特发性和继发性快速眼动睡眠行为障碍的睡眠结构研究

目的：探讨快速眼动睡眠行为障碍（REM sleep behavior disorder，RBD）患者的睡眠结构改变。方法：纳入的22例患者符合国际睡眠障碍协会（第2版）的RBD诊断标准，16例患者符合RBD主要诊断标准以及英国脑库的PD、2005年国际路易体痴呆协作组或者2008年多系统萎缩第2版的诊断标准。同时纳入年龄、性别匹配的健康对照19例。利用日本光电32信道9200K脑电图机，所有患者均完成多项睡眠图监测（PSG），记录脑电图、眼球运动、下颌和肢体肌电活动、心电图、经鼻气流、胸腹部呼吸运动、血氧、鼾声等多个项目，并录像监测患者的行为。使用Polysmith软件和视觉评估分析睡眠结构、呼吸、运动等相关指标。结果：RBD患者展现了典型临床表现和电生理改变。特发性RBD组（72．7％）较继发性RBD组（43．8％）显示有更多的夜间活动和言语，差异有统计学意义（P=0．071）。特发性RBD在睡眠结构并未发生明显改变，仅有周期性腿动（PLM）指数增高。继发性RBD与特发性RBD和健康对照相比，总体睡眠时间缩短、睡眠效率减低、睡眠潜伏期和REM潜伏期延迟、Ⅱ期和REM睡眠减少、Ⅰ期睡眠增加、低通气指数增高、PLM指数增高。结论：特发性RBD患者具有更多的夜间行为异常，而睡眠结构无改变，仅有PLM指数增加；而继发性RBD出现明显的睡眠结构紊乱、呼吸紊乱以及PLM异常。

The study on sleep architectures in patients with idiopathic rapid eye movement sleep behavior disorder

Objective： To investigate the changes of sleep architectures in patients with rapid eye movement sleep behavior disorder （RBD）. Methods： Twenty-two patients with RBD were enrolled ac- cording to the Crileria of International Sleep Disorder Association （second edition）. 16 patients were con- sidered as with secondary RBD according to the diagnostic criteria of RBD and Parkinson＇s disease （PD） （the brain bank UK Parkinson＇s Disease Society） ,dementia with lewy body （DLB） （third report of the DLB consortium） ,multiple system atrophy （MSA） （2008 consensus criteria established by Gilman）. Re cruited 19 normal controls of matched age and sex were also recruited. All cases with RBD were video- monitored with recordings of electroencephalography, electrooculography and electromyography on the chins and limbs, electrocardiography, nasal airflow, thoracic and abdominal respiratory movement, oxy- gen and snore. The sleep architecture and other parameters were analyzed on the software of Polysmith and visual analysis. Results＇ The typical clinical manifestations and changes of polysomnography were shown. The patients with idiopathic RBD （72.7 %） had more night behaviors and talks than those of sec- ondary RBD patients （43. 8%） on PSG, but the tendency of statistical significance were found （P= 0. 071）. The sleep architectures of patients with idiopathic RBD remained unchanged compared with healthy controls and secondary RBD ones, only PLMs index increased. As to secondary RBD patients, to- tal sleep time and sleep efficiency decreased. Sleep latency and RME sleep latency were prolonged and the time of stage Ⅰ increased, the times of stage Ⅱ and REM stage was shortened, while hypopnea and PLMs index increased. Conclusion：The patients with idiopathic RBD have normal sleep architectures, but with more sleep behaviors and PLMs. The obvious abnormal sleep architectures, respiratory functions and PLMs are found on secondary RBD patients.