快速眼动期睡眠行为障碍的临床与神经生理研究

Clinical and polysomnographic features of rapid eye movement sleep behavior disorder

目的 探讨快速眼动期睡眠行为障碍 (RBD)患者的临床和神经生理特征。方法 对 6例睡眠行为障碍患者及 6例年龄、性别匹配的正常人 ,进行了连续 2次的全夜录像 多导睡眠生理监测 ,包括脑电图、眼动图、下颌和四肢肌电图、心电图、经鼻气流等。患者平均发病年龄为 5 8(5 0～ 6 6 )岁 ,其中男 4例 ,女 2例。平均病程为 9 5 (2～ 18)年。结果 多导睡眠生理监测发现 ,患者快速眼动期睡眠中肌张力位相性或持续性增高 ,并伴有复杂的行为 ,而且行为多与梦有关 ,未发现癫痫波。患者的总体睡眠时间为 35 3min± 4 2min ,Ⅱ期睡眠时间为 139min± 76min ,较正常人减少 ,睡眠效率74 3%± 12 3%减低。 6例患者主要表现为夜间伴随生动梦境的大幅度活动。其中 1例逐渐出现帕金森综合征 ,2例出现痴呆。共 3例经氯硝基安定治疗 ,RBD症状明显好转。结论 国人快速眼动期睡眠行为障碍患者的临床特征及快速眼动期睡眠肌张力具有不消失的电生理特点。

Objective To evaluate the clinical and polysomnographic features of rapid eye movement sleep behavior disorder (RBD) in Chinese patients. Methods Six parasomnic patients, 4 males and 2 females, with the mean onset age of 58 years (range 50～66 years) and 6 age and sex matched controls, were video monitored for successive two nights, to record the electroencephalography, electrooculography, electromyography, electrocardiography and nasal airflow. Results Polysomnographic recordings disclosed an augmented muscle tone, which appeared intermittently or continuously in REM sleep, accompanied by complex behaviors correlated to dream contents observed by video monitoring, and without seizure activity. All the 6 patients presented with a long history of parasomnia. The average total sleep time of the patients was 353±42 minutes, the stage Ⅱ sleep time was 139±76 minutes, and sleep efficiency was 74.3%±12.3% lower compared with that of the controls. Pakinsonism occurred in 1 patient 9 years after parasomnia and dementia in 2 patients 8 and 18 years respectively after symptom of RBD. Clonazepam was administered for parasomnia in 3 cases with a favorable response. Conclusion REM sleep without atonia is demonstrated in association with violent movements by video monitored polysomnography in 6 Chinese patients.