561), RBDSSS-PT vs CGI-S ( = 0.556), and RBDSSS-BP vs CGI-S ( = 0.491, all < 0.0001). Item response analysis showed a high discriminatory value (range 1.40-2.12) for the RBDSSS-PT and RBDSSS-BP (1.29-3.47). DISCUSSION: We describe the RBDSSS with adequate psychometric and clinimetric properties to quantify RBD symptom severity and good concordance between participant and bedpartner questionnaires and between RBDSSS scores and clinician-assessed global severity.
背景与目的：快速眼动睡眠行为障碍（RBD）是一种以梦境演变为特征的睡眠障碍。国际 RBD 研究小组制定了 RBD 症状严重程度量表（RBDSSS），用于评估临床或研究使用中的症状严重程度。我们评估了北美前驱神经变性综合征（NAPS）RBD 合作研究中入组参与者的 RBDSSS 的心理测量和临床计量学特性。
方法：NAPS 参与者进行了多导睡眠图确认的 RBD，他们的同床者完成了 RBDSSS（参与者和同床者版本）。RBDSSS 包含 8 个问题，用于评估（1）梦境内容、（2）发声、（3）动作和（4）与 RBD 相关的伤害的频率和严重程度/影响。参与者（最高得分= 54）和同床者（最高得分= 38）问卷的总得分通过为每个问题的频率和严重程度得分相乘得出。临床总体印象严重程度量表（CGI-S）和 RBD 症状频率由研究参与者（如果有）及其同床者的半结构化临床访谈中的医生进行评估。评估了总体评分和子项之间的描述性分析和相关性，并进行了项目反应分析以确定量表的有效性。
结果：在 261 名研究参与者中，RBDSSS-PT（参与者）的中位数（四分位距）评分为 10（4-18），RBDSSS-BP（同床者）的中位数评分为 8（4-15）。CGI-S 的中位数为 3（3-4），表明中度严重程度。患有 RBD 的女性的 RBDSSS-BP 评分明显较低（6 分与 9 分， = 0.02），而 RBDSSS-PT 评分在性别之间没有差异（8 分与 10.5 分， = 0.615）。RBDSSS-PT 与 RBDSSS-BP（Spearman = 0.561）、RBDSSS-PT 与 CGI-S（ = 0.556）和 RBDSSS-BP 与 CGI-S（ = 0.491，均 < 0.0001）之间存在正相关。项目反应分析显示 RBDSSS-PT 和 RBDSSS-BP（范围 1.40-2.12）具有较高的鉴别价值（1.29-3.47）。
讨论：我们描述了 RBDSSS，其具有足够的心理测量和临床计量学特性，可量化 RBD 症状的严重程度，并且参与者和同床者问卷之间以及 RBDSSS 评分与临床医生评估的总体严重程度之间具有良好的一致性。
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