特发性快速眼动期睡眠行为障碍患者的多项睡眠图

目的 探讨特发性快动眼睡眠行为障碍(iRBD)患者在多项睡眠监测下(PSG)睡眠结构和快速眼动期肌肉失弛缓(RSWA)严重程度及特点。方法 选取2018年8月至2021年8月就诊于福建医科大学附属协和医院神经内科的iRBD患者共156例(iRBD组)以及同期来体检的健康人群101例(对照组),所有人行PSG监测。分析iRBD组和对照组受检者睡眠结构特点和RSWA参数结果,并对两者进行相关性分析。结果 iRBD组睡眠结构紊乱,片段化,慢波睡眠减少,周期性肢体运动(PLM)相关指数增高。iRBD患者RSWA现象明显,但男女亚组分析发现两组的下颌时相性肌张力增高指数、下颌紧张性肌张力增高指数无明显差异。下颌时相性肌张力增高指数与睡眠效率呈负相关。结论 iRBD患者睡眠结构明显异常,男女患者RSWA严重程度相当,睡眠效率是iRBD患者RSWA严重程度的影响因素,提高iRBD患者的睡眠效率有助于降低iRBD患者的RSWA严重程度。     

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?     

卒中后抑郁患者的多项睡眠图研究

目的:探讨多项睡眠图(PSG)各项指标对卒中后抑郁(PSD)患者的诊断价值.方法:卒中后抑郁组(PSD组)和卒中后无抑郁组(对照组)以年龄1∶1配对,用PSG仪对两组各59例患者进行整夜睡眠描记并对结果进行分析.结果:睡眠进程:PSD组睡眠潜伏期延长,觉醒时间增多,睡眠总时间减少,睡眠效率下降,睡眠维持率下降,两组比较...     

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。     

快速眼动睡眠行为障碍2例

1 病例 病例1,患者男性,汉族,65岁.在睡眠中出现喊叫、拳打脚踢行为,醒后不能回忆间歇出现2年.既往有高血压及腔隙性脑梗死,病情控制稳定.2年前起,在睡眠中出现自行坐起,大声喊叫,并用拳头砸墙,被家人唤醒后,自述在做梦,看见小偷进入家门,拿砖头追赶小偷,并大声喊叫抓小偷,梦境发生.     

帕金森病合并快速眼动睡眠行为障碍与认知损害相关性的研究进展

快速眼动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)和认知损害(cognitive impairment,CI)都是帕金森病(Parkinson’s disease,PD)常见的非运动症状,大量研究表明,合并RBD的PD患者更易出现CI,且认知功能下降速度更快、认知损害程度更严重,明显降低PD患者生活质量、增加照料者负担。既往研究着重于RBD和帕金森病认知损害(Parkinson’s disease-cognitive impairment,PD-CI)的临床特征,本文进一步对伴RBD的PD患者在认知功能损害的领域以及RBD和PD-CI发生的病理基础及遗传学基础进行阐述,以便深入了解RBD与PD患者发生CI的关系。     

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。     

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。     

帕金森病合并快速眼动睡眠行为障碍与认知损害相关性的研究进展

快速眼动睡眠行为障碍（rapid eye movement sleep behavior disorder,RBD）和认知损害（cognitive impairment,CI）都是帕金森病（Parkinson's disease,PD）常见的非运动症状,大量研究表明,合并RBD的PD患者更易出现CI,且认知功能下降速度更快、认知损害程度更严重,明显降低PD患者生活质量、增加照料者负担。既往研究着重于RBD和帕金森病认知损害（Parkinson's disease-cognitive impairment,PD-CI）的临床特征,本文进一步对伴RBD的PD患者在认知功能损害的领域以及RBD和PD-CI发生的病理基础及遗传学基础进行阐述,以便深入了解RBD与PD患者发生CI的关系。     

老年癫痫患者睡眠障碍的多项睡眠图研究

目的 探讨老年癫痫患者的睡眠期结构及睡眠中相关的事件等多项睡眠图(polysomno-gram,PSG)特点.方法 分析41例老年癫痫患者(癫痫组)和33例无明确中枢神经系统疾病老年人(对照组)的含16信道的脑电图视频PSG,进一步分析癫痫组和对照组的夜间睡眠期结构、睡眠的相关事件.结果 癫痫组与对照组比较,患者的非快...     

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.     

A preliminary quantitative analysis of REM sleep chin EMG in Parkinson's disease with or without REM sleep behavior disorder

ObjectivesTo compare REM sleep chin EMG quantitative features between Parkinson’s disease (PD) patients with or without REM sleep behavior disorder (RBD).Subjects and methodsTwenty-seven consecutive PD patients (mean age 67.9 years) and 19 normal controls (mean age 67.5 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all participants and characteristics of chin electromyographic amplitude during rapid eye movements sleep were analyzed by means of an automatic quantitative approach (Atonia Index).ResultsSixteen of the 27 patients were affected by RBD. An Atonia Index below 0.90 showed high sensitivity (0.938) and specificity (0.909) for the diagnosis of RBD within the group of PD patients.ConclusionThis study recommends the Atonia Index as an objective measure to support and aid the diagnosis of RBD in PD.     

Longitudinal changes in cognition in early Parkinson's disease patients with REM sleep behavior disorder

IntroductionCognitive decline is common in Parkinson's disease (PD), and identifying patients at highest risk for it is essential. We aimed to examine the effect of possible REM sleep behavior disorder (pRBD) on rate of cognitive decline in early PD, for both global cognition and in specific cognitive domains.MethodsParkinson's Progression Markers Initiative (PPMI) is a multi-site, international study of PD patients untreated at enrollment. pRBD was assessed with the REM sleep behavior disorder questionnaire (RBDSQ). Global cognition was assessed at baseline and annually using the Montreal Cognitive Assessment (MoCA) and a cognitive battery. Linear mixed effects models were used to examine the relationship between pRBD (RBDSQ ≥ 6) and rate of change in cognitive variables. Age, sex, years of education, and baseline motor and cognitive scores were included as covariates.ResultsThe baseline sample consisted of 423 individuals with PD, mean age 61.7 years and 65.5% male. Data was available on 389, 366, and 196 participants at 1-year, 2-year, and 3-year follow-up respectively. Possible RBD occurred in 108 (25.5%) at baseline. In multivariate analyses, baseline RBD was associated with greater annual rate of decline in MoCA score (β = −0.34, 95%CI −0.54, −0.13, p < 0.001), Symbol Digit Modalities Test (β = −0.69, 95%CI −1.3, −0.09, p = 0.024), and Hopkins Verbal Learning Test-Revised, delayed free recall (β = −0.21, 95%CI −0.41, −0.013, p = 0.037).ConclusionsPossible RBD is common in early PD and predicts future cognitive decline, particularly in attention and memory domains.     

Relationship between visual hallucinations and REM sleep behavior disorder in patients with Parkinson's disease

OBJECTIVES: REM sleep behavior disorder (RBD) has been documented to precede or to co-occur with Parkinson's disease (PD). Parkinson's disease is one of the most common neurological conditions associated with visual hallucinations. Cognitive dysfunction is present in PD, even at the early stages of these diseases. In this study we aimed to investigate the relationship between visual hallucinations and RBD in patients with idiopathic Parkinson's disease (IPD). Additionally, we evaluated the association of the cognition and the pattern of cognitive impairment with VHs and RBD, effects of factors like duration and severity of the disease and duration of levodopa usage. PATIENTS AND METHODS: Seventy-nine patients, diagnosed as PD, were included the study and then, patients were divided into four groups; with RBD and VHs (group 1), with RBD but no VHs (group 2), with VHs but no RBD (group 3), without RBD and VHs (group 4). We compared each group with the others according to demographic characteristics and neuropsychological test scores. RESULTS: Of all patients, in 46% (n=36) RBD and in 48% (n=38) VHs were observed. Our study established VHs in 58% of patients with RBD, and RBD in 55% of patients with VHs. However, due to a 40% incidence of VHs in patients without RBD, RBD and VHs were not found to be correlated. All of the neuropsychometric test scores did not reveal significant difference between groups. CONCLUSION: Although it seems like there is a small association between RBD and VHs in our patients, it was not significant. Group 1 presented with significantly worse scores in UPDRS total scores and I, II subscores.     

Detection of REM sleep behaviour disorder by automated polysomnography analysis

ObjectiveEvidence suggests Rapid-Eye-Movement (REM) Sleep Behaviour Disorder (RBD) is an early predictor of Parkinson’s disease. This study proposes a fully-automated framework for RBD detection consisting of automated sleep staging followed by RBD identification.MethodsAnalysis was assessed using a limited polysomnography montage from 53 participants with RBD and 53 age-matched healthy controls. Sleep stage classification was achieved using a Random Forest (RF) classifier and 156 features extracted from electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) channels. For RBD detection, a RF classifier was trained combining established techniques to quantify muscle atonia with additional features that incorporate sleep architecture and the EMG fractal exponent.ResultsAutomated multi-state sleep staging achieved a 0.62 Cohen’s Kappa score. RBD detection accuracy improved from 86% to 96% (compared to individual established metrics) when using manually annotated sleep staging. Accuracy remained high (92%) when using automated sleep staging.ConclusionsThis study outperforms established metrics and demonstrates that incorporating sleep architecture and sleep stage transitions can benefit RBD detection. This study also achieved automated sleep staging with a level of accuracy comparable to manual annotation.SignificanceThis study validates a tractable, fully-automated, and sensitive pipeline for RBD identification that could be translated to wearable take-home technology.     

REM sleep behavior disorder in Parkinson's disease and dementia with Lewy bodies

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. Patients appear to "act out their dreams," in which the exhibited behaviors mirror the content of the dreams. Management of RBD involves counseling about safety measures in the sleep environment; in those at risk for injury, clonazepam and/or melatonin is usually effective. In this article, the authors present a detailed review of the clinical and polysomnographic features, differential diagnosis, diagnostic criteria, management strategies, and pathophysiologic mechanisms of RBD. They then review the literature and their institutional experience of RBD associated with neurodegenerative disease, particularly Parkinson's disease and dementia with Lewy bodies. The evolving data suggests that RBD may have clinical diagnostic and pathophysiologic significance in isolation and when associated with neurodegenerative disease.     

47例REM睡眠行为障碍分析

目的 分析REM睡眠行为障碍的临床表现,探讨其病因、发病机制和治疗方法 .方法 回顾性分析47例REM睡眠行为障碍患者的病历资料.结果 47例患者均为中、老年人,均在熟睡过程中突然出现表现多样的行为障碍,多导睡眠图均为REM睡眠期出现肌弛缓现象消失而伴随肌电活动;病因为5例为帕金森病,3例为酒精戒断,1例为脑外伤,2例多系统萎缩,4例为药物滥用,32例为原发性;治疗应用氯硝西泮,或/和卡马西平、左旋多巴,所有患者有效.结论 REM睡眠行为障碍病因复杂、临床表现多样,经过合理药物、心理治疗,可以取得理想的治疗效果.     

REM sleep behaviour disorder in Parkinson's disease

Journal of Neurology - REM sleep behaviour disorder (RBD) is a parasomnia that is characterized by dream-enacting behaviours associated with REM sleep without atonia (RWA). As experimental animal...