快速眼球运动期睡眠行为障碍合并不同程度阻塞性睡眠呼吸暂停综合征患者的睡眠结构研究

The polysomnographic characteristics in idiopathic rapid eye movement sleep behavior disorder patients with different severity of obstructive sleep apnea

目的通过分析特发性快速眼球运动期睡眠行为障碍（idiopathic rapid eye movement sleep behavior disorder，iRBD）合并不同程度阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）综合征患者的睡眠结构，了解iRBD与OSA之间可能存在的潜在关系。方法收集1996年7月至2016年7月在香港中文大学沙田医院睡眠检查室就诊的206例iRBD患者（男性占80.1%）,平均年龄（66.2±10.0）岁，所有iRBD患者均符合睡眠障碍国际分类第2版诊断标准，并行夜间视频多导睡眠监测确定诊断。根据呼吸暂停-低通气指数（apnea-hypopnea index，AHI）将患者分为3组，即无OSA组（AHI≤5次/h，n=48），轻-中度OSA组（5次/h〈AHI≤30次/h，n=100），重度OSA组（AHI〉30次/h，n=58）。结果重度OSA组较无OSA组及轻-中度OSA组Ⅰ期睡眠所占比例更多（22.9%±12.2%与13.2%±6.4%、15.4%±6.0%，F=21.80，P〈0.01），Ⅱ期睡眠所占比例更少（58.5%±10.4%与68.0%±20.5%、61.8%±10.5%，F=6.62，P〈0.01），快速眼球运动期睡眠显著减少（16.0%±8.2%与19.3%±9.8%、20.0%±7.8%，F=4.24，P=0.02），且觉醒指数最高[（33.4±16.2）次/h与（8.9±4.3）次/h、（14.9±6.5）次/h，F=94.56，P〈0.01]。重度OSA组较其余两组存在更少的总肌电活动[27.2%（25.9%）与30.3%（25.2%）、39.1%（28.0%），H=8.20，P=0.02]。3组患者在总睡眠时间、睡眠效率、入睡潜伏期、慢波睡眠及周期性腿动指数方面的差异无统计学意义。结论合并重度OSA的iRBD患者夜间存在Ⅰ期睡眠增多，Ⅱ期睡眠及快速眼动期睡眠减少，且睡中更易觉醒。iRBD患者的紧张性肌电活动与AHI呈负相关关系，重度OSA的iRBD患者有更低的紧张性肌电活动趋势。紧张性肌电活动可能减轻OSA患者的气道塌陷，从而降低OSA的严重程度。

Objective To determine the polysomnographic characteristics in idiopathic rapid eye movement （REM） sleep behavior disorder （iRBD） patients with different severity of obstructive sleep apnea （OSA）.Methods A total of 206 consecutive iRBD patients （80.1% males, mean age was （66.2±10.0） years） were recruited based on international classification of sleep disorders Ⅱ diagnostic criteria and confirmed by video-polysomnography. Patients were divided into three groups according to the severity of OSA, namely no OSA group （apnea-hypopnea index （AHI）≤5/hour, n=48）, mild to moderate OSA group （AHI 5-30/hour, n=100）, and severe OSA group （AHI〉30/hour, n=58）.Results When comparing the severe OSA patients with no and mild to moderate OSA patients, as expected, patients with severe OSA had higher percentage of stage Ⅰ sleep （22.9%±12.2% vs 13.2%±6.4%, 15.4%±6.0%, F=21.80, P〈0.01）, lower percentage of stage Ⅱ sleep （58.5%±10.4% vs 68.0%±20.5%, 61.8%±10.5%, F=6.62, P〈0.01）, less REM sleep （16.0%±8.2% vs 19.3%±9.8%, 20.0%±7.8%, F=4.24, P=0.02） as well as higher arousal index （（33.4±16.2）/h vs （8.9±4.3）/h, （14.9±6.5）/h, F=94.56, P〈0.01）. In addition, patients with severe OSA had a lower percentage of total electromyography （EMG） activity during REM sleep than other two groups （27.2%（25.9%）vs 30.3%（25.2%）, 39.1%（28.0%）, H=8.20, P=0.02）. There were no statistically significant differences in total sleep time, sleep efficiency, sleep latency, slow wave sleep, periodic limb movement index and period limb movements during sleep.Conclusions Patients with iRBD comorbided with severe OSA have distinct polysomnographic characteristics when compared with those without OSA and those with mild-to-moderate OSA. Those patients have increased sleep time in stage Ⅰ sleep, decreased sleep time in stage Ⅱ sleep and REM sleep, and more easily awakened from total sleep. Patients with iRBD comorbided with severe OSA have a lower percentage of tonic EMG activity during REM sleep. Excessive tonic EMG activity of upper airway muscle during REM sleep in iRBD might protect patients against severe OSA.