快速眼动睡眠行为障碍与帕金森病进展之间的相关性：一项系统评价和荟萃分析。
The correlation between rapid eye movement sleep behavior disorder and the progress of Parkinson's disease: a systematic review and meta-analysis.
作者信息
Zheng Wentao, Pan Yang, Li Kunhua, Tao Keyu, Wang Qiuyu, Yang Yungui
机构信息
Internal Medicine, Qujing Third People's Hospital, Qujing, Yunnan, China.
出版信息
Front Aging Neurosci. 2024 Jul 17;16:1418751. doi: 10.3389/fnagi.2024.1418751. eCollection 2024.
BACKGROUND
This meta-analysis was conducted to evaluate potential differences in symptoms between PD patients with or without RBD.
METHODS
A systematic search was conducted in PubMed, Cochrane, Embase, and Web of Science databases (as of August 16, 2023), to identify relevant studies on PD and RBD. Statistical analysis was performed using Stata 15.0. Continuous variables were analyzed using the standardized mean difference (SMD) and 95% confidence interval (95% CI), while count data were assessed using the odds ratio (OR) and 95% CI as statistical effect sizes. Heterogeneity among all included studies was tested; for studies with low heterogeneity (I < 50%), a fixed-effects model was used to calculate statistical results. For studies with relatively high heterogeneity (I > 50%), a random-effects model was applied, followed by sensitivity and subgroup analyses to identify sources of heterogeneity.
RESULTS
A total of 5,672 subjects were involved in this study. Compared to the NRBD group, the UPDRS-III score in the RBD group was significantly higher (SMD = 0.20, 95% CI: [0.11, 0.29], < 0.001), and the Hoehn-Yahr score in the RBD group was also significantly higher (SMD = 0.29, 95% CI: [0.03, 0.55], < 0.001). Patients with PD in the RBD group had more severe cognitive impairments than those in the NRBD group (SMD = -0.30, 95% CI: [-0.48, -0.11], < 0.001). The incidence of hallucination in PD patients in the RBD group was 3.0 times that of the NRBD group (OR = 3.0, 95% CI: [2.15, 4.20], = 0.110). PD patients in the RBD group also experienced more severe anxiety symptoms (SMD = 0.13, 95% CI: [-0.26, 0.51], < 0.001), had higher scores in depression scales (SMD = 0.22, 95% CI: [0.02, 0.43], < 0.001), and higher scores in sleep disorder scales than those in NRBD group (SMD = 0.10, 95% CI: [-0.11, 0.31], < 0.001).
CONCLUSION
Results show PD patients with co-occurring RBD have more severe motor and non-motor symptoms likely due to overlapping affected regions in RBD and PD-related pathology, plus broader neurodegeneration seen in PD patients with RBD.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier CRD42023476331.
背景
本荟萃分析旨在评估伴或不伴快速眼动睡眠行为障碍（RBD）的帕金森病（PD）患者在症状方面的潜在差异。
方法
在PubMed、Cochrane、Embase和Web of Science数据库（截至2023年8月16日）中进行系统检索，以识别关于PD和RBD的相关研究。使用Stata 15.0进行统计分析。连续变量采用标准化均值差（SMD）和95%置信区间（95%CI）进行分析，计数资料则采用比值比（OR）和95%CI作为统计效应量进行评估。对所有纳入研究的异质性进行检验；对于异质性较低（I²<50%）的研究，采用固定效应模型计算统计结果。对于异质性相对较高（I²>50%）的研究，应用随机效应模型，随后进行敏感性分析和亚组分析以识别异质性来源。
结果
本研究共纳入5672名受试者。与无RBD组相比，RBD组的统一帕金森病评定量表第三部分（UPDRS-III）评分显著更高（SMD = 0.20，95%CI：[0.11, 0.29]，P<0.001），且RBD组的 Hoehn-Yahr评分也显著更高（SMD = 0.29，95%CI：[0.03, 0.55]，P<0.001）。RBD组的PD患者比无RBD组患者有更严重的认知障碍（SMD = -0.30，95%CI：[-0.48, -0.11]，P<0.001）。RBD组PD患者的幻觉发生率是无RBD组的3.0倍（OR = 3.0，95%CI：[2.15, 4.20]，P = 0.110）。RBD组的PD患者还经历更严重的焦虑症状（SMD = 0.13，95%CI：[-0.26, 0.51]，P<0.001），抑郁量表得分更高（SMD = 0.22，95%CI：[0.02, 0.43]，P<0.001），且睡眠障碍量表得分高于无RBD组（SMD = 0.10，95%CI：[-0.11, 0.31]，P<0.001）。
结论
结果表明，共患RBD的PD患者有更严重的运动和非运动症状，这可能是由于RBD和PD相关病理中受影响区域重叠，以及RBD型PD患者中更广泛的神经退行性变所致。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/#searchadvanced，标识符CRD42023476331。
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