快速动眼睡眠行为障碍(Rapid eye movement sleep behavior disorder,RBD)是快速动眼睡眠期间(Rapid eye movement sleep,REM)的一种异态睡眠类型,常表现为梦境演绎的睡眠行为异常,如夜间拳打脚踢、异常发声,严重者可导致自身或床伴受...快速动眼睡眠行为障碍(Rapid eye movement sleep behavior disorder,RBD)是快速动眼睡眠期间(Rapid eye movement sleep,REM)的一种异态睡眠类型,常表现为梦境演绎的睡眠行为异常,如夜间拳打脚踢、异常发声,严重者可导致自身或床伴受伤。在出现典型RBD症状之前数十年,患者常表现为睡眠期间出现梦呓或肢体频繁活动等。患者清醒后可回忆梦境内容,异常行为与梦境内容相关。相比于男性RBD患者,女性RBD患者伴有更少的暴力内容的梦境,在梦境中多为受害者角色[1]。文章主要综述RBD流行病学、发病机制、多导睡眠监测特点及治疗等方面内容。展开更多
Objective: To compare the clinical and video-polysomnog-raphic (VPSG) characteristics of idiopathic REM sleep behavior disorder (RBD) vs the RBD seen in multiple system atrophy (MSA) and Parkinson disease (PD). Method...Objective: To compare the clinical and video-polysomnog-raphic (VPSG) characteristics of idiopathic REM sleep behavior disorder (RBD) vs the RBD seen in multiple system atrophy (MSA) and Parkinson disease (PD). Methods: Clinical features and VPSG measures were evaluated in 110 consecutive nondemented subjects (26 MSA, 45 PD, and 39 idiopathic RBD) free of psychoactive medications referred for suspected RBD to our sleep unit over a 5-year period, with extended follow-up (mean 26.9 ±21.3 months). Results: Across the three groups studied, logistic regression analysis demonstrated that there were no differences in the quality of RBD symptoms (e.g., nature of unpleasant dream recall or behaviors witnessed by bed partners), most PSG variables, abnormal behaviors captured by VPSG, and clinical response to clonazepam. When compared to subjects with PD, however, patients with MSA had a significantly shorter duration of disease, a higher REM sleep without atonia percentage, a greater periodic leg movement index, and less total sleep time. Subjects with idiopathic RBD, as compared to those with either MSA or PD, were more often male, had greater self-reported clinical RBD severity, and were more often aware of their abnormal sleep behaviors. Conclusions: REM sleep behavior disorder (RBD)-related symptoms and neurophysiologic features are qualitatively similar in RBD subjects with the idiopathic form, multiple system atrophy (MSA), and Parkinson disease (PD). Polysomnographic abnormalities associated with RBD in the setting of MSA are greater than in PD, suggesting a more severe dysfunction in the structures that modulate REM sleep.展开更多
文摘快速动眼睡眠行为障碍(Rapid eye movement sleep behavior disorder,RBD)是快速动眼睡眠期间(Rapid eye movement sleep,REM)的一种异态睡眠类型,常表现为梦境演绎的睡眠行为异常,如夜间拳打脚踢、异常发声,严重者可导致自身或床伴受伤。在出现典型RBD症状之前数十年,患者常表现为睡眠期间出现梦呓或肢体频繁活动等。患者清醒后可回忆梦境内容,异常行为与梦境内容相关。相比于男性RBD患者,女性RBD患者伴有更少的暴力内容的梦境,在梦境中多为受害者角色[1]。文章主要综述RBD流行病学、发病机制、多导睡眠监测特点及治疗等方面内容。
文摘Objective: To compare the clinical and video-polysomnog-raphic (VPSG) characteristics of idiopathic REM sleep behavior disorder (RBD) vs the RBD seen in multiple system atrophy (MSA) and Parkinson disease (PD). Methods: Clinical features and VPSG measures were evaluated in 110 consecutive nondemented subjects (26 MSA, 45 PD, and 39 idiopathic RBD) free of psychoactive medications referred for suspected RBD to our sleep unit over a 5-year period, with extended follow-up (mean 26.9 ±21.3 months). Results: Across the three groups studied, logistic regression analysis demonstrated that there were no differences in the quality of RBD symptoms (e.g., nature of unpleasant dream recall or behaviors witnessed by bed partners), most PSG variables, abnormal behaviors captured by VPSG, and clinical response to clonazepam. When compared to subjects with PD, however, patients with MSA had a significantly shorter duration of disease, a higher REM sleep without atonia percentage, a greater periodic leg movement index, and less total sleep time. Subjects with idiopathic RBD, as compared to those with either MSA or PD, were more often male, had greater self-reported clinical RBD severity, and were more often aware of their abnormal sleep behaviors. Conclusions: REM sleep behavior disorder (RBD)-related symptoms and neurophysiologic features are qualitatively similar in RBD subjects with the idiopathic form, multiple system atrophy (MSA), and Parkinson disease (PD). Polysomnographic abnormalities associated with RBD in the setting of MSA are greater than in PD, suggesting a more severe dysfunction in the structures that modulate REM sleep.
文摘目的快速眼动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)是帕金森病(Parkinson's disease,PD)常见的非运动症状且是重要预后因素。本研究通过静息态功能磁共振成像,利用度中心度(degreecentrality,DC)和低频振幅(amplitudes of low-frequency fluctuation,ALFF)分析PD伴RBD和不伴有RBD患者组以及健康对照组三组间DC值和ALFF值,探索PD伴RBD患者脑功能活动特征及RBD特异性脑区,探究RBD发生的病理机制。材料与方法招募20例伴有RBD的PD患者(PD-RBD组)、40例无RBD的PD患者(PD-nonRBD组)和44例年龄性别匹配的健康对照(健康对照组),三组被试均接受磁共振扫描。利用静息态数据计算DC值和ALFF值,探测脑功能特征。结果方差分析结果显示三组间DC值主效应脑区为右侧中央前回、颞上回、小脑、额中回(P<0.05,FDR校正);ALFF值主效应脑区为左侧海马旁回、楔叶、舌回(P<0.05,FDR校正)。进一步分析发现相比于PD-nonRBD组,PD-RBD患者表现为右侧额中回DC值升高(t=4.02;P=0.007,FDR校正);左侧楔前叶DC值降低(t=5.30;P=0.009,FDR校正)。相比于健康对照组,PD-RBD患者表现为左侧额上回、小脑、右侧颞上回、左侧颞中回、额中回的DC值升高(P<0.05,FDR校正);左侧中央前回、颞上回和颞中回的DC值降低(P<0.05,FDR校正);右侧楔叶ALFF值降低(P<0.05,FDR校正)。结论PD-RBD在DC和ALFF上有独特的影像学特征,特别是右侧额中回、左侧楔前叶的功能异常可能与PD患者RBD的发生密切相关。
