快速动眼睡眠行为障碍症10例报告

目的 介绍快速眼动(REM)睡眠行为障碍症(RBD)的临床表现，探讨其原因和可能的发病机制。方法 对由多导睡眠图确诊的10例RBD患者进行回顾性分析。结果 10例患者发病年龄均为中老年人，男性9例，表现睡梦中出现粗暴动作、喊叫和其他行为异常，其中4例为帕金森病患者，2例多系统萎缩，1例脑外伤，3例原因不明；睡前服用氯硝安定可控制发作。全部多导睡眠图(PSG)均为REM睡眠期肌弛缓现象消失而伴随肌电活动。结论 对睡眠中出现的异常行为特别是粗暴动作者．应考虑本病的可能，PSG有助确诊并与癫痫鉴别，氯硝安定治疗有效?     

帕金森病患者睡眠障碍的多导睡眠图研究

目的 了解帕金森病（Parkinson disease，PD）睡眠障碍的多导睡眠图（PSG）监测表现及睡眠结构、进程特点。方法 对42例临床确诊的PD患者和40名健康对照者行全夜PSG监测，分析比较各项睡眠结构、进程参数及快速眼动睡眠（REM）期视频监测特点。结果 经PSG监测发现，PD组入睡困难、睡眠破碎、白天过度嗜睡等的发生率（分别为73．8％、59．5％、46．1％）均高于对照组（P〈0．05）；PD组患者总睡眠时间、非快速眼动睡眠2期、REM潜伏期、睡眠效率、睡眠纺锤波密度较对照组缩短或降低（P值分别为0．000、0．000、0．045、0．000、0．000），睡眠潜伏期、觉醒时间、觉醒次数、〉5min的觉醒次数、Epworth嗜睡量表评分均延长或增加（P值分别为0．022、0．000、0．007、0．001、0．ooo）。另外，监测中发现PD组有6例（14．3％）出现睡眠始发REM时段，而对照组无一例出现。PD组中有36例（85．7％）在REM睡眠中呈现肌电活动不消失（RWA），其中19例出现REM期睡眠行为障碍（RBD）；对照组有6例出现RWA，其中2例出现RBD。统计学分析显示，PD组RWA、RBD的发生率（分别为85．7％、45．2％）与对照组比较差异均有统计学意义（P〈0．01）。结论 研究显示PD患者睡眠结构、睡眠进程等多项睡眠参数改变；PD患者中RBD发生率高，其临床症状表现形式多样，且很多时候RBD可先于PD的其他症状而早期出现。     

多系统萎缩与快动眼睡眠行为障碍研究进展

多系统萎缩(multiple system atrophy,MSA)中睡眠障碍非常常见,如睡眠减少和不连续性、日间嗜睡、快动眼睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)、喘鸣以及睡眠相关呼吸障碍等[1].其中,RBD最为常见,被认为是MSA的"红旗(Red Flag)"[1-2].RBD特征性表现是REM睡眠期出现生动、恐怖性的梦境伴有简单或复杂的动作行为增多[3-4].多导睡眠监测(polysomnography,PSG)发现REM睡眠期显著增加的下颏肌强直形式肌电活动和/或频繁的相位形式肌电活动,即快动眼睡眠期失张力消失(REM sleep without atonia,RSWA).RBD对MSA早期诊断、尽早采取神经保护治疗改善病程有重要意义.本文在复习文献的基础上,就MSA中RBD的发病机制、临床特点、PSG表现及治疗进行综述.     

老年快速眼动睡眠行为障碍13例分析

<正>异态睡眠在儿童中多见,老年中少见,且老年中异态睡眠则多出现在快速动眼睡眠相(REM)。现将我院在近2年中13例老年REM睡眠行为障碍(RBD)报告如下。1对象和方法为我院2012年1月至2013年12月诊治的老年RBD患者13例,男12例,女1例;年龄56~81岁,平均(66.8±7.3)岁;病程1~16年,平均(5.1±3.8)年;起病年龄55~81岁,平均     

快速眼动睡眠期行为障碍

快速眼动(REM)睡眠期行为障碍(RBD)是在快速眼动睡眠时反复出现的肌紧张现象,而其他快速眼动睡眠成分均存在,并出现与梦境相关的肢体和躯体的行为活动.     

15例夜间睡眠期行为异常患者的脑电图及多导睡眠图分析

目的通过对夜间睡眠期行为异常患者的脑电图及多导睡眠图分析,鉴别诊断额叶癫痫及REM期睡眠行为异常(RBD),并结合文献对其临床表现、电生理特点进行总结。方法对15例夜间睡眠期行为异常患者,均行长程录像脑电图(Video-EEG)及多导睡眠监测(PSG)。并依据国际睡眠障碍分型修订版(ICSD-R)及国际抗癫痫联盟(ILAE)所制定的癫痫综合征分类标准,给予鉴别诊断及相应治疗,随访观察预后。结果其中9例为额叶癫痫患者,其发作间期脑电图,额区、额中线区可见异常放电者7例;发作期脑电图,额区、额中线区可见节律性演变者2例,伴有大量肌肉及动作伪差,行为异常多发作于非快速眼动睡眠Ⅰ～Ⅱ期,睡眠结构中,总睡眠时间缩短、睡眠Ⅲ～Ⅳ期、REM睡眠期缩短、Ⅰ～Ⅱ期睡眠时间延长。6例为RBD患者:发作间期及发作期脑电图正常;PSG记录中,发作均位于REM期,并持续出现肌电活动增加,总睡眠时间、睡眠Ⅰ～Ⅱ期、REM睡眠期均缩短。结论额叶癫痫及RBD的临床症状复杂,容易误诊、延诊,故借助神经电生理检查手段(长程脑电图结合PSG)可以提高疾病的诊断率。     

抗癫痫药对癫痫患者睡眠结构的影响

目前对于癫痫的研究发现,癫痫患者存在睡眠障碍问题,此可归因于抗癫痫药本身、癫痫发作和不规律的睡眠等方面〔1〕,其中抗癫痫药对癫痫患者睡眠结构的影响不可忽视,纠正癫痫患者的睡眠障碍有助于癫痫的治疗〔2〕。1.睡眠多导监测介绍1953年,Aserinsky等在记录脑电的同时记录到了眼球的运动,发现了快速眼动期睡眠(REM),从而推动了睡眠多导监测技术的发展。多导睡眠仪(PSG)的应用开始于20世纪80年代。装备有直流信号处理器:处理呼吸气流、呼吸运动和血氧饱和度信号;②交流信号处理器:处理脑电、眼动、心电和肌电信号。根据脑电、眼球运动和肌电表现,可以将睡眠分成非快眼动睡眠(NREM)和快眼动睡眠(REM),NREM睡眠又可进一步分为1、2、3、4期。目前使用的PSG大多配有视频录像系统,可以同时捕捉患者的夜间睡眠情况。2.睡眠生理⑴睡眠结构:正常睡眠是由NREM睡眠与REM睡眠两个不同睡眠时相构成。NREM睡眠分为1、2、3、4期,NREM睡眠的3期和4期合称慢波睡眠(SWS)。REM睡眠又称快波睡眠。在整个睡眠过程中,NREM睡眠与REM睡眠交替出现。以正常成人8小时睡眠为例,一开始首先进入NREM睡眠期,并迅...     

女性快速眼动睡眠行为障碍伴摔伤1例

<正>快速眼动(REM)睡眠行为障碍(REM behavior disorder,RBD)是REM睡眠期出现肌张力缺失现象并伴随不愉快梦境相关的复杂运动为特征的发作性疾病[1]。国内近年有陆续的报导,但女性RBD伴摔伤报导较少,现报道1例女性RBD案例如下。1病例患者女,39岁,汉族,医生。间歇出现"夜眠中出现喊叫、拳打脚踢并摔伤,醒后不能回忆2年余"于2013年11月5日入院。2011年初无明显原因出现夜眠时梦多,出现腿乱     

特发性过度睡眠

目的 探讨特发性过度睡眠患者临床表现以及多导睡眠图特征.方法 与结果回顾分析4 例特发性过度睡眠患者的临床资料,均以白天过度嗜睡首发,无猝倒、睡眠麻痹、睡前幻觉及睡眠行为障碍,其中2 例伴自主神经功能障碍.4 例患者Epworth 嗜睡量表评分均＞ 11 分;多次小睡潜伏期试验平均睡眠潜伏期明显缩短,未见睡眠起始快速眼动期;例3 患者全夜多导睡眠图监测显示睡眠潜伏期明显缩短,总睡眠时间延长,但夜间睡眠结构正常.结论 明确诊断特发性过度睡眠需结合患者病史资料、临床表现及实验室检查进行综合考虑,多次小睡潜伏期试验和全夜多导睡眠图监测是鉴别诊断特发性过度睡眠与发作性睡病的有效方法.     

REM睡眠行为障碍

本文对REM睡眠行为障碍的临床特征，多导睡眠图特征，发病机制和治疗等作一综述。     

REM sleep behavior disorder and REM sleep without atonia in Parkinson's disease

OBJECTIVE: To determine the frequency of REM sleep behavior disorder (RBD) among patients with PD using both history and polysomnography (PSG) recordings and to further study REM sleep muscle atonia in PD. BACKGROUND: The reported occurrence of RBD in PD varies from 15 to 47%. However, no study has estimated the frequency of RBD using PSG recordings or analyzed in detail the characteristics of REM sleep muscle atonia in a large group of unselected patients with PD. METHODS: Consecutive patients with PD (n = 33) and healthy control subjects (n = 16) were studied. Each subject underwent a structured clinical interview and PSG recording. REM sleep was scored using a method that allows the scoring of REM sleep without atonia. RESULTS: One third of patients with PD met the diagnostic criteria of RBD based on PSG recordings. Only one half of these cases would have been detected by history. Nineteen (58%) of 33 patients with PD but only 1 of 16 control subjects had REM sleep without atonia. Of these 19 patients with PD, 8 (42%) did not present with behavioral manifestations of RBD, and their cases may represent preclinical forms of RBD associated with PD. Moreover, the percentage of time spent with muscle atonia during REM sleep was lower among patients with PD than among healthy control subjects (60.1% vs 93.2%; p = 0.003). CONCLUSIONS: RBD and REM sleep without atonia are frequent in PD as shown by PSG recordings.     

快眼动睡眠调控机制及快眼动睡眠期行为障碍的神经通路相关研究

快眼动(REM)睡眠行为障碍(RBD)是一种以REM睡眠期骨骼肌弛缓能力障碍为特征的异态睡眠。患病个体因此在REM睡眠期出现不同严重程度的与梦境吻合的异常行为。至今与RBD相关的神经核团及通路尚未完全阐明,存在不同假说。文中从REM睡眠神经调控机制入手,结合猫和大鼠RBD模型发现,回顾近年来RBD相关神经通路研究的进展,并与人类RBD病例对照,综合阐述RBD产生的相关神经通路,为RBD发病机制的研究进一步提供线索。     

Quantitative assessment of isolated rapid eye movement (REM) sleep without atonia without clinical REM sleep behavior disorder: clinical and research implications

BackgroundRapid eye movement (REM) sleep without atonia (RWA) is observed in some patients without a clinical history of REM sleep behavior disorder (RBD). It remains unknown whether these patients meet the refined quantitative electromyographic (EMG) criteria supporting a clinical RBD diagnosis. We quantitatively evaluated EMG activity and investigated its overnight distribution in patients with isolated qualitative RWA.MethodsFifty participants with an incidental polysomnographic finding of RWA (isolated qualitative RWA) were included. Tonic, phasic, and ‘any’ EMG activity during REM sleep on PSG were quantified retrospectively.ResultsReferring to the quantitative cut-off values for a polysomnographic diagnosis of RBD, 7/50 (14%) and 6/50 (12%) of the patients showed phasic and ‘any’ EMG activity in the mentalis muscle above the respective cut-off values. No patient was above the cut-off value for tonic EMG activity or phasic EMG activity in the anterior tibialis muscles. Patients with RWA above the cut-off value showed higher amounts of RWA during later REM sleep periods.ConclusionsThis is the first study showing that some subjects with incidental RWA meet the refined quantitative EMG criteria for a diagnosis of RBD. Future longitudinal studies must investigate whether this subgroup with isolated qualitative RWA is at an increased risk of developing fully expressed RBD and/or neurodegenerative disease.     

Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study

BACKGROUND: Rapid-eye-movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by dream-enacting behaviours related to unpleasant dreams and loss of muscle atonia during REM sleep. RBD may be idiopathic or associated with neurological disease. Available data suggest that in some cases RBD might be the initial manifestation of a neurodegenerative disease. We sought to determine the frequency and nature of neurological disorders developing in patients diagnosed with idiopathic RBD at our sleep centre. METHODS: We retrospectively assessed 44 consecutive patients (39 men and five women with a mean age of 74 years), with at least 2 years of clinical follow-up after a diagnosis of idiopathic RBD, through a detailed clinical history, complete neurological examination, rating scales of parkinsonism, and neuropsychological tests. FINDINGS: 20 (45%) patients developed a neurological disorder after a mean of 11.5 years from the reported onset of RBD and a mean follow-up of 5.1 years from the diagnosis of idiopathic RBD at our sleep centre. Emerging disorders were Parkinson's disease in nine patients, dementia with Lewy bodies in six, multiple system atrophy with predominant cerebellar syndrome in one, and mild cognitive impairment in four in whom visuospatial dysfunction was prominent. Patients with longer clinical follow-up developed a neurological disease (OR 1.512, 95% CI 1.105-2.069; p=0.010). INTERPRETATION: Our study indicates that in people presenting to sleep centres, RBD often antedates the development of a neurodegenerative disorder. Close follow-up of patients with idiopathic RBD could enable early detection of neurodegenerative disease. This finding may be of great interest when early effective treatment strategies and neuroprotective drugs become available.     

Rapid Eye Movement Sleep Behavior Disorder

Abstract: Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of normal voluntary muscle atonia during REM sleep, and is associated with excessive motor activity related to dreaming. The movements are often potentially harmful and may lead to repeated injuries to the patients and/or their bedpartners.
RBD is more common in the elderly and affects predominantly males. A recent survey reported an estimated prevalence of RBD of 0.38% in the elderly and 0.5% in the general population. Because the treatment of RBD is effective and safe in most cases, awareness and diagnosis of RBD is critical. Overnight polysomnography is required to differentiate accurately between RBD and other sleep disorders, even though the patients have been clinically diagnosed as RBD according to the minimal criteria of the International Classification of Sleep Disorders. Muscle tone persists during REM sleep in RBD patients, and may be frequently augmented for prolonged periods of time. The density of REMs or phasic muscle activity occurring during REM sleep significantly increases in these patients, although their overall sleep architecture is usually normal, with the expected cycles of non-REM and REM sleep.
RBD occurs in both acute and chronic form. Acute cases are associated with intoxication and withdrawal. Chronic cases are most often either idiopathic or associated with neurological disorders—especially neurodegenerative diseases. The etiology of idiopathic RBD is still unknown, but a recent study has shown an association between some cases of idiopathic RBD and neurodegenerative disorders with parkinsonism such as Parkinson's disease, multiple system atrophy, and diffuse Lewy body disease. RBD patients thus need to be carefully followed up in terms of neurological evaluation.     

Quantification of tonic and phasic muscle activity in REM sleep behavior disorder.

REM sleep behavior disorder (RBD) is characterized by excessive tone of the chin muscle and limb movement during sleep. In the past, quantification of increased muscle tone in REM sleep has been performed visually, using no stringent criteria. The aim of this study was to develop an automatic analysis, allowing the quantification of muscle activity and its amplitude for all sleep stages, with a focus on REM sleep in patients with RBD. Forty-eight patients (27 male, 21 female) with RBD were included in the analysis. Twenty-one had idiopathic RBD; 28 had narcolepsy plus RBD. Twenty-five patients without confirmed sleep disorder served as control subjects. The amplitude of the EMG was generated from the difference of the upper and lower envelope of the mentalis muscle recordings. By smoothing the amplitude curve, a threshold curve was defined. Any muscle activity beyond the threshold curve was defined as motor activity. The means of the motor activity per second were summarized statistically and calculated for each sleep stage. Due to variable distribution of REM sleep, the latter was assigned to respective quartiles of the recorded night. Muscle activity was defined according to a histogram as short-lasting (<0.5 second) and long-lasting (>0.5 second) activity. No difference in the distribution of REM sleep/quartile and mean muscle tone throughout the sleep cycle could be found within the RBD groups and control subjects. Muscle activity was in the range of 200 ms. No clusters or regular distribution of muscle activity were found. Long muscle activity in the group with manifest clinical RBD was significantly higher than in control subjects, whereas it was nonsignificantly higher in subclinical RBD. The correlation between the frequency of long muscle activity in REM sleep and age was highly significant only for patients with idiopathic RBD. Automatic analysis of muscle activity in sleep is a reliable, easy method that may easily be used in the evaluation for REM sleep behavior disorder, creating indices of muscle activity similar to the indices for sleep apnea or PLMS. Together with the overt behavior, the analyses provides an important tool to get a deeper insight into the pathophysiology of RBD. Long movements appear to represent the motor disinhibition in REM sleep more distinct than short movements. The positive correlation of age and increased motor activity in REM sleep in idiopathic RBD highlights the idea of age dependant motor disinhibition as a continuum of a neurodegenerative disorder, which in narcolepsy patients with RBD only seems to happen as a single temporal event at onset of the disorder.     

Functional brain imaging in combined motor and sleep disorders

The pathophysiology of sleep-related motor diseases and sleep dysfunction in movement disorders is widely unknown as yet. Functional brain imaging, in particular radioisotope and magnetic resonance techniques, are powerful tools to investigate possible pathomechanisms of combined sleep and motor dysregulation. In patients with Restless legs syndrome (RLS), only a subtle striatal dopamine deficit was found in PET and SPECT despite a good treatment effect of dopaminergic drugs. Functional MRI suggested a central generator of periodic limb movements during sleep (PLMs) in RLS. In contrast, a marked striatal dopamine depletion was demonstrated in patients with REM sleep behaviour disorder (RBD) as the base for the clinical and nosological overlap of RBD with parkinsonian disorders. PET and SPECT also suggested that sleep abnormalities in Parkinson's disease (PD), such as REM sleep diminution or increased PLMs, are indirect manifestations of the primary striatal dopamine deficiency.     

Clinical, behavioural and polysomnographic correlates of cataplexy in patients with narcolepsy/cataplexy

BACKGROUND: Cataplexy is the main motor symptom of narcolepsy/cataplexy and is considered a form of rapid eye movement (REM) sleep motor dyscontrol appearing during wakefulness and elicited by emotions. This study examined the relationship between the frequency of cataplectic attacks in patients with narcolepsy/cataplexy and (a) the clinical and behavioural characteristics of cataplectic attacks, including the emotional tone of trigger events, and (b) the polysomnographic characteristics of daytime sleepiness, nocturnal sleep structure and indices of motor disorders during sleep. METHODS: A consecutive series of 44 first-diagnosed drug-naive patients with narcolepsy/cataplexy, fulfilling the International Classification of Sleep Disorders, 2nd edition (ICSD-2) clinical and polysomnographic diagnostic criteria, were interviewed to estimate the frequency and clinical characteristics of cataplectic attacks and the occurrence of REM sleep behaviour disorder (RBD). All patients also underwent a video-polysomnographic recording to assess their sleep parameters and indices of altered motor control during sleep. RESULTS: Patients were divided into two groups on the basis of the frequency of cataplectic attacks, namely high-frequency (n=30) or low-frequency (n=14) depending on whether they estimated they had more or less than one attack per month. High-frequency patients (with a larger proportion of men) reported attacks more often affecting mainly the head, jaw and shoulder muscles and experienced more events among those listed as possible triggers of attacks. Sixty-one percent of patients reported RBD and 43% had an RBD episode at video-polysomnography regardless of the frequency of cataplectic attacks or gender. Lastly, the frequency of periodic leg movements (PLM) per hour was higher in men than women and increased with age. CONCLUSIONS: Patients with more than one cataplectic attack per month had more frequent involvement of head, jaw and shoulder muscles and were mainly men. The proportions of patients with clinically assessed RBD and an RBD episode documented by video-polysomnography, as well as conspicuous values of PLM per hour, are fairly consistent with those reported in recent small-group studies. Therefore, it seems legitimate to argue that RBD and PLM are nocturnal manifestations intrinsic to narcolepsy/cataplexy and that the gender-related differences in the frequency of attacks and the value of PLM per hour may be indicative of a larger difference in the clinical and polysomnographic characteristics of narcolepsy/cataplexy than hitherto suspected.     

REM Sleep Behavior Disorder and Epileptic Phenomena: Clinical Aspects of the Comorbidity

Summary:  Purpose: To document the occurrence of REM sleep behavior disorder (RBD) episodes in patients with epilepsy, and of interictal EEG epileptiform abnormalities (IEA) in patients with idiopathic RBD.
Methods: Consecutive observations in a tertiary epilepsy center and a tertiary sleep center. RBD diagnosis was based on standard clinical and video-polysomnographic findings.
Results: Co-occurrence of epileptic seizures and RBD episodes was found in six cases (all men; mean age 70.5 ± 11.1 years). Focal, isolated, sporadic sharp waves during wakefulness and/or during sleep were documented in 9 out of 34 (26.4%) patients with idiopathic RBD; no significant differences in age at onset and duration of RBD emerged between RBD patients with and without IEA.
Conclusions: RBD episodes can occur in epilepsy patients and focal IEA in patients with idiopathic RBD. This, apart from being a possible cause for misdiagnosis, may indicate a possible link between the two disorders. Further systematic investigations of the occurrence of RBD episodes in epilepsy will help to establish the real extent of this comorbidity and its ultimate neurobiological significance.