The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder.
The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder.
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DOI：
10.2147/nss.s396853
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发表时间：
2023
影响因子：
3.4
通讯作者：
St Louis, Erik K.
中科院分区：
文献类型：
--
作者：
Levendowski, Daniel J.;Neylan, Thomas C.;Lee-Iannotti, Joyce K.;Timm, Paul C.;Guevarra, Cyrus;Angel, Elise;Shprecher, David;Mazeika, Gandis;Walsh, Christine M.;Boeve, Bradley F.;St Louis, Erik K.
这项研究的目的是建立一个先前验证的睡眠分级系统对可能的孤立性REM睡眠行为障碍(IRBD)患者的诊断准确性，并比较医生对iRBD的诊断基于无张力的REM睡眠(RSWA)和非REM高张(NRH)，非REM高张(NRH)是一种与帕金森谱系障碍独立相关的睡眠指标。26名有做梦行为史的患者在两个部位接受了诊断性多导睡眠图(PSG)和同步睡眠监测(SP)。PSG和SP记录是分阶段的，两位睡眠神经科医生根据多导睡眠图确定的RSWA的存在与否独立诊断iRBD。使用kappa系数(K)、阳性和阴性百分比一致性(PPA和NPA)和卡方检验，比较PSG与SP睡眠分期以及基于PSG的RSWA与自动SP检测的NRH的定性存在与否。PSG和SP分期的Kappa值分别为觉醒(k=0.82vs.0.65)、氮气(k=0.63vs.0.72)和快速眼动(k=0.83vs.0.72)，−-1和Rem2的Kappa评分不同。重新编辑PSG记录后，N3阶段的现场kappa值从0.72和0.37增加到0.88和0.74。在iRBD诊断中，医生间一致性的Kappa值是公平的(k=0.22)。每个医生的iRBD诊断与NRH之间的一致性也是公平的(k=0.29和0.22)。在83%的记录中，NRH异常与至少一名医生的iRBD诊断一致。由医生间的iRBD一致性得到的PPA比由每个医生的iRBD诊断和异常的NRH得到的值更强，而NPA更弱。RSWA和N3期作为神经退行性疾病生物标记物的潜在效用受到视觉评分的部位间差异的影响。NRH与iRBD的关联程度与医生之间使用RSWA诊断iRBD的一致意见相似。
This study aimed to establish the diagnostic accuracy of a previously validated sleep staging system in patients with probable isolated REM sleep behavior disorder (iRBD), and to compare physicians’ diagnoses of iRBD based on REM sleep without atonia (RSWA) to non-REM hypertonia (NRH), a sleep measure independently associated with Parkinsonian spectrum disorders. Twenty-six patients with a history of dream enactment behavior underwent a diagnostic PSG with simultaneous Sleep Profiler (SP) acquisition at two sites. PSG and SP records were sleep staged, and two sleep neurologists independently diagnosed iRBD based on the presence or absence of polysomnographic identified RSWA. Comparisons for PSG vs SP sleep staging and the qualitative presence or absence of PSG-based RSWA vs automated SP-detected NRH was performed using kappa coefficients (k), positive and negative percent agreements (PPA and NPA), and chi-square tests. The kappa scores from Sites-1 and −2 for PSG vs SP staging were different for Wake (k=0.82 vs 0.65), N2 (k=0.63 vs 0.72) and REM (k=0.83 vs.0.72). The by-site kappa values for stage N3 increased from 0.72 and 0.37 to 0.88 and 0.74 after PSG records were reedited. The kappa values for between-physician agreement in iRBD diagnoses were fair (k = 0.22). The agreement between each physician’s iRBD diagnoses and NRH were also fair (k=0.29 and 0.22). Abnormal NRH agreed with at least one physician’s iRBD diagnosis in 83% of the records. The PPA resulting from between-physician iRBD agreement was stronger and the NPA weaker than the values obtained from comparison of each physician’s iRBD diagnosis and abnormal NRH. The potential utility of RSWA and stage N3 as neurodegenerative disorder biomarkers was influenced by between-site variability in visual scoring. The degree to which NRH was associated with iRBD was similar to the between-physician agreement in their diagnosis of iRBD using RSWA.