Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Eur J Neurol. 2024 Jun;31(6):e16260. doi: 10.1111/ene.16260. Epub 2024 Feb 26.
This study compared the features of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and antidepressant-related REM sleep behaviour disorder (RBD) with the aim of highlighting markers that might distinguish the two entities.
The observational cohort study included RBD patients with and without antidepressant use (antiD+ and antiD- patients, respectively), without cognitive impairment and parkinsonism. Clinical features of RBD, subtle motor and non-motor symptoms of parkinsonism, sleep architecture, REM atonia index, dopamine transporter-single photon emission computed tomography (DAT-SPECT) and skin biopsies for the intraneuronal alpha-synuclein (α-syn), were evaluated in the baseline work-up.
Thirty-nine patients, 10 antiD+ and 29 antiD-, were included. AntiD+ patients (more frequently female) reported more psychiatric symptoms, less violent dream enactment, and less frequent hyposmia. Dermal α-syn was detected in 93.1% of antiD- versus 30% of antiD+ patients (p = 0.00024). No differences appeared in other motor and non-motor symptoms, Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III score, DAT-SPECT, or polysomnographic features.
Patients with antidepressant-related RBD have clinical and neuropathological features suggesting a lower risk of evolution than those with iRBD.
本研究旨在比较孤立性快速眼动睡眠行为障碍（iRBD）和抗抑郁药相关 REM 睡眠行为障碍（RBD）的特征，以突出可能区分这两种疾病的标志物。
这项观察性队列研究纳入了无认知障碍和帕金森病的 RBD 患者，包括使用和未使用抗抑郁药的患者（分别为 antiD+和 antiD-患者）。在基线检查中，评估了 RBD 的临床特征、帕金森病的细微运动和非运动症状、睡眠结构、REM 期肌电活动指数、多巴胺转运体单光子发射计算机断层扫描（DAT-SPECT）和用于检测细胞内α-突触核蛋白（α-syn）的皮肤活检。
共纳入 39 例患者，其中 10 例为 antiD+，29 例为 antiD-。antiD+患者（更常见于女性）报告了更多的精神症状、较少的暴力梦境行为和较少的嗅觉减退。抗抑郁药相关 RBD 患者中 93.1%的皮肤活检检测到α-syn，而 iRBD 患者中仅 30%的患者检测到（p=0.00024）。在其他运动和非运动症状、运动障碍学会统一帕金森病评定量表第三部分评分、DAT-SPECT 或多导睡眠图特征方面，两组之间没有差异。
与 iRBD 患者相比，抗抑郁药相关 RBD 患者的临床和神经病理学特征提示其进展风险较低。
