快速眼动期睡眠行为障碍与突触核蛋白病的关系

Relationship between rapid-eye-movement sleep behavior disorder and synucleinopathies

目的 研究快速眼动（REM）期睡眠行为障碍（RBD）在突触核蛋白病中的出现率、出现时间、电生理特点,探讨RBD与突触核蛋白病之间的关系以及电生理诊断指标.方法 通过对患者的睡眠状况调查以及夜间多导睡眠监测（NPSG）,研究本组疾病的睡眠障碍特征：（1）主观睡眠调查：帕金森病（PD）患者66例,多系统萎缩（MSA）患者30例,性别、年龄匹配的健康对照组65名,询问睡眠史,了解RBD出现的比例及出现时间.（2）NPSG：PD组8例、MSA组13例,健康对照组15名,所有受试者行连续两夜NPSG监测.分析伴发RBD的突触核蛋白病患者的NPSG特点.结果 PD和MSA合并RBD比例分别是59.1%（39/66）和86.6%（26/30）,明显高于对照组（4.6%,3/65）,其中RBD早于两种变性病临床发病的患者比例分别是46.2%（18/39）和84.6%（22/26）.PD和MSA合并RBD最主要的NPSG特点是：REM期肌肉弛缓现象消失（RWA）和运动增多.RWA比例和位相性肌电活动密度可能成为神经变性病合并RBD的NPSG诊断指标.结论 RBD在PD和MSA患者中出现率明显增高,部分RBD发生先于变性病,提示RBD与突触核蛋白病关系密切,RBD有可能是突触核蛋白病的早期表现.NPSG特征应作为RBD的主要诊断标准,RWA比例和位相性肌电活动密度可能成为神经变性病合并RBD的NPSG诊断指标.

Objective To investigate the incidence rate, onset time and electrophysiological characteristics of rapid eye movement sleep behavior disorder （RBD） and the relationship between RBD and synucleinopathies as well as the electrophysiological diagnostic criteria of RBD in Parkinson＇ s disease （PD） and multiple system atrophy （MSA）. Methods Sleep survey and night video-polysomnography （NPSG）were used to study sleep disturbance of PD and MSA. （1） Subjective sleep assessments： All subjects,including 66 PD patients, 65 age and sex matched healthy controls and 30 MSA patients, completed the sleep questionnaires, and the RBD incidence rate and onset time were got. （2） Objective sleep assessments： 8 PD patients, 13 MSA patients, and 15 age and sex matched healthy controls underwent video-NPSG recording on two consecutive nights. Sleep architect were analyzed. The NPSG characteristics of RBD accompany with PD and MSA were analyzed, and the electrophysiological diagnostic varameters of it were determined. Results Patients with PD or MSA had a higher prevalence of RBD. RBD was found in 59. 1% （39/66） PD patients and 86. 6% （26/30） MSA patients, among those, 46. 2% （ 18/39 ） and 84.6% （22/26） had the waking symptoms of MSA and PD. The main NPSG characteristics of RBD of PD or MSA were chin REM without atonia （RWA） and increased movement. Conclusions The relatively higher RBD prevalence in MSA and PD patients indicates that RBD has close relationship with PD and MSA.Part of patients with RBD preceding neurology disease indicates that RBD may be the early marker of PD and MSA. The main NPSG characteristics of RBD accompany with PD and MSA are chin RWA and the motor manifestations. RWA and phasic EMG activity density are supposed to be the NPSG diagnostic parameters.