帕金森病患者快速眼球运动睡眠行为障碍的回顾分析及前瞻性研究

目的 临床回顾分析帕金森病(PD)患者快速眼球运动(REM)睡眠行为障碍(RBD)的发生率及其危险因素,前瞻性研究RBD对PD进展的影响.方法 根据国际睡眠障碍分型修订版(ICSD-R)关于RBD的最低诊断标准,对符合临床疑似RBD(cpRBD)的患者进行统一PD评估量表(UPDRS)、MMSE、蒙特利尔认知功能评估量表(MoCA)等测定与随访观察,随访时间为2.5年.结果 基线时cpRBD的发生率为35.6%(47/132),随访末的发生率为41.7%(55/132),脱落率为11.4%(15/132).RBD的独立危险因素为MoCA分值低(OR=0.817,P=0.004),而震颤型起病形式为RBD的保护因素(OR=0.247,P=0.020).cpRBD患者病情进展较非cpRBD患者快[UPDRSⅢ终点与基线差值:(9.86±4.96)分与(6.76±4.26)分,t=2.909,P=0.005;H-Y分期终点与基线差值:(0.77±0.54)期与(0.33±0.49)期,t=3.664,P=0.000].结论 RBD的发生可能预测PD病情的快速进展、认知功能损害、精神症状的出现.

A retrospective study on rapid eye movement sleep behavior disorder in Parkinson's disease

Objective To determine the prevalence of rapid eye movement(REM)sleep behavior disorder(RBD)in patients with Parkinson' s disease(PD)and to investigate the risk factors of PD-RBD and its effect on the progress of PD. Methods Using the minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised(ICSD-R)to diagnose clinically probable RBD(cpRBD), patients were assessed by Unified Parkinson's Disease Rating Scale(UPDRS),MMSE, Montreal Cognitive Assessment(MoCA)at baseline and followed for 2.5 years. Results The frequency of cpRBD ranged from 35.6%(47/132)to 41.7%(55/132)during the study period. 11.4% (15/132)patients dropped out from the study. Lower MoCA score and type of onset are independent factors with cpRBD; Lower MoCA score(OR =0. 817 ,P =0. 004)is the risk factor while tremor(OR =0. 247 ,P =0. 020)is the protective factor. PD in patients with PD-RBD may progress more rapidly than non PD-RBD patients(UPDRS Ⅲ change from baseline 9. 86 ± 4. 96 vs 6. 76 ± 4. 26, t = 2. 909, P = 0. 005; H-Y change from baseline 0. 77 ± 0. 54 vs 0. 33 ± 0. 49, t = 3. 664, P = 0. 000). Conclusion RBD may be a symptom predictive for rapid PD progression, declining cognition and psychosis.