特发性快速眼动睡眠行为障碍患者的眼动异常分析

Abnormal eye movements in patients with idiopathic rapid eye movement sleep behavior disorder

目的:探讨特发性快速眼动睡眠行为障碍(iRBD)患者的眼动异常特点。方法:纳入2017年1月至2019年5月在浙江大学医学院附属邵逸夫医院就诊的iRBD患者22例,对照组20例,收集临床资料并完成视频眼震图检查。比较iRBD组和对照组视频眼震图检查结果差异,并采用Logistic回归分析一般情况(包括年龄、性别、病程、体质指数等)及多导睡眠图各睡眠生理参数与视频眼震图异常结果的相关性。结果:iRBD组与对照组自发眼震、方波急跳、不自主眼动、凝视眼震、扫视、视动性眼震试验结果差异均无统计学意义(均P>0.05)。在0.4~0.5 Hz及0.6~0.7 Hz频率平稳跟踪时,iRBD组Ⅰ和Ⅱ型曲线比例低于对照组,Ⅲ型和Ⅳ型曲线比例高于对照组,差异有统计学意义(χ^2分别为5.177和5.301,均P<0.05)。Logistic分析结果提示,平稳跟踪0.4~0.5 Hz曲线分型异常与患者N3期睡眠减少有一定相关性(OR=0.963,P<0.05)。Ⅲ~Ⅳ型曲线患者N3期睡眠时间明显少于Ⅰ~Ⅱ型曲线患者[分别为(52±28)min与(76±23)min,t=2.197,P<0.05]。结论:iRBD患者平稳跟踪异常的比例明显升高,提示iRBD的发病机制可能与平稳跟踪通路异常具有一定相关性。

Objective:To analyze the characteristics of eye movements in patients with idiopathic rapid eye movement sleep behavior disorder(iRBD).Methods:Twenty two patients with iRBD and 20 controls were enrolled between January 2017 and May 2019 from Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.Clinical data including polysomnogram(PSG)results were collected.Videonystagmography(VNG)including spontaneous nystagmus,gaze,saccade,tracking and optokinetic test were performed.The difference of VNG results between iRBD patients and controls were analyzed.The factors related to the abnormal VNG results were analyzed by using logistic regression analysis.Results:No significant differences were found between the iRBD and control groups in the spontaneous nystagmus,gaze nystagmus,square wave jerk,involuntary eye movement,saccade and optokinetic nystagmus(all P>0.05).In smooth pursuit of 0.4-0.5 Hz and 0.6-0.7 Hz,iRBD patients had more typeⅢ-Ⅳcurve than controls(χ^2=5.177 and 5.301,both P<0.05).Logistic regression analysis indicated that less sleep time of N3 stage was related to the abnormal results in smooth pursuit of 0.4-0.5 Hz(OR=0.963,P<0.05).iRBD patients withⅢ-Ⅳtype curve in smooth pursuit of 0.4-0.5 Hz had less N3 sleep time than iRBD patients withⅠ-Ⅱtype curve(52±28 min vs.76±23 min,t=2.197,P<0.05).Conclusion:Abnormal smooth pursuit was found in iRBD patients,which might be related to the pathological mechanism of iRBD.