孤立性快速眼动睡眠行为障碍的临床特征与表型转换：韩国一项前瞻性单中心研究，并与蒙特利尔队列进行比较

Clinical characteristics and phenoconversion in isolated REM sleep behavior disorder: a prospective single-center study in Korea, compared with Montreal cohort.

作者信息

Byun Jung-Ick, Sunwoo Jun-Sang, Shin Yong Woo, Shin Jung-Won, Kim Tae-Joon, Jun Jin-Sun, Shin Jung Hwan, Kim Han-Joon, Montplaisir Jacques, Gagnon Jean-François, Pelletier Amelie, Delva Aline, Postuma Ronald B, Jung Ki-Young

机构信息

Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea.

Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea.

出版信息

J Clin Sleep Med. 2025 Jan 1;21(1):81-88. doi: 10.5664/jcsm.11318.

DOI:10.5664/jcsm.11318

PMID:39177811

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11701292/

Abstract

STUDY OBJECTIVES

Isolated rapid eye movement sleep behavior disorder is a prodromal synucleinopathy, but its conversion rate and subtypes can vary among different cohorts. We report the clinical characteristics and phenoconversion rate of the large single-center isolated rapid eye movement sleep behavior disorder cohort in Korea and compared it to the Montreal cohort.

METHODS

This prospective cohort study examined 238 patients with polysomnography confirmed isolated rapid eye movement sleep behavior disorder from Seoul National University Hospital (SNUH) who completed at least 1 follow-up evaluation. We compared the baseline and phenoconversion data of the SNUH cohort to those of 242 isolated rapid eye movement sleep behavior disorder patients in the Montreal cohort.

RESULTS

In the SNUH cohort, age at rapid eye movement sleep behavior disorder diagnosis was similar (66.4 ± 7.8 vs 65.6 ± 8.4, = .265), but the proportion of men was lower (63.0% vs 74.0%, = .01), and the duration of follow-up was shorter than that in the Montreal cohort (3.7 ± 2.0 vs 4.8 ± 3.6 years, < .001). During follow-up, 34 (11.8%) patients in the SNUH cohort converted to neurodegenerative disease: 18 (52.9%) to Parkinson's disease, 9 (26.5%) to dementia with Lewy bodies, and 7 (20.6%) to multiple system atrophy. The conversion rate in the SNUH cohort was 15% after 3 years, 22% after 5 years, and 32% after 7 years, which was significantly lower than that of the Montreal cohort (log-rank test, = .002). Among phenoconversion subtype, fewer patients in the SNUH group than in the Montreal group converted to dementia with Lewy bodies (Gray's test = .001).

CONCLUSIONS

Through a comparative analysis between the SNUH and Montreal cohorts, we identified a significant difference in phenoconversion rates, particularly for dementia with Lewy bodies patients. These findings underscore the importance of further research into the underlying factors, such as racial and geographical factors contributing to such disparities.

CITATION

Byun J-I, Sunwoo J-S, Shin YW, et al. Clinical characteristics and phenoconversion in isolated REM sleep behavior disorder: a prospective single-center study in Korea, compared with Montreal cohort. . 2025;21(1):81-88.

摘要

研究目的

孤立性快速眼动睡眠行为障碍是一种前驱性突触核蛋白病，但其转化率和亚型在不同队列中可能有所不同。我们报告了韩国一个大型单中心孤立性快速眼动睡眠行为障碍队列的临床特征和表型转化率，并将其与蒙特利尔队列进行了比较。

方法

这项前瞻性队列研究对238例经多导睡眠图证实患有孤立性快速眼动睡眠行为障碍且至少完成1次随访评估的首尔国立大学医院（SNUH）患者进行了检查。我们将SNUH队列的基线和表型转化数据与蒙特利尔队列中的242例孤立性快速眼动睡眠行为障碍患者的数据进行了比较。

结果

在SNUH队列中，快速眼动睡眠行为障碍诊断时的年龄相似（66.4±7.8岁 vs 65.6±8.4岁，P = 0.265），但男性比例较低（63.0% vs 74.0%，P = 0.01），随访时间短于蒙特利尔队列（3.7±2.0年 vs 4.8±3.6年，P < 0.001）。在随访期间，SNUH队列中有34例（11.8%）患者转化为神经退行性疾病：18例（52.9%）转化为帕金森病，9例（26.5%）转化为路易体痴呆，7例（20.6%）转化为多系统萎缩。SNUH队列3年后的转化率为15%，5年后为22%，7年后为32%，显著低于蒙特利尔队列（对数秩检验，P = 0.002）。在表型转化亚型中，SNUH组转化为路易体痴呆的患者少于蒙特利尔组（Gray检验，P = 0.001）。