帕金森病与快动眼睡眠行为障碍

快动眼期睡眠行为障碍(RBD)是以REM期睡眠肌肉失张力的消失、伴随梦境发生的暴力行为等为特点,患者常会伤及他人和自身。RBD与帕金森病(PD)密切相关,伴有RBD的PD与不伴有RBD的PD有着不同的发病模式。在少动-强直型PD患者,RBD可在PD典型症状出现之前发生。RBD在经颅脑超声信号、脑电图、脑血流灌注、多巴胺代谢等方面的异常表现越来越支持RBD可能是PD发病的一个阶段。多数患者对氯硝西泮治疗有效。     

快眼动睡眠行为障碍的影像学研究进展

<正>快眼动睡眠行为障碍(rapid eye movement sleep behaviour disorder,RBD)是一种发生在快眼动睡眠期(rapid eye movement sleep,REM)的异态睡眠,以骨骼肌失弛缓,伴噩梦以及不同程度的梦境演绎行为为特征,常引起自伤或伤及同床者。RBD根据病因可以分为特发性与继发性,继发性RBD也称症状性RBD,常继发于神经系统疾病(如神经退行性疾病、发作性睡病、脑干损伤)、服用药物(如抗抑郁药物、β受体阻滞剂)以及酒精戒断等~([1,2])。近年来,大量研究表明     

伴或不伴快动眼睡眠行为障碍的帕金森病临床特点比较

目的 比较伴或不伴快动眼睡眠行为障碍的帕金森病(PD-RBD⁺;PD-RBD^-)在临床特征上的差异。方法 收集在陕西省人民医院就诊的PD患者,通过多导睡眠监测技术(PSG)将其划分为PD-RBD⁺组和PD-RBD^-组,收集人口学资料,完成临床资料收集及相关神经心理量表测评,统计两组患者病情严重程度、运动及非运动症状特点,并进行统计分析。结果 共纳入PD患者59例,其中PDRBD+组25例,PD-RBD^-组34例。PD-RBD⁺组比PD-RBD^-组男性更多,强直为主型占比多,UPDRS第Ⅲ部分分数更高,冻结和体位性低血压发生率高。结论 总体而言,PD-RBD⁺组症状较PD-RBD^-组更重。     

快动眼睡眠行为障碍

对快动眼睡眠行为障碍（RBD）的认识过程、临床表现、多导睡眠图特征、可能的病因及病理生理机制以及药物治疗方法等进行了综述。     

快动眼睡眠行为障碍

对快动眼睡眠行为障碍 (RBD)的认识过程、临床表现、多导睡眠图特征、可能的病因及病理生理机制以及药物治疗方法等进行了综述     

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。     

快动眼睡眠行为障碍的研究进展

正快动眼睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)是一种异态睡眠的形式,主要特征是在快动眼睡眠(rapid eye movement,REM)期间,出现骨骼肌迟缓现象消失(rapid eye movement sleep without atonia,RWA)及梦境演绎行为(dream enactment behavior,DEB)。其中RWA,又称为骨骼肌失弛缓,是一种由多导睡眠监测(polysomnography,PSG)发现的异常电生理表现,主要特点     

快眼动睡眠行为障碍与心率变异性的关系研究

目的 探讨快眼动睡眠行为障碍(REM sleep behavior disorder,RBD)患者的心率变异指标,评估心脏自主神经功能的情况。方法 本研究选取2016年1月-2017年12月就诊于新疆医科大学第五附属医院神经内科门诊及住院的患者,并经视频多导睡眠监测(vPSG)且符合RBD诊断标准的患者30例作为病例组,其中特发性RBD 5例,帕金森病(PD)伴RBD 12例,多系统萎缩(MSA)伴RBD 8例,进行性核上性麻痹(PSP)伴RBD 5例。另选健康对照者25例。使用动态心电图的心率变异(HRV)分析来定量测定30例RBD患者和25例健康对照者的时域及频域分析指标,比较2组的HRV情况。结果 病例组患者的时域分析指标如NN间期标准差(SDNN)、每5 min NN间期标准差(SDANN)、每5 min NN间期标准差的均值(ASDNN)及相邻NN间期差值的均方根(rMSSD)均较健康对照组低(P均<0.05)。病例组频域分析指标低频功率(LF)、高频功率(HF)、LF/HF均较健康对照组低(P均<0.05)。结论 RBD患者存在不同程度的HRV下降情况,提示心脏自主神经功能损害。     

快动眼睡眠行为障碍与神经退变性疾病的研究进展

快动眼睡眠行为障碍(REM sleep behaviour disorder, RBD)是指正常REM睡眠期骨骼肌张力弛缓消失,伴随与梦境相关的吵架斗殴等暴力性异常行为.20世纪90年代末期以来,众多研究显示约50%的RBD与神经退变性疾病有关,例如帕金森病(Parkinson disease, PD)、路易体痴呆(Dementia with lewy bodies, DLB)等.本文将对RBD的研究进展予以回顾,全面阐述RBD与神经退变性疾病之间的临床和病理生理学意义.     

快动眼睡眠行为障碍的诊断与干预策略

快动眼睡眠行为障碍(RBD)是一种发生于快动眼睡眠(REM)期的异态睡眠,常见于帕金森病、路易体痴呆和多系统萎缩等突触核蛋白病,并可作为上述神经系统变性病的前驱症状。RBD的确诊有赖于多导睡眠图。鉴别诊断主要包括阻塞性睡眠呼吸暂停、睡行症、夜间癫痫发作及周期性肢体运动障碍等。干预措施主要包括最大程度保护患者睡眠安全、应用氯硝西泮/褪黑素等。     

伴与不伴快速眼动睡眠行为障碍帕金森病患者临床差异的meta分析

目的 系统评价伴与不伴快速眼动睡眠行为障碍（RBD）帕金森病（PD）患者之间临床特征的差异。方法 检索PubMed、EMbase等外文数据库及中国生物医学数据库（CMB）、中国知识基础设施工程（CNKI）、维普中文科技期刊全文数据库（VIP）、万方数据库等中文数据库关于PD与RBD相关性分析的病例对照研究,检索时限从建库至2018年09月01日。对入选文献进行质量评价,并用Stata 12.0软件进行Meta分析。结果 共纳入了17项符合标准的病例对照研究,共计PD患者3006例,Meta分析结果显示：与不伴RBD的PD患者相比,伴RBD的PD患者年龄更大（SMD=0.26;95%CI 0.19~0.34;P<0.00 001）、病程更长（SMD=0.29;95%CI 0.21~0.37;P<0.00 001）、Hoehn-Yahr分级更高（SMD=0.22;95%CI 0.11~0.33;P<0.00 001）、UPDRS-Ⅲ评分更高（SMD=0.25;95%CI 0.15~0.36;P<0.00 001）、左旋多巴剂量更大（SMD=0.17;95%CI 0.08~0.26;P<0.00 001）,更易出现症状波动（OR=1.65;95%CI1.34~2.03;P<0.00 001）、异动症（OR=2.24;95%CI 1.74~2.88;P<0.00 001）,MMSE评分更低（SMD=-0.23;95%CI-0.40~-0.06;P=0.008）,幻觉（OR=3.15;95%CI 2.06~4.80;P<0.00 001）更多见,而性别（OR=1.15;95%CI 0.99~1.35;P=0.07）、发病年龄（SMD=0.09;95%CI-0.01~0.19;P=0.08）组间差异不明显。结论 PD患者中RBD的发生与患者年龄、病程有关,且伴RBD的PD患者需要更高的左旋多巴剂量、更易出现运动并发症,非运动症状更明显,提示伴RBD的PD患者中枢神经系统变性程度更严重、损害范围更广泛。     

Severity of idiopathic rapid eye movement sleep behavior disorder correlates with depression and alexithymia

BackgroundDepression and alexithymia often accompany early stages of Parkinson's disease (PD). However, these symptoms in idiopathic rapid eye movement sleep behavior disorder (iRBD) remain incompletely understood. The aim of this study was to compare depression and alexithymia between iRBD patients and healthy controls, and to evaluate the association between clinical RBD severity and severity of depression and alexithymia.MethodsPolysomnography-confirmed iRBD patients (n = 86) and healthy controls (n = 74) were enrolled. Clinical RBD severity was assessed using the RBD questionnaire-Hong Kong (RBDQ-HK). Depression and alexithymia were evaluated by the Beck Depression Inventory (BDI) and the 20-item Toronto Alexithymia Scale (TAS-20), respectively. Multivariate linear regression analysis was performed with adjustments for several covariates to determine the correlations between RBD severity and severity of depression and alexithymia.ResultsBDI scores were significantly higher in the iRBD group (10.6 ± 7.3) than in healthy controls (8.2 ± 6.0, p = 0.024). Higher total RBDQ-HK scores were associated with more severe depression in iRBD patients, even after controlling for confounding variables. iRBD patients exhibited significantly higher TAS-20 scores (45.7 ± 10.4) than healthy controls (42.1 ± 9.8, p = 0.026). Total RBDQ-HK scores were positively correlated with TAS-20 scores independent of BDI scores.ConclusionsPatients with iRBD were more depressed and had more severe alexithymia than healthy controls. Notably, as the clinical severity of RBD increased, both depression and alexithymia worsened.     

伴与不伴快速眼动睡眠行为障碍帕金森病患者临床差异的meta分析

目的系统评价伴与不伴快速眼动睡眠行为障碍(RBD)帕金森病(PD)患者之间临床特征的差异。方法检索Pub Med、EMbase等外文数据库及中国生物医学数据库(CMB)、中国知识基础设施工程(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据库等中文数据库关于PD与RBD相关性分析的病例对照研究,检索时限从建库至2018年09月01日。对入选文献进行质量评价,并用Stata 12. 0软件进行Meta分析。结果共纳入了17项符合标准的病例对照研究,共计PD患者3006例,Meta分析结果显示:与不伴RBD的PD患者相比,伴RBD的PD患者年龄更大(SMD=0. 26; 95%CI0. 19～0. 34; P 0. 00 001)、病程更长(SMD=0. 29; 95%CI 0. 21～0. 37; P 0. 00 001)、Hoehn-Yahr分级更高(SMD=0. 22; 95%CI 0. 11～0. 33; P 0. 00 001)、UPDRS-III评分更高(SMD=0. 25; 95%CI 0. 15～0. 36; P 0. 00 001)、左旋多巴剂量更大(SMD=0. 17; 95%CI 0. 08～0. 26; P 0. 00 001),更易出现症状波动(OR=1. 65; 95%CI1. 34～2. 03; P0. 00 001)、异动症(OR=2. 24; 95%CI 1. 74～2. 88; P 0. 00 001),MMSE评分更低(SMD=-0. 23; 95%CI-0. 40～-0. 06; P=0. 008),幻觉(OR=3. 15; 95%CI 2. 06～4. 80; P 0. 00 001)更多见,而性别(OR=1. 15; 95%CI 0. 99～1. 35; P=0. 07)、发病年龄(SMD=0. 09; 95%CI-0. 01～0. 19; P=0. 08)组间差异不明显。结论 PD患者中RBD的发生与患者年龄、病程有关,且伴RBD的PD患者需要更高的左旋多巴剂量、更易出现运动并发症,非运动症状更明显,提示伴RBD的PD患者中枢神经系统变性程度更严重、损害范围更广泛。     

Impulse control disorder and rapid eye movement sleep behavior disorder in Parkinson's disease

IntroductionThe relationship between ICD and RBD is still not yet understood and the results from the current literature are contradictory in PD. We aimed to explore the association between rapid eye movement (REM) sleep behavior disorder (RBD) and impulse control disorder in Parkinson's disease.MethodsNinety-eight non-demented patients with Parkinson's disease underwent one night of video-polysomnography recording. The diagnosis of RBD was established according to clinical and polysomnographic criteria. Impulse control disorders were determined by a gold standard, semi-structured diagnostic interview.ResultsHalf of the patients (n = 49) reported clinical history of RBD while polysomnographic diagnosis of RBD was confirmed in 31.6% of the patients (n = 31). At least one impulse control disorder was identified in 21.4% of patients, 22.6% with RBD and 20.9% without. Logistic regression controlling for potential confounders indicated that both clinical RBD (OR = 0.34, 95% CI = 0.07–1.48, P = 0.15) and polysomnographic confirmed RBD diagnoses (OR = 0.1.28, 95% CI = 0.31–5.33, P = 0.34) were not associated with impulse control disorder.ConclusionIn Parkinson's disease, REM Sleep Behavior Disorder is not associated with impulse control disorder. The results of our study do not support the notion that PSG-confirmed RBD and ICD share a common pathophysiology.     

Comparison of the clinical features of rapid eye movement sleep behavior disorder in patients with Parkinson's disease and multiple system atrophy

Aims: The aim of this study was to evaluate differences in the clinical presentation and polysomnographic characteristics of rapid eye movement sleep behavior disorder (RBD) between patients with Parkinson's disease (PD) and those with multiple system atrophy (MSA). Methods: We conducted clinical interviews examining RBD symptoms, including violent and non‐violent behaviors, in 49 patients with PD and 16 patients with MSA (as well as their bed partners) and performed polysomnography on all subject patients. Results: Twenty‐seven patients with PD (55.1%) and 11 patients with MSA (68.8%) had rapid eye movement sleep without atonia (RWA) on polysomnogram. The relative amounts of RWA were quite similar between the two groups. For most of the RWA‐positive patients in both groups, RBD symptoms remained non‐violent or silent. RBD symptoms in PD patients seemed to increase with the course of PD, while most of the RBD symptoms in the MSA patients occurred just prior to or at the onset of MSA and then disappeared within a short period. Conclusion: Although PD and MSA frequently accompany RWA, RBD symptoms often remain non‐violent or silent. Differences in the course of RBD symptoms in patients with PD and MSA may reflect the difference in the degeneration process of the two disorders.     

Dynamic functional connectivity impairments in idiopathic rapid eye movement sleep behavior disorder

IntroductionPrevious functional magnetic resonance imaging (fMRI) studies typically analyzed static functional connectivity (sFC) to reveal the pathophysiology of iRBD and overlooked the dynamic nature of brain activity. Thus, we aimed to explore whether iRBD showed abnormalities of brain network dynamics using the dynamic functional connectivity (dFC) approach.MethodsResting-state fMRI data from 33 iRBD patients and 38 matched healthy controls were analyzed using an independent component analysis, sliding window correlation and k-means clustering. Relationships between clinical symptoms and abnormal dFC were evaluated using Spearman's correlation analysis.ResultsFour distinct connectivity states were identified to characterize and compare dFC patterns. We demonstrated that iRBD had fewer occurrences and a shorter dwell time in the infrequent and strongly connected State 1, but with more occurrences and a longer dwell time in the frequent and sparsely connected State 2. In addition, iRBD patients showed significantly decreased FC in certain dFC states compared to healthy controls. More importantly, the impairments in the temporal properties of State 2 were found to be associated RBDSQ scores in the patient group.ConclusionsThis study detected dFC impairments in iRBD patients and provided new insights into the pathophysiology of iRBD, which might contribute to the development of disease-modifying drugs in future clinical trials.     

Patterns of cortical thinning in idiopathic rapid eye movement sleep behavior disorder

Idiopathic rapid eye movement sleep behavior disorder is a parasomnia that is a risk factor for dementia with Lewy bodies and Parkinson's disease. Brain function impairments have been identified in this disorder, mainly in the frontal and posterior cortical regions. However, the anatomical support for these dysfunctions remains poorly understood. We investigated gray matter thickness, gray matter volume, and white matter integrity in patients with idiopathic rapid eye movement sleep behavior disorder. Twenty‐four patients with polysomnography‐confirmed idiopathic rapid eye movement sleep behavior disorder and 42 healthy individuals underwent a 3‐tesla structural and diffusion magnetic resonance imaging examination using corticometry, voxel‐based morphometry, and diffusion tensor imaging. In the patients with idiopathic rapid eye movement sleep behavior disorder, decreased cortical thickness was observed in the frontal cortex, the lingual gyrus, and the fusiform gyrus. Gray matter volume was reduced in the superior frontal sulcus only. Patients showed no increased gray matter thickness or volume. Diffusion tensor imaging analyses revealed no significant white matter differences between groups. Using corticometry in patients with idiopathic rapid eye movement sleep behavior disorder, several new cortical regions with gray matter alterations were identified, similar to those reported in dementia with Lewy bodies and Parkinson's disease. These findings provide some anatomical support for previously identified brain function impairments in this disorder. © 2014 International Parkinson and Movement Disorder Society     

帕金森病合并快速眼球运动睡眠行为障碍患者的客观睡眠结构及认知功能

目的 评价帕金森病合并快速眼球运动睡眠行为障碍(RBD)患者的睡眠结构及认知功能,并探讨其睡眠结构与认知功能之间的相关性.方法 本研究为横断面研究,以在我院睡眠中心进行睡眠监测的39例帕金森病合并RBD患者作为病例组,并以年龄、性别相匹配的21例原发性快速眼球运动睡眠行为障碍(iRBD)患者及37例不合并RBD的帕金森病患者作为对照组.所有患者均行整夜睡眠监测以定量睡眠相关参数,并且于监测当天使用蒙特利尔(MoCA)评估量表评估其认知功能.采用多重线性回归分析量表得分与睡眠结构之间的相关性.结果 (1)帕金森病合并RBD患者的睡眠效率(60.9％±16.9％)、总睡眠时间[(329.7±96.5)min]、非快速眼动睡眠2期时间[(127.6±67.6) min]及快速眼动睡眠期时间[(45.3 ±33.2) min]较iRBD组的相应值[77.8％±16.9％以及(397.1 ±88.9)、(188.0±94.7)、(70.6 ±25.9) min]比较明显减少(均P＜0.05),较不合并RBD的PD组的相应值[61.3％±21.7％以及(324.9 ±134.6)、(132.6 ±65.6)、(47.1±31.9)min]减少,但差异均无统计学意义.3组的睡眠潜伏期、快速眼球运动睡眠潜伏期、非快速眼球运动睡眠1期,慢波睡眠比例、氧减指数、呼吸暂停低通气指数及周期性肢体运动指数比较差异均无统计学意义.(2)帕金森病合并RBD患者认知功能最差,其中视空间与执行功能得分[(3.8±1.1)分]较iRBD组[(4.4±0.7)分]比较差异有统计学意义(F=3.426,P＜0.05).(3)多重线性回归显示帕金森病合并RBD患者的RBD病程、睡眠效率和非快速眼动睡眠2期与视空间与执行功能得分有相关性.结论 帕金森病合并RBD患者的睡眠效率、总睡眠、非快速眼动睡眠2期及快速眼动睡眠期时间和认知功能均明显下降,认知功能的改变与睡眠结构的变化可能存在相关性.     

Neural substrates of rapid eye movement sleep behavior disorder in Parkinson's disease

ObjectivesTo investigate neural substrates of symptomatic rapid eye movement sleep behavior disorder (RBD) in Parkinson's disease (PD) by analyzing brain changes based on both hypothesis-free and hypothesis-driven neuroimaging analyses.MethodsA total of 63 subjects (14 PDRBD−, 24 PDRBD+, and 25 age-matched healthy controls = HC) were enrolled in this study. RBD was defined by RBD screening questionnaire with video-polysomnographic confirmation. All subjects underwent volumetric and diffusion tensor imaging. The whole brain gray- and white-matter changes were analyzed and the central ascending cholinergic pathway involving the pedunculopontine nucleus and thalamus was compared with a region-of-interest analysis and probabilistic tractography.ResultsThe PDRBD+ group showed decreased gray matter volume of the left posterior cingulate and hippocampus compared to the PDRBD− and additional gray matter decrease in the left precuneus, cuneus, medial frontal gyrus, postcentral gyrus and both inferior parietal lobule compared to the HC group (uncorrected p < 0.001, k = 50). There were no significant differences in white matter changes between the PDRBD− and PDRBD+ groups both by fractional anisotropy and mean diffusivities. However, both PD groups showed widespread changes by fractional anisotropy reductions and mean diffusivity increments compared to HC (p < 0.05 corrected). There were no significant differences in tract-based spatial statistics and the normalized tract volumes as well as the diffusion indices of both the thalamus and pedunculopontine nuclei among the study groups.ConclusionsThe appearance of RBD in PD may be related to regional gray matter changes in the left posterior cingulate and hippocampus but not localized to the brainstem.     

Reduced rapid eye movement sleep latency in patients with parkinson's disease

Summary Rapid eye movement (REM) sleep latency (time from sleep onset to the first REM episode) was measured in 39 patients with idiopathic Parkinson's disease. Reduced REM sleep latency (65.0 min) was found in a high proportion of patients (69%). Since reduced REM sleep latency may be a trait-like abnormality relatively specific to primary depression, we evaluated this parameter in two groups of parkinsonian patients: depressed (16 patients) and non-depressed (23 patients). Its incidence was significantly higher in depressed patients with Parkinson's disease.