Partinen Eemil, Ylikoski Ari, Sieminski Mariusz, Partinen Markku
Department of Neurology, University of Helsinki, Helsinki, FIN.
Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, FIN.
Cureus. 2024 Jan 19;16(1):e52565. doi: 10.7759/cureus.52565. eCollection 2024 Jan.
Background REM sleep behavior disorder (RBD) is a prodromal marker for Parkinson's disease (PD) and other alpha-synucleinopathies. Sleep talking (ST) is an isolated symptom and is frequent in PD and RBD. Here, we investigate the associations of ST and RBD with the mortality of PD patients. Patients and methods A total of 1,500 PD patients were randomly selected from the registry of the Finnish Parkinson's Association. Of the 855 that participated at baseline, 645 gave permission for follow-up studies. We gathered a completely filled sleep questionnaire and mortality information from 384 subjects. The Nelson-Aalen test and Cox hazard ratios (HR) were used for mortality analyses. Results The mean follow-up time was 4.3 years (0.3-7.0). PD patients with RBD or frequent ST had more non-motor symptoms. Depression, hallucinations, constipation, and excessive daytime sleepiness were more prevalent among subjects with RBD. Subjects with RBD and frequent ST (talking in their sleep ≥ once per week) had increased mortality (HR: 1.90, 95% CI: 1.18-3.06). RBD without frequent ST was not associated with mortality (HR: 0.77, 95% CI: 0.4-1.5). Frequent ST was associated with increased mortality when adjusted for age, PD duration, depression, gender, RBD, BMI, and hallucinations (HR: 2.22, 95% CI: 1.10-4.51). Additionally, age, duration of PD, arterial hypertension, and lower BMI were associated with increased mortality. Male gender, dopaminergic medication, depression, and hallucinations were not significantly associated with mortality. Conclusions RBD with frequent ST and ST alone appear to be risk factors for mortality in PD. Frequent ST may be a sign representing wider neurodegeneration. RBD subjects and frequent sleep talkers demonstrated more non-motor symptoms compared to PD without RBD or ST. Our findings have clinical implications. It remains to be seen if frequent ST indicates a poorer prognosis. Prospective studies are needed to find whether frequent ST is also a risk factor for developing PD.
背景 快速眼动睡眠行为障碍（RBD）是帕金森病（PD）和其他α-突触核蛋白病的前驱标志物。说梦话（ST）是一种孤立症状，在PD和RBD中很常见。在此，我们研究ST和RBD与PD患者死亡率的关联。
患者与方法 从芬兰帕金森病协会登记处随机选取1500例PD患者。在855例基线参与者中，645例同意进行随访研究。我们收集了384名受试者填写完整的睡眠问卷和死亡率信息。采用Nelson-Aalen检验和Cox风险比（HR）进行死亡率分析。
结果 平均随访时间为4.3年（0.3 - 7.0年）。患有RBD或频繁说梦话的PD患者有更多非运动症状。抑郁、幻觉、便秘和日间过度嗜睡在RBD患者中更为普遍。患有RBD且频繁说梦话（每周说梦话≥1次）的患者死亡率增加（HR：1.90，95%CI：1.18 - 3.06）。无频繁说梦话的RBD与死亡率无关（HR：0.77，95%CI：0.4 - 1.5）。在调整年龄、PD病程、抑郁、性别、RBD、体重指数（BMI）和幻觉后，频繁说梦话与死亡率增加相关（HR：2.22，95%CI：1.10 - 4.51）。此外，年龄、PD病程、动脉高血压和较低的BMI与死亡率增加相关。男性、多巴胺能药物治疗、抑郁和幻觉与死亡率无显著关联。
结论 伴有频繁说梦话的RBD和单独的频繁说梦话似乎是PD患者死亡的危险因素。频繁说梦话可能是更广泛神经退行性变的一个标志。与无RBD或说梦话的PD患者相比，RBD患者和频繁说梦话者表现出更多非运动症状。我们的研究结果具有临床意义。频繁说梦话是否预示较差的预后仍有待观察。需要进行前瞻性研究以确定频繁说梦话是否也是PD发病的危险因素。
