REM sleep behaviour disorder in older individuals: epidemiology, pathophysiology and management.
REM sleep behaviour disorder in older individuals: epidemiology, pathophysiology and management.
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DOI：
10.2165/11536260-000000000-00000
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发表时间：
2010-06-01
期刊：
影响因子：
2.8
通讯作者：
Trotti LM
中科院分区：
文献类型：
--
作者：
Trotti LM
快速眼动（REM）睡眠行为障碍（RBD）是一种主要影响老年人的睡眠障碍，患者在快速眼动睡眠时似乎在表演他们的梦。这些行为通常是暴力的，与暴力的梦境内容有关，因此可能对患者或床伴造成严重伤害。成人中估计患病率为0.4-0.5%，但在某些神经退行性疾病中发病率要高得多，特别是帕金森病、路易体痴呆和多系统萎缩。RBD可以在没有诊断出神经系统疾病（“特发性”形式）的情况下发生，尽管这种形式的RBD患者可能有轻微的神经系统异常，最终往往发展为神经退行性疾病。脑干病变（脑桥被、髓质）后发生RBD的动物模型和病例使我们认识到，RBD是由缺乏正常的快速眼动肌张力和缺乏正常的快速眼动运动产生器抑制引起的。氯硝西安定被用作RBD的一线治疗，褪黑素被用作二线治疗，尽管这两种干预措施的证据都来自不受控制的病例系列。由于患者或床伴受伤的风险很高，改善睡眠环境安全的干预措施也常常是必要的。本文综述了RBD的流行病学、病理生理学和治疗。
Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder that predominantly affects older adults, in which patients appear to be enacting their dreams while in REM sleep. The behaviors are typically violent, in association with violent dream content, so serious harm can be done to the patient or the bed-partner. The estimated prevalence in adults is 0.4–0.5%, but the frequency is much higher in certain neurodegenerative diseases, especially Parkinson's disease, Dementia with Lewy bodies, and multiple systems atrophy. RBD can occur in the absence of diagnosed neurologic diseases (the “idiopathic” form), although patients with this form of RBD may have subtle neurologic abnormalities and often ultimately develop a neurodegenerative disorder. Animal models and cases of RBD developing after brainstem lesions (pontine tegmentum, medulla) have led to the understanding that RBD is caused by a lack of normal REM muscle atonia and a lack of normal suppression of locomotor generators during REM. Clonazepam is used as first-line therapy for RBD and melatonin for second-line therapy, although evidence for both of these interventions comes from uncontrolled case series. Because the risk of injury to the patient or the bed-partner is high, interventions to improve the safety of the sleep environment are also often necessary. This review describes the epidemiology, pathophysiology, and treatment of RBD.
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