Orthostatic hypotension and cardiac sympathetic denervation in Parkinson disease patients with REM sleep behavioral disorder
Orthostatic hypotension and cardiac sympathetic denervation in Parkinson disease patients with REM sleep behavioral disorder
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DOI：
10.1016/j.jns.2016.01.020
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发表时间：
2016-03-15
影响因子：
4.4
通讯作者：
Lee, Kwang-Soo
中科院分区：
文献类型：
--
作者：
Kim, Joong-Seok;Park, Hyung-Eun;Lee, Kwang-Soo
背景：快速眼动（REM）睡眠行为障碍（RBD）、体位性低血压（OH）和心脏交感神经失支配在PD中很常见，并且在运动前和运动期都有关联。本研究旨在评估PD患者的OH和心脏交感神经失支配是否与RBD相关。方法：94例轻度PD患者中，53例有RBD。记录体位生命体征和24小时动态血压值。所有患者的I-123-metaiodobenzylguanidine （MIBG）心脏显像。分析体位性低血压、仰卧位高血压、夜间高血压、不倾斜、心肌MIBG摄取和RBD之间的关系。结果：RBD与体位性低血压相关。与非RBD患者和对照组相比，RBD患者在站立时收缩压变化更高，心肌MIBG摄取更低。OH患者的平均H/M比也低于非OH组。结论：本研究表明，早期和轻度PD患者的RBD与OH和心脏交感神经失支配密切相关。结果还提示心脏交感神经损伤可能是PD中OH的机制。这种关联可能与Braak α -突触核蛋白致病序列密切相关，这将解释PD的临床谱。(C) 2016 Elsevier B.V.版权所有
Background: Rapid eye movement (REM) sleep behavioral disorder (RBD), orthostatic hypotension (OH), and cardiac sympathetic denervation were commonly observed in PD and are related in both the premotor and motor periods. This study is intended to evaluate if the OH and cardiac sympathetic denervation found in PD are associated with RBD.Methods: Among 94 non-medicated and mild PD patients, 53 had RBD. Orthostatic vital signs and ambulatory 24-hour blood pressure values were recorded. I-123-metaiodobenzylguanidine (MIBG) cardiac scintigraphy as obtained in all patients. The association between orthostatic hypotension, supine hypertension, nocturnal hypertension, non-dipping, myocardial MIBG uptake, and RBD was analyzed.Results: RBD was associated with orthostatic hypotension. Patients with RBD had higher systolic blood pressure changes during orthostasis and lower myocardial MIBG uptake than patients without RBD and controls. Patients with OH also had lower mean H/M ratios those in the non-OH group.Conclusion: This study showed that RBD was closely associated with OH and cardiac sympathetic denervation in patients with early and mild PD. The result also suggests that impaired cardiac sympathetic innervation could be the mechanism behind OH in PD. This association may be closely correlated with Braak alpha-synuclein pathogenetic sequences, which would account for the clinical spectrum of PD. (C) 2016 Elsevier B.V. All rights reserved.