Factors Influencing the Presentation of REM Sleep Behavior Disorder: The Relative Importance of Sex, Associated Neurological Disorder, and Context of Referral to Polysomnography
Factors Influencing the Presentation of REM Sleep Behavior Disorder: The Relative Importance of Sex, Associated Neurological Disorder, and Context of Referral to Polysomnography
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DOI：
10.5664/jcsm.8086
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发表时间：
2019-12-15
影响因子：
4.3
通讯作者：
Salavisa, Manuel
中科院分区：
文献类型：
--
作者：
Bugalho, Paulo;Salavisa, Manuel
研究目的：确定性别、相关神经系统疾病和多导睡眠图 (PSG) 背景对快速眼动 (REM) 睡眠行为障碍 (RBD) 表现的相互关系和相对影响。方法：使用视频 PSG 评估 57 名 RBD 患者在 REM 睡眠期间的睡眠结构、肌肉活动和运动事件 (ME)。根据性别、相关神经系统疾病（临床分离的 RBD [iRBD] 与与明显的 α-突触核蛋白病 [sRBD] 相关的 RBD）和 PSG 动机（由于 RBD 症状直接转诊 [首先，n = 14]；在筛查程序后转诊 [筛选，n = 13]；在其他疾病的临床随访期间转诊 [后续，n = 22]；因 RBD 以外的症状转诊）对患者进行分类[顺便说一句，n = 8]）。结果：男性患者的阶段性肌肉活动指数以及肌阵挛和躯干 ME 的相对数量显着较高，女性患者的节段性 ME 显着较高。 sRBD 与筛选相关，iRBD 与第一类别相关。 iRBD 患者的 ME 严重程度更高。第一类中 ME 的整体运动严重程度明显较高。在多变量分析中，PSG 的动机和相关的神经系统疾病对 ME 的整体严重程度都有显着且独立的影响。结论：相关的神经系统疾病和 PSG 的动机可以显着影响 RBD 的表现。男性与较高的肌肉阶段性活动和不同的 ME 模式有关，这可能会导致不同研究中的患病率差异。拥有 iRBD 和因与 RBD 兼容的投诉而直接转诊进行首次咨询是相互关联的，并且独立地导致 ME 的严重程度更高。
Study Objectives: To identify the interrelation and relative influence of sex, associated neurological disorder, and polysomnography (PSG) context on the manifestations of rapid eye movement (REM) sleep behavior disorder (RBD).Methods: Fifty-seven patients with RBD were assessed with video PSG regarding sleep structure, muscular activity, and motor events (ME) during REM sleep. Patients were categorized according to sex, associated neurological disorder (clinically isolated RBD [iRBD] versus RBD associated with an overt alpha-synucleinopathy [sRBD]) and motive for PSG (direct referral due to RBD symptoms [First, n = 14]; referred after screening procedures [Screening, n = 13]; referred during clinical follow-up for other disorders [Follow-up, n = 22]; referred for symptoms other than RBD [Incidental, n = 8]).Results: Phasic muscular activity index and the relative number of myoclonic and trunk ME were significantly higher in males and segmental ME in female patients. sRBD was associated with Screening and iRBD with First categories. There was a higher severity of ME in patients with iRBD. Global motor severity of ME was significantly higher in the First category. In multivariate analysis, both motive for PSG and associated neurological disorder had a significant and independent influence in the global severity of ME.Conclusions: Associated neurological disorder and motive for PSG can significantly influence RBD presentation. Male sex is related with higher muscular phasic activity and a different pattern of ME, which could contribute to prevalence variations across studies. Having iRBD and being directly referred for a first consultation because of complaints compatible with RBD are interrelated and contribute independently to a higher severity of ME.